Characteristics of sources of evidence

Twenty sources from diverse geographical contexts applied the CA to the health and well-being of Indigenous Peoples including 13 peer-reviewed articles, 5 theses, 1 book and 1 report (Table 1). No Portuguese or French articles were found, and only one Spanish report was included.

Table 1. Characteristics of sources of evidence where the CA has been applied

^a Levels of participation (Wright & Lemmen, Reference Wright and Lemmen2012):

Information: Decision-makers (professionals) tell the beneficiaries what problems they have and what help they need. Various behaviors and actions are recommended by the professionals. The professionals explain their actions. The perspective of the beneficiaries is taken into account in order to maximize the acceptance of the messages developed by the professionals.

Consultation: The professionals take an active interest in the perspectives of the beneficiaries. Beneficiaries are passively consulted (for example, by way of questionnaires)

Inclusion: The professionals seek active consultation on the part of the beneficiaries (for example by entering a dialogue with certain people from the beneficiary group).

Shared decision-making: The professionals routinely consult with beneficiaries. Decisions are made in terms of negotiating solutions between professionals and beneficiaries. Beneficiaries have a formal right to be heard in decision-making processes

Decision-making authority: All major aspects of planning and implementation are decided by the beneficiaries themselves. There exists a partnership between all stakeholders (including the beneficiaries). Beneficiaries receive active support from professionals for their actions.

Figure 1. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources.

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

Geographical locations where the CA has been integrated with indigenous conceptualizations of health and well-being

Thirty-seven Indigenous groups were represented in the included studies. The majority are from the Global South (Colombia, Bolivia, Guyana, Chile, Ecuador, Venezuela, Mexico, Uganda, Rwanda, Bangladesh, Sri Lanka and India), with two from Global North countries (Australia and United States). Studies from South American countries (Colombia, Bolivia, Guyana, Chile, Ecuador and Venezuela) included a total of 1,175 participants from 22 Indigenous groups – 7 Andean and 15 Amazonian. Those from North American countries (United States and Mexico) included a total of 52 participants, from 2 Indigenous groups; African countries (Uganda and Rwanda), a total of 400 participants, including 4 Indigenous groups; Asian countries (Bangladesh, Sri Lanka and India), a total of 234 participants, including 4 Indigenous groups; and Oceania (Australia), with a total of 84 participants, from 7 Indigenous groups. Key participant demographics within each study are summarized in Table 1 (including gender and age), and the Indigenous groups represented in the included studies are summarized in Figure 2.

Figure 2. Map illustrating the geographical distribution of countries and Indigenous groups where the capability approach has been implemented to health and well-being.

In the present review, not all studies evidenced the same level of Indigenous communities’ participation (Table 1). Two studies were assessed at the “Information” level (Téllez Cabrera, Reference Téllez Cabrera2021; Dawson & Martin, Reference Dawson and Martin2015) and eight at the “Consultation” level (Téllez Cabrera, Reference Téllez Cabrera2022; Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Dawson, Reference Dawson2018; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Bevilacqua et al., Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015; Undurraga, Reference Undurraga2014; Vaughan, Reference Vaughan2011; Calestani Reference Calestani2009). Four studies were reported at the “Inclusion” level (Addison et al., Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019; Gigler, Reference Gigler2015; de Ville de Goyet, Reference de Ville de Goyet2017; Nalwanga & Lund, Reference Nalwanga and Lund2018). Further along the spectrum of participation, three studies were considered to indicate participation at the “Shared decision-making” level (Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020; Fricas, Reference Fricas2019; Valdivia Quidel, Reference Valdivia Quidel2019) and two studies at the “Decision-making authority” level (Gordon Reference Gordon2018, Yap & Yu, Reference Yap and Yu2016).

Dimensions of the CA that are important for the health and well-being of indigenous peoples

Eight descriptive themes of the CA were identified as important for the health and well-being of Indigenous People: Social cohesion; Environment and community-based natural resource management; Indigenous cultural identity; Sustenance autonomy; Rights and self-governance; Services provision; Sustainable economic development and Health and Well-being. Three overarching themes were identified as being relevant to the health and well-being of Indigenous settings. Two of them: harmony in territorial management and community-based sustainable development emphasize the comprehensive representation of well-being in Indigenous settings. The third one: culturally sensitive health care resulted from the focus of this review on literature relating to health and healthcare.

