ABSTRACT:
Public health systems are confronting concurrent crises—pandemics, climate change, and widening inequities—that expose the limits of approaches grounded primarily in individual behaviour change and biomedical risk. This presentation advances relationality—an Indigenous principle recognizing the interconnectedness of people, place, history, and more-than-human relations—as a unifying framework for equitable public health policy and practice across domains as diverse as vaccine programming, food security, and data governance. Grounded in Indigenous knowledge, methodology, and leadership, this work draws on mixed-methods epidemiologic research with urban Indigenous Peoples who use drugs during COVID-19, implementation research with Nuxalk Nation to restore traditional foods in a hospital setting, and the development of an Indigenous data governance framework within a regional health authority. Across these contexts, findings converge: public health decisions are rarely driven by information alone, but are shaped by relationships—to family and social networks, to land and food systems, to institutions, and to histories of harm and resilience. Vaccine uptake, for example, was strongly associated with trust mediated through social networks, gendered experiences, housing and food insecurity, and cultural connection. Similarly, integrating traditional foods into hospital menus improved not only nutrition but community engagement, cultural safety, and climate resilience. Data governance work revealed how relational accountability can transform policy by centring Indigenous sovereignty and ethical stewardship. Relational approaches reposition public health from a system that delivers interventions to populations toward one that works with communities through sustained relationships, reciprocity, and shared authority. This framework offers practical implications for designing immunization strategies, strengthening food and climate resilience, and developing ethical data systems that advance equity for all populations. By centring relational futures, Indigenous public health approaches offer scalable, action-oriented pathways for re-imagining public health systems capable of responding to today’s intersecting emergencies.