Applying Passamaquoddy wisdom to contemporary tribal health decision-making

Background. Elevating the health status of Native Americans in the United States remains an important public policy concern at the federal, state and tribal levels. Historically, health policy-making on the federal and state levels has eclipsed the tribal role in developing health policy. This critical ethnographic study employed qualitative methods to explore concepts of health and decision-making processes in the Passamaquoddy community at Sibyig; and to examine how the values and principles expressed in the Passamaquoddy language can be integrated into tribal health policy-making processes.;Aims. This research project addressed four aims: (1) understand the underlying concepts and cultural frameworks for health and decision-making in a Native community; (2) document how, and in what context public health decision-making operates in the community; (3) explore and articulate how culturally relevant health concepts can be integrated into the decision-making process; and (4) examine the experience of an Indigenous researcher conducting research in community.;Methods. I reviewed documentary material and conducted individual and group interviews with fluent Passamaquoddy speakers to inform the first aim of the research. For aims two and three, in-depth interview, documentary data and participant observation methods were employed. All of the data including analytic and reflexive notes were utilized to address the fourth aim.;Findings. Main findings center on the important role of the Passamaquoddy language in informing tribal health decision-making and ensuring the intergenerational transmission of Indigenous knowledge. Traditional tribal beliefs and practices articulated in the language include a collective sense of responsibility for the wellbeing of all community members, and a profound respect for the natural life cycles integrated with a deep understanding of interdependency and the importance of providing for the collective interests of the tribal community.;Discussion. In order to accurately reflect Indigenous teachings and provide for intergenerational transmission, Indigenous researchers should center Indigenous language in research processes. This approach could be replicated in other Indigenous communities struggling to discover an effective, culturally appropriate way to achieve positive public health outcomes and to address significant health disparities. The research carries important implications for the long term strengthening and sustainability of healthy Indigenous communities.