Harmony in territorial management

Territorial management was conceptualized to achieve valued approaches to harmony with the natural environment, ensuring the delivery of resources for sustenance and promoting health and well-being through self-determination and governance. An interviewee in the study conducted by Gordon (Reference Gordon2018) emphasized Alaska’s Indigenous governance of natural resources as relevant to attain important capabilities to meet community subsistence, and thus health and well-being, needs:

This quote highlights structural barriers to achieving equitable resource management, in part due to diminishing the capability of being listened to as traditional knowledges are silenced by national authorities. These are framed within a broader conceptualization of reproductive cycles, echoing the cycles of nature and animal and human reproduction that arise across the literature as a core component of achieving harmony with the natural world, with living in harmony with nature consistently identified as essential to Indigenous health and well-being (Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020, Sahoo & Pradhan, Reference Sahoo and Pradhan2021, Fricas, Reference Fricas2019, Pratt & Warner, Reference Pratt and Warner2019, Adisson et al., Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019, Dawson, Reference Dawson2018, de Ville de Goyet, Reference de Ville de Goyet2017, Yap & Yu, Reference Yap and Yu2016, Dawson & Martin, Reference Dawson and Martin2015, Vaughan, Reference Vaughan2011).

Yap and Yu (Reference Yap and Yu2016) explored an interviewee’s perspective on the connections between self-identity and the management of sites of natural resources for the Yawuru people in Australia:

This quote connects the physical restrictions to achieving the valued Yawuru capability of freedom to hunt fish enacted by government authorities that are fundamental to self-identity and expression of a community of saltwater peoples. These access barriers have deep implications for individual and collective health and well-being, limiting opportunities for achieving valuable functionings such as sharing food with friends and family or maintaining the connection to country and culture (Yap & Yu, Reference Yap and Yu2016). According to the authors, at the core of the Indigenous philosophy of the Yawaru people is their definition of well-being “mabu liyan” which is “both an instrument and an outcome of wellbeing” (Yap & Yu, Reference Yap and Yu2016, 324), permeating all aspects of Yawaru well-being across relational, spiritual and resilient conceptions of well-being that help the Yawaru to adapt whilst staying true to their Indigenous identity.

Active negotiations between Indigenous communities and dominant social groups are highlighted in the existing unequal power dynamics and oppressive historical relationships with governments and wider society. The conversion factors of self-determination and autonomy in attaining land rights appear as relevant for achieving an integrated governance that promotes Indigenous communities’ autonomy, human rights and well-being. It is notable that collective territorial management as an element of Indigenous well-being is addressed by 12 of the studies (Téllez Cabrera, Reference Téllez Cabrera2021; Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020; Gordon, Reference Gordon2018; Adisson et al., Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019; Fricas, Reference Fricas2019, Pratt & Warner, Reference Pratt and Warner2019; Dawson, Reference Dawson2018; Yap & Yu, Reference Yap and Yu2016; Dawson & Martin, Reference Dawson and Martin2015; Bevilacqua et al. Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015; Vaughan, Reference Vaughan2011).

Community-based sustainable development CA models of decision-making and leadership indicate collective capabilities of community and family sustenance, income generation and economic enterprise as dimensions of well-being. These collective capabilities are related to opportunities for partnership development and the preservation of cultural knowledge and languages. Sixteen studies examine the economic foundations of Indigenous well-being by analysing the vulnerability of Indigenous identities and the effects of cultural change resulting from marginalization (Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020; Sahoo & Pradhan, Reference Sahoo and Pradhan2021, Téllez Cabrera, Reference Téllez Cabrera2021, Gordon, Reference Gordon2018, Adisson et al., Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019, Fricas, Reference Fricas2019, Pratt & Warner, Reference Pratt and Warner2019, Valdivia Quidel, Reference Valdivia Quidel2019, Dawson, Reference Dawson2018, Nalwanga & Lund, Reference Nalwanga and Lund2018, de Ville de Goyet, Reference de Ville de Goyet2017, Yap & Yu, Reference Yap and Yu2016, Dawson & Martin, Reference Dawson and Martin2015, Gigler, Reference Gigler2015, Vaughan, Reference Vaughan2011, Calestani, Reference Calestani2009). De Ville de Goyet (Reference de Ville de Goyet2017) explored the economic well-being of the Makushi Indigenous community through the valued capability of autonomy over development initiatives for Surama village in North Rupununi, Guyana. The author cites the Ecolodge business declaration:

