Elana Nightingale, Diana Lewis, Veronica Reitmeier, Olivia Thom, and Heather Castleden

Indigenous health impact assessment: Systematic review of the literature

January 2026

Resource extraction and industrial processes have long worked to displace and dispossess Indigenous Peoples from their lands and resources, prioritizing state and industry profits over the health and well-being of First Nations people, Inuit, and Métis people. Fostering Indigenous self-determination within health impact assessment (HIA) and decision-making processes is essential to advance reconciliation in Canada. Integrating Indigenous Peoples’ knowledges, values, and priorities into HIA processes is also the only way to identify all potential health impacts of resource extraction and industrial activities and meaningfully ensure those impacts are adequately mitigated and addressed.

This systematic review of the literature examines Indigenous participation in the assessment of resource and infrastructure developments, utilizing an inclusive (i.e., rights-, gender-, and equity-based) approach, the paper provides an overview of Indigenous community-specific frameworks of health and well-being. The implications of these frameworks for HIA are discussed, along with Indigenous Peoples’ perspectives of current impact assessment (IA) processes. The paper identifies gaps in available resources, challenges with engaging and collaborating with government and industry, and opportunities for enhanced leadership. It also highlights national and international best practices, tools, and guidance for the meaningful engagement of Indigenous individuals, communities, organizations, and governments in IA processes.

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