Health priorities for rural Alaska native communities at the extremes of weather and climate change

Climate change is occurring at an accelerated pace in high-latitude regions, with implications for the health and well-being of rural northern communities– places that have long navigated significant health disparities with limited resources. Here, we present a community-driven effort to identify community priorities for improving health in the context of a changing climate. We used Q-methodology in four rural Alaska Native communities to systematically identify complex perspectives related to climate change and health priorities. The mixed qualitative-quantitative approach helped to engage the community, prioritize the most locally relevant issues, and identify targets for future interventions. Consistently top-ranked priorities include food security, Indigenous knowledge and practices, and the transmission of culture and traditional ways of living to the younger generations. Community perspectives reflect a holistic view of health that connects climate change to individual health and community well-being. These three components are linked together through the social-ecological landscape, providing resources that are embedded in the local and Indigenous cultural practices. We show that a community-engaged approach can generate consensus data, directing research and interventions towards the highest needs and priorities of Alaska Native communities highly affected by climate change. Overall, participating rural Alaska Native communities prioritized the impacts of climate change on traditional ways of living from the land to subsist and thrive in these remote, culturally important areas. Additionally, the well-being and futures of young people arose as a primary shared concern, directing interventions to address the impacts of climate change on health towards place-based solutions that protect and preserve environmental resources and engage young people in the transmission of traditional knowledge and practices on the land.