Embedded within this vision are valued functionings of community cohesion and mutually respectful partnerships. Importantly, ecotourism is identified as a means to generate income and promote cultural knowledges to those from and outside the community. For Indigenous participants, the promotion of traditional culture is seen as essential to economic benefit and thus their own well-being. However, as noted by de Ville de Goyet (Reference de Ville de Goyet2017), development in the form of information community technology (ICT) resources can lead to negative impacts on community cohesion. De Ville de Goyet (Reference de Ville de Goyet2017) found that if collective political and economic freedoms are enhanced by ICT resources facilitating access to information on government policies, these freedoms can also be perceived as exclusionary for elder generations who do not access such resources.

Across the diverse Indigenous settings included in this review, sustainable development is conceptualized under rights of self-governance and cultural perspectives of well-being. Included studies described community-based initiatives seeking to ensure economic capabilities for future and younger generations (Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020, Gordon, Reference Gordon2018; Fricas, Reference Fricas2019; Yap & Yu, Reference Yap and Yu2016). Some studies approach social cohesion and the provision of health services to achieve partnership in initiatives that promote sustainable development (Téllez Cabrera, Reference Téllez Cabrera2022; Téllez Cabrera, Reference Téllez Cabrera2021; Pratt & Warner, Reference Pratt and Warner2019; Nalwanga & Lund, Reference Nalwanga and Lund2018, Bevilacqua et al. Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015, Calestani, Reference Calestani2009), while others offer examples of initiatives in cross-cultural education and cultural recognition as valuable conversion factors to understand how Indigenous Peoples preserve their culture while adapting to contemporary changes (Gordon, Reference Gordon2018; De Ville de Goyet, Reference de Ville de Goyet2017; Dawson, Reference Dawson2018; Gigler, Reference Gigler2015; Vaughan, Reference Vaughan2011). Recovering the memories of older generations is seen as strengthening cultural identities, intergenerational ties and community capabilities for partnership in development.

Culturally sensitive health care

The CA highlights the critical role of listening to community needs when developing, implementing and evaluating public health policies (Tellez Cabrera Reference Téllez Cabrera2021; Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020; Adisson et al., Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019; Pratt & Warner, Reference Pratt and Warner2019; Dawson, Reference Dawson2018, Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Dawson & Martin, Reference Dawson and Martin2015, Vaughan, Reference Vaughan2011). This is reinforced by the literature on Indigenous Peoples, which consistently points to the need for comprehensive healthcare strategies, interventions and models that are grounded in Indigenous conceptualizations of health and well-being (Téllez Cabrera, Reference Téllez Cabrera2021; Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Valdivia Quidel, Reference Valdivia Quidel2019; Pratt & Warner, Reference Pratt and Warner2019; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Bevilacqua et al., Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015; Dawson & Martin, Reference Dawson and Martin2015; Undurraga, Reference Undurraga2014). A prime example is Bevilacqua et al. (Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015), who developed an adaptive management and ecohealth framework to eliminate malaria in Indigenous communities of the Ye’kwana and Sanema groups of the Venezuelan riparian forest. Their model incorporated the environmental, sociocultural and economic dimensions of malaria, recognizing the importance of the CA:

Regarding health and healthcare services, ten studies included in this review explore reproductive health, alcohol consumption and forced displacement and underscore the lack of data collection from Indigenous Peoples and their exclusion from these dimensions of well-being (Téllez Cabrera, Reference Téllez Cabrera2021, 2021; Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Valdivia Quidel, Reference Valdivia Quidel2019; Pratt & Warner, Reference Pratt and Warner2019; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Bevilacqua et al., Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015; Dawson & Martin, Reference Dawson and Martin2015; Undurraga, Reference Undurraga2014; Vaughan, Reference Vaughan2011).

