The following research presents a vital methodology that integrates land-based pedagogies, Indigenous knowledge systems, and Indigenous youth wellness, with an emphasis on practical application and on decolonizing and simultaneously revitalizing cultural practices. Four complementary studies explore programming in Canada’s Northwest Territories and subarctic regions, discovering that the foundational determinant of Indigenous health is structured around engagement with land, nature, and traditional practices.
Across these studies, the Two-Eyed Seeing framework offers an epistemological approach in which each “eye” represents a distinct yet equally valid way of knowing: Indigenous knowledge systems and Western scientific paradigms. Rather than seeking synthesis or assimilation, the framework emphasizes a non-hierarchical relationship in which both approaches remain distinct while informing one another.
This approach creates an integrative understanding that is nuanced and contextually relevant. The relational and land-based practices throughout this selection operate interdependently with the individual, relational, and structural levels, reinforcing one another; thus, a more precise evaluation tool would be to refine the classic social determinants of health into relational determinants of health.
These studies demonstrate how land-based interventions informed by Indigenous epistemological principles transcend biomedical frameworks in health promotion by grounding the approach in relationality (the interconnectedness among all living beings), the preservation of culture, and ongoing efforts to uphold intergenerational transmission of cultural knowledge.
The first study used a community-based participatory research (CBPR) approach to explore the relationships between urban Indigenous youth in central Canada (Northwest Territories, Saskatchewan, and Manitoba) and nature, and how these relationally grounded connections emerge as a determinant of health over nine years. The framework embraced was integrating Indigenous methodologies with Western research approaches, known as “Two-Eyed Seeing”, employing semi-structured interviews, photovoice methodology (using GoPro cameras to capture meaningful experiences), sharing circles with elders, and focus group discussions. They examined programs that included land-based activities such as traditional fishing, hunting, and trapping; seasonal harvesting; time spent on traditional territories; and ceremonies/teachings from Elders. The art approach included digital storytelling, theatre-based practices, hand drumming and traditional songs, and traditional visual art and beading. They found three significant themes: promoting cultural belonging and positive identity, connecting to community and family, and supporting spiritual health and relationships. The results post-retreat showed statistically significant scores in the areas of leadership and empowerment.
The second study employs a Two-Eyed Seeing framework by integrating Indigenous and conventional epistemologies to explore the human-nature relationship among Indigenous youth. Taking place in Saskatchewan and Manitoba over nine years and across three CBPR projects, the findings emerge with an analysis that positions land as an active determinant within a system of health, based on relationality. Interrelated functions of relational engagement with land emerged: land serves as an ontological anchor and reinforces cultural identity and belonging amid urban displacement. It also facilitates the transmission of intergenerational knowledge and serves as a site for social and relational networks to reproduce, strengthening cohesion and collective identity. Lastly, land-based practices help sustain spiritual health through an integrated model that treats spirituality as foundational rather than ancillary. The study conceptually advances the conventional Social Determinants of Health to a Relational Determinants of Health framework, grounded in relationships with land, community, and cultural practices. Additionally, it challenges deficit-based paradigms by centering youth agency and positioning Indigenous youth as active participants within the production of health through land-based practices.
The third study used a CBPR approach and, like the previous study, was grounded in the decolonizing methodology: the Two-Eyed Seeing framework to challenge the historically dominant conventional scientific paradigms. The Sibi (River) program was a culturally grounded intervention that examined how traditional fishing practices function as a determinant of health for the Omushkego Cree Community of Fort Albany First Nation in the subarctic Ontario, Canada. They found four interconnected themes: the program facilitated intergenerational knowledge transmission and nourished cultural revitalization. They found that being on the Land strengthened place-based identity and belonging. Using the Medicine Wheel framework (an Indigenous concept of health encompassing physical, emotional, mental, and spiritual harmony), they found participants healed across all domains, contrasting with the reductionist biomedical models. And lastly, Land emerged as a Relational Determinant of Health (RDH), again challenging Cartesian dualism (separation of humans and nature), and moves beyond conventional social determinants of health, emphasizing land access as an RDH.
The fourth study examines an emerging health prescription movement that advocates for the formal prescription of “time in nature” (i.e., Canada’s PARx program and Park Rx America) within the context of Indigenous populations, while interrogating the tensions between well-intentioned interventions and Indigenous self-determination. Using qualitative methodologies and a reflexive research approach, the authors acknowledge the lead author as Indigenous and identify the broader research team as representing diverse racial, cultural, gender, and sexual identities. This reflexive framework examines how identity, authority, and assumptions shape both the process and outcomes of research. The findings highlight concerns that nature prescription programs may inadvertently perpetuate colonial medical paternalism if they are not grounded in Indigenous self-determination and community priorities. This can manifest through the use of specific terminology and frameworks, such as “land-based healing,” the support of culturally relevant activities tied to health directives, and an emphasis on priorities that emerge from the collective aspirations of the community.
