Extreme weather events have demonstrated that there is a mismatch between available climate data and metrics (reflecting on-the-ground lived realities) that communities can use to inform community climate adaptation. A similar mismatch occurs in disaster health responses. Healthcare systems use hazard vulnerability analyses (HVA) to identify hazards such as climate disasters, evaluate their potential impact, and guide resource allocation. HVAs rely primarily on US census data to understand community resiliency. This lack of inclusivity and disregard for local and Indigenous knowledge in disaster preparedness, response, and recovery undermines local capacity, slows the recovery process, and exacerbates health inequities. However, even when transformational ideas and Indigenous leaders are present, bureaucratic systems may not respond to community recommendations and requests. Given the lack of accountability that Indigenous and local communities have experienced with disaster response, it is critical that the centering of local and Indigenous knowledge in climate disaster health response must be done by ensuring non-discrimination, participation, accountability, and transparency in healthcare design. A rights-based approach, reflecting these core principles, provides a means for climate HVAs to center local and Indigenous knowledges and advance better health provisioning in climate disasters. A rights-based approach to health ensures that principles of fairness, participation and accountability are applied in disaster response and extends to the provision of the underlying determinants of health (food, safe water, housing, land). The AAAQ framework—comprising Availability, Accessibility, Acceptability, and Quality—a crucial element of a rights-based approach - ensures that health goods and services are available, accessible (including economic affordability, physical and information accessibility) culturally appropriate, and of high quality. A rights-based approach addresses the inequalities, discriminatory practices, and unjust distributions of power that often prevent Indigenous leadership in decision-making climate and health protection. A rights-based approach, however, requires concrete context-specific metrics to ensure effective implementation and monitoring. We propose that a rights-based approach can be used to create usable Indigenous-led metrics and bridge knowledge rifts currently preventing effective partnerships between Indigenous communities and health care institutions for climate disaster response.