Téllez Cabrera (Reference Téllez Cabrera2021) addressed the health governance of P’urhépecha people in Mexico, emphasizing the integration of both traditional and biomedical health perspectives as a vital condition for health capabilities, empowering the community to make informed health choices and preserve self-identity by achieving the valued individual capabilities of being healthy that is attained through adherence to traditional beliefs (Téllez Cabrera, Reference Téllez Cabrera2021). One interviewed member of the P’urhépecha community explained:

Health resource allocations present an opportunity for Indigenous communities to mobilize politically and collaborate with governments in designating land resources and traditional knowledge and practices for healthcare services. In this context, participatory deliberation and self-governance are crucial for the community’s ability to establish the governance healthcare services, manage hospitals and choose medical treatments. Political mobilization is conceptualized by Téllez Cabrera (Reference Téllez Cabrera2021) as a key conversion factor in the articulation of Indigenous community development plans within government policies.

Fifteen studies oriented by Sen’s perspective describe political mobilization as how Indigenous communities have responded to policy inconsistency in services and social programmes. This mobilization seeks more equitable and inclusive forms of governance by empowering communities to advocate for their needs, challenge existing power structures and participate in decision-making processes that affect their lives (Téllez Cabrera, Reference Téllez Cabrera2021; Adisson et al., Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019; Pratt & Warner, Reference Pratt and Warner2019; Valdivia Quidel, Reference Valdivia Quidel2019; Fricas, Reference Fricas2019; Dawson, Reference Dawson2018; Nalwanga & Lund, Reference Nalwanga and Lund2018; Gordon, Reference Gordon2018; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; De Ville de Goyet, Reference de Ville de Goyet2017; Yap & Yu, Reference Yap and Yu2016; Dawson & Martin, Reference Dawson and Martin2015; Gigler, Reference Gigler2015; Vaughan, Reference Vaughan2011; Calestani, Reference Calestani2009). Nussbaum’s perspective of CA is preferred in studies that seek to address barriers to social inclusion and equitable access to resources, on the assumption that human dignity can be achieved by covering specifically defined conditions of life (Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Nalwanga & Lund Reference Nalwanga and Lund2018). These studies demonstrate that applying Nussbaum’s 10 capabilities (Life; Bodily Health; Bodily Integrity; Senses, Imagination, and Thought; Emotions; Practical Reason; Affiliation; Other Species; Play; Control over One’s Environment) as a minimum threshold can be useful as an evaluative tool. However, for some authors, this approach was found to be overly narrow and failed to harmonize local perspectives with broader policy frameworks effectively (Vaughan, Reference Vaughan2011). Nevertheless, its focus on the quality of life and the unequal status in capabilities, such as reproductive health care status, can reduce vulnerabilities and articulate demands for government (Sahoo & Pradhan, Reference Sahoo and Pradhan2021).

Sahoo & Pradhan (Reference Sahoo and Pradhan2021) approached the healthcare capabilities of Indigenous women in post-displacement settings established by the government of India in three wildlife sanctuaries. The authors discuss Nussbaum’s list of ten capabilities in a context of extreme inequality where Indigenous Peoples have lost control over natural resources and self-governance. The study interviewed Indigenous Women who had arrived at the rehabilitation colonies and who explained:

In this quote, interviewees acknowledge how the community’s access to markets, education and health services in the “rehabilitation colony” has expanded their capabilities. However, they emphasize that these resources cannot replace the territorial integrity they have lost. This may also reflect a concern that the education and health services provided may not align with their traditional knowledge and identities, potentially leading to the erosion of these cultural elements in the future. Sahoo & Pradhan (Reference Sahoo and Pradhan2021) interpreted the importance of restoring an emotional bond with the land as being central to attaining the tribe’s collective capabilities of adequate shelter and health and well-being (19-20). Participants also described increasing domestic violence and substance abuse:

For the authors, the structural violence described here signals the lack of choices and decision-making power that Indigenous Women have under the circumstances of displacement, which has not only disrupted the physical territorial integrity of the community but has also undermined their social and cultural well-being.

