Today’s guest blogger is Jamie Donatuto, PhD, community environmental public health analyst for the Swinomish Indian Tribal Community’s Department of Social Services in Washington State.

Indigenous peoples face some of the largest-scale and potentially most devastating health impacts from climate change. Yet there is too little national attention paid to these impacts and too few action plans created to address them. In 2009-2010, the Swinomish Tribe became one of the first Indigenous communities in the United States to release a climate change impact assessment and adaptation action plan.

The Swinomish are a federally recognized Coast Salish people located in Western Washington State. With a low-lying reservation that is 90 percent surrounded by the estuarine and salt water of Puget Sound’s Skagit River-Delta, the Swinomish have experienced intense stream and coastal flooding associated with sea-level rise and warmer air and sea-surface temperatures of climate change.

Many Swinomish people are fishers, clam diggers and crabbers; the storm damage to roads, homes, equipment and to the natural resources is devastating. More than a source of calories, these traditional foods are “cultural keystone species,” woven into the cultural fabric of values and beliefs.

Many Indigenous communities define health on a familial and communities scale, rather than on the individual level. They consider socio-cultural facets of health just as important as physiological ones. Yet the Swinomish Impact Assessment and Climate Action Plan focused on physiological health impacts, unable to evaluate impacts to socio-cultural realms due to a lack of established metrics.

There are no methods to determine the impacts of being unable to practice ceremony on a particular beach with cultural keystone foods because that beach and those foods are no longer accessible. Without an understanding of the effect that such a loss of cultural continuity has on health, how can one develop a suitable action plan?

We at the Swinomish Indian Tribal Community’s Department of Social Services set out to “indigenize” public health climate change impact assessments, basing our work on a set of Indigenous Health Indicators (IHIs) specific to the Swinomish.

We developed these indicators based on over 100 interviews with community members about health meanings and priorities. We then thought about what was missing from current health assessments — for Swinomish, it was the connections between the ecological and socio-cultural dimensions. The six IHIs are:

  • Education: Knowledge, values and beliefs are actively passed on from Elders to youth.
  • Cultural Use and Practice: The community is able to carry forth its cultural traditions in a respectful and fulfilling way using the local natural resources.
  • Community Connection: Community members are actively participating in community functions and helping each other, particularly in connection with the harvest, preparation and storage of natural resources. The community equitably shares these natural resources.
  • Self Determination: The community develops and enacts its own healing, development and restoration programs.
  • Natural Resources Security: Local natural resources (water, land, plants and animals) are abundant and accessible so that they can support a healthy ecosystem(s) and a healthy human community.
  • Resilience: Community members maintain their connection to their homeland, confident that their health and the health of the next seven generations are not at risk.

We have employed the IHIs in many types of health-related assessments, including determining baseline health status, potential impacts from proposed development, impacts from contamination of local natural resources and, most recently, impacts from projected climate change effects.

For our climate change work, we partnered with modelers and fisheries scientists to determine habitat changes on Reservation beaches, and how those changes would impact cultural keystone species — salmon, crabs and clams. We then took those results to the community and asked them to tell us which health indicators would be most impacted and why. The results will be incorporated into the updated Swinomish climate change impact assessment and adaptation action plan.

Metrics that evaluate both physiological impacts, such as increase in vector-borne diseases, and the IHIs provide the Swinomish with a more comprehensive understanding of anticipated effects, and how to better address them — thus providing an example of Swinomish resiliency in a changing climate.

To learn more about this project, visit And for more about how climate change impacts tribal and Indigenous health, visit