Diving below the surface: A framework for arctic health research to support thriving communities.

AIMS: Historically, health research in the Arctic has focused on documenting ill-health using a narrow set of deficit-oriented epidemiologic indicators (i.e., prevalence of disease and mortality rates). While useful, this type of research does not adequately capture the breadth and complexities of community health and well-being, and fails to highlight solutions. A community's context, strengths, and continued expressions of well-being need to guide inquiries, inform processes, and contextualize recommendations. In this paper, we present a conceptual framework developed to address the aforementioned concerns and inform community-led health and social research in the Arctic. METHODS: The proposed framework is informed by our collective collaborations with circumpolar communities, and syntheses of individual and group research undertaken throughout the Circumpolar North. Our framework encourages investigation into the contextual factors that promote circumpolar communities to thrive. RESULTS: Our framework centers on the visual imagery of an iceberg. There is a need to dive deeper than superficial indicators of health to examine individual, family, social, cultural, historical, linguistic, and environmental contexts that support communities in the Circumpolar North to thrive. A participatory community-based approach in conjunction with ongoing epidemiologic research is necessary in order to effectively support health and wellness. Conclusions: The iceberg framework is a way to conceptualize circumpolar health research and encourage investigators to both monitor epidemiologic indicators and also dive below the surface using participatory methodology to investigate contextual factors that support thriving communities.

Cancer Education for High School Students in the Northwest Arctic Increases Knowledge and Inspires Intent to Share Information and Reduce Cancer Risk.

Culturally appropriate cancer education is an opportunity to reduce health inequities in cancer. This manuscript describes the outcomes of piloting cancer education for youth in the Northwest Arctic region of Alaska. The project began due to community concerns, was focused through sharing circles conducted in the region, and was guided by a community advisory board. The project was based on the principles of Community Based Participatory Action Research (CBPAR), honored Indigenous Ways of Knowing, and was grounded in Empowerment Theory. In response to community requests, eleven cancer education lessons were developed for young people in the Northwest Arctic. Several lessons were piloted in spring 2022. Each participant was invited to complete a pre-lesson and a post-lesson survey. A total of 113 surveys were completed from five different lessons: 66 pre-lesson surveys and 47 post-lesson surveys. Respondents' mean cancer knowledge scores were significantly higher after the Cancer Basics lesson. On 98% of post-lesson surveys, respondents said they planned to share cancer education messages such as staying tobacco-free and increasing physical activity with others, including their family, friends, and community members. On 93% of the post-lesson surveys, respondents indicated they planned to make changes to reduce their own personal cancer risk, including by staying tobacco-free, eating healthier, and increasing physical activity. "Cancer is serious, and something we should start talking about".

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes.

PURPOSE: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS: Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer.

BACKGROUND: Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014-2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska's tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion. KEY FINDINGS: Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules. IMPLICATIONS FOR PRACTICE AND FURTHER RESEARCH: Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.

Learning Together: Sharing Circles in Rural Alaska on Cancer Education Priorities for Youth.

Culturally relevant health promotion with youth is an opportunity to reduce health inequities in cancer. This manuscript describes sharing circles conducted with three communities in the Northwest Arctic region of Alaska. The circles were designed to begin understanding community priorities and lay the foundation to develop culturally relevant cancer education. The project was guided by the principles of Community-Based Participatory Action Research (CBPAR), honored Indigenous ways of knowing, and was grounded in Empowerment Theory. The project team facilitated 13 sharing circles in November 2019 in three communities in the Northwest Arctic. There were a total of 122 participants, including teachers/school staff (31%), community members (30%), high school students (23%), and health professionals (16%). The circles explored youth knowledge, perceptions, questions, concerns, and hopes for cancer information; community members' desires for youth knowledge about cancer; and how teachers would like content to be formatted for effective inclusion in their classrooms. Common themes from the sharing circles included a desire for information on cancer prevention (all 13 sharing circles) and a need for information on cancer risk factors (12). In most sharing circles, participants shared that cancer information for youth should include stories like those of local people, cancer survivors, and role models (11), visuals (8), and local data and statistics (8). In addition, teachers and school staff in all communities wanted an online resource for teaching about cancer in their classrooms that had short videos/visuals with related lesson plans and activities."If I learn, I can reduce the chance of getting cancer in the future."

An Evaluation of Cancer Education Webinars in Alaska.