Similarities and differences in CA dimensions related to health and well-being across indigenous settings

Authors of the included studies approached the CA from three perspectives. These include viewing it as an integrative well-being framework including dimensions relevant to health and well-being that measure people’s capacity to meet basic needs and that serve as an informational basis for public policy (Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Dawson, Reference Dawson2018; Nalwanga & Lund, Reference Nalwanga and Lund2018; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Bevilacqua et al. Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015; Dawson & Martin, Reference Dawson and Martin2015; Undurraga, Reference Undurraga2014; Vaughan, Reference Vaughan2011); as an approach to measure Indigenous well-being and what constitutes a “good life” or a “good place” in their own terms (Addison et al. Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019; Pratt & Warner, Reference Pratt and Warner2019; Valdivia Quidel, Reference Valdivia Quidel2019; Yap &Yu, 2016; de Ville de Goyet, Reference de Ville de Goyet2017; Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020; Gordon, Reference Gordon2018; Gigler, Reference Gigler2015; Calestani, Reference Calestani2009); and as a framework that can be complemented by the “health capability paradigm” (Ruger, Reference Ruger2010), which argues that the goal of public health policy should be people’s freedom to achieve the health states they value (Téllez Cabrera, Reference Téllez Cabrera2021).

There are distinctive patterns emerging between geographies and Indigenous settings. Conversion factors related to inclusive development initiatives are discussed in Australia, South America and North American countries, illuminating Indigenous communities’ demands for recognition and negotiation with governments. Land titles and the effects of the Stolen Generation in Australia are linked with well-being functionings, such as maintaining a connection to country and culture, and with capabilities in cross-cultural education and being able to choose where to live (Adisson et al. Reference Addison, Stoeckl, Larson, Jarvis and Esparon2019, Yap & Yu, Reference Yap and Yu2016, Vaughan, Reference Vaughan2011). Indigenous communities in South America and North American settings also prioritize the preservation of their cultural heritage, territorial management and self-determination (Gordon, Reference Gordon2018, Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020).

In these contexts, the maintenance of cross-cultural and cross-generational knowledge are also relevant capabilities to participate in decision-making processes, articulated with the promotion of sustainable economic activities to prevent isolation and to expand the knowledge, markets and services for achieving collective well-being (Pratt & Warner, Reference Pratt and Warner2019, Fricas, Reference Fricas2019, Gigler, Reference Gigler2015, Calestani, Reference Calestani2009), or through ecotourism (De Ville de Goyet, Reference de Ville de Goyet2017). Likewise, in Australia, South America and North American settings, there is a notable concern about the engagement of younger generations in traditional Indigenous community activities as key aspects of their functionings and adaptation to contemporary changes. The adult’s concerns are about their inclusion in the job market, participation in communal activities, alcohol and drug consumption, external cultural influence and decisions to live in urban areas (Téllez Cabrera, Reference Téllez Cabrera2021; Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020; Gordon, Reference Gordon2018; Pratt & Warner, Reference Pratt and Warner2019; Fricas, Reference Fricas2019; Valdivia Quidel, Reference Valdivia Quidel2019; De Ville de Goyet, Reference de Ville de Goyet2017; Gigler, Reference Gigler2015; Calestani, Reference Calestani2009).

Across the literature, social justice, self-determination and harmonization with nature are repeatedly discussed in relation to the attainment of health and well-being capabilities of Indigenous Peoples. Although significant differences arise from the specific situations and needs of Indigenous Peoples who have been displaced (Sahoo & Pradhan, Reference Sahoo and Pradhan2021) and those who live on ancestral lands (Dawson, Reference Dawson2018; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Nalwanga & Lund, Reference Nalwanga and Lund2018), interviewees highlight similar capabilities, such as community and family cohesion to care for illness (Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Nalwaga & Lund, 2018; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017) and their deep cultural and ancestral ties to the land, highlighting its importance in shaping their health, well-being and identities (Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Dawson, Reference Dawson2018; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017).

Studies from Rwanda, Uganda, India and Bangladesh reveal tensions between governments orientation and Indigenous health and well-being (Dawson, Reference Dawson2018; Sahoo & Pradhan, Reference Sahoo and Pradhan2021; Palas et al., Reference Palas, Ashraf, Quazi, Grunfeld and Hasan2017; Nalwanga & Lund, Reference Nalwanga and Lund2018), highlighting the risks of policies that imply the loss of Indigenous cultural integrity and community cohesion for the well-being of Indigenous Peoples. In contrast, studies from communities in Ecuador, Bolivia, Canada and Australia manifest approval and benefits approval of certain government initiatives, especially those related to technological and infrastructural development, as well as efforts to revitalize cultural identity (Pratt & Warner, Reference Pratt and Warner2019; Yap & Yu, Reference Yap and Yu2016; Gigler, Reference Gigler2015; De Ville de Goyet, Reference de Ville de Goyet2017; Gordon, Reference Gordon2018).

Some studies interrogate the suitability of the CA for capturing Indigenous Peoples’ health and well-being perspectives and guaranteeing their cultural freedoms (Téllez Cabrera, Reference Téllez Cabrera2021; Fricas, Reference Fricas2019; Yap & Yu, Reference Yap and Yu2016; Gigler, Reference Gigler2015; Vaughan, Reference Vaughan2011). In these studies, Sen’s approach is preferred for encouraging agency and context-specific definitions of health and well-being (Téllez Cabrera, Reference Téllez Cabrera2021; Yap & Yu, Reference Yap and Yu2016; Gigler, Reference Gigler2015). Sen’s orientation questions the narrow frame in which policies and measurements are stated, seeking to incorporate dimensions of well-being beyond socio-economic indicators (Yap & Yu, Reference Yap and Yu2016; Gigler, Reference Gigler2015). Furthermore, it is argued that aligning CA concepts of individual and collective capabilities with Indigenous ontologies is a challenging endeavour (Vaughan, Reference Vaughan2011). For instance, the notion of substantive freedom as defined within the CA is not perceived to be equivalent to the dominance of collective values over personal aspirations in Indigenous communities (Calestani, Reference Calestani2009). Moreover, the CA is not regarded as a strong political tool for marginalized groups to achieve redistribution of resources because it is unable to capture historical social struggles and structural power relationships (Gigler, Reference Gigler2015; Fricas, Reference Fricas2019).

Capability-based assessment tools for indigenous health and well-being

Nine out of 20 studies use or develop capacity-based assessment tools for Indigenous health and well-being. These tools include both indicators and indexes. Examples of indicators include the Indigenous well-being indicators in the Colombian Amazon that highlight the relevance of traditional medicines in preventive and curative health care in Indigenous territories (Acosta et al., Reference Acosta, Mendoza, De La Cruz and Murcia García2020) and the P’urhépecha people indicators which cover diseases such as diabetes, hypertension and cancer, as well as broader aspects such as literacy, access to health services, social security and material conditions (Téllez Cabrera, Reference Téllez Cabrera2022). In terms of indexes, the Women Capabilities Index for displaced Dampara and Achanakma women captures domestic violence, access to desired contraceptives, use of modern health facilities and access to agricultural land and forest resources (Sahoo & Pradhan, Reference Sahoo and Pradhan2021). The CAPSAS (Subjective health capabilities in adults) index is a health capabilities indicator created with the P’urhépecha people in Mexico (Téllez Cabrera, Reference Téllez Cabrera2021). Other tools include questionnaires and census instruments to measure the effectiveness and long-term viability of technical solutions to local malaria control that show the relevance of individual knowledge, skills and community practices (Bevilacqua et al., Reference Bevilacqua, Rubio-Palis, Medina and Cárdenas2015) and the multidimensional well-being approach utilized by Dawson & Martin (Reference Dawson and Martin2015) which emphasizes meeting basic needs such as food, shelter, health care and social relationships.