Culturally relevant health promotion is an opportunity to reduce health inequities in the cancer burden, and online learning is an emerging avenue for health promotion. To address a desire for synchronous online cancer education, a project team offered ten 1-hr cancer education webinars for Alaska's rural tribal health workers. The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. The evaluation of this community-based intervention included end-of-webinar surveys. Between February and April 2018, 41 surveys were completed by 11 unique participants. All participants reported that, as a result of the webinars, they planned both to change their own behavior to reduce cancer risk, and to talk with their patients more often about cancer prevention strategies such as screenings, physical activity, tobacco cessation, and eating healthy. While the webinars addressed desires for synchronous actions to support cancer learning, and led to intentions to positive change behaviors, the ten webinars engaged far fewer unique learners than the team's asynchronous cancer education modules. This experience may inform other cancer educators' efforts to develop, implement, and evaluate online learning opportunities. Despite the small numbers, these webinars resulted in increased learners' intent to reduce cancer risk behaviors, share cancer information, and improved learners' capacity to talk about cancer in their communities.

A Qualitative Evaluation of a Community Based, Culturally Relevant Intervention to Promote Healthy Food Access in American Indian Communities.

In response to a need for healthy, affordable food, Johns Hopkins Center for American Indian Health and three rural indigenous communities launched the "Feast for the Future," (FFF) to promote access to healthy foods and the transfer of traditional food-based knowledge from farmers/elders to youth. To assess program impact, 43 in-depth interviews were conducted with participating farmers, elders, and Community Advisory Board members. Interviews were recorded, transcribed, and analyzed in Atlas.ti. Common themes from qualitative analyses included: FFF programs support farming/gardening revitalization and cultural connectedness/identity; FFF has supported positive behavior change among interviewees and their families; There is a need to revitalize traditional food systems; Farming/gardening is central to cultural identity; and Responsibility for food choices. The interviews revealed that the community-based program is perceived by key stakeholders as reaffirming cultural identity and promoting healthy eating. As a CAB member shared.

A Framework for Culturally Relevant Online Learning: Lessons from Alaska's Tribal Health Workers.

Culturally relevant health promotion is an opportunity to reduce health inequities in diseases with modifiable risks, such as cancer. Alaska Native people bear a disproportionate cancer burden, and Alaska's rural tribal health workers consequently requested cancer education accessible online. In response, the Alaska Native Tribal Health Consortium cancer education team sought to create a framework for culturally relevant online learning to inform the creation of distance-delivered cancer education. Guided by the principles of community-based participatory action research and grounded in empowerment theory, the project team conducted a focus group with 10 Alaska Native education experts, 12 culturally diverse key informant interviews, a key stakeholder survey of 62 Alaska Native tribal health workers and their instructors/supervisors, and a literature review on distance-delivered education with Alaska Native or American Indian people. Qualitative findings were analyzed in Atlas.ti, with common themes presented in this article as a framework for culturally relevant online education. This proposed framework includes four principles: collaborative development, interactive content delivery, contextualizing learning, and creating connection. As an Alaskan tribal health worker shared "we're all in this together. All about conversations, relationships. Always learn from you/with you, together what we know and understand from the center of our experience, our ways of knowing, being, caring." The proposed framework has been applied to support cancer education and promote cancer control with Alaska Native people and has motivated health behavior change to reduce cancer risk. This framework may be adaptable to other populations to guide effective and culturally relevant online interventions.

Culturally-Relevant Online Education Improves Health Workers' Capacity and Intent to Address Cancer.

To address a desire for timely, medically-accurate cancer education in rural Alaska, ten culturally-relevant online learning modules were developed, implemented, and evaluated with, and for, Alaska's Community Health Aides/Practitioners (CHA/Ps). The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. Each learner was invited to complete an end-of-module evaluation survey. The survey asked about changes in intent to share cancer information with patients as a result of the module. In 1 year, August 1, 2016-July 31, 2017, 459 surveys were completed by 79 CHA/Ps. CHA/Ps reported that, because of the modules, they felt more knowledgeable about cancer, and more comfortable, confident, and prepared to talk about cancer with their patients, families, and communities. All learners shared that because of the modules, they intended to talk with their patients more often about cancer screenings, tobacco cessation, physical activity, or nutrition. These findings suggest that the application of this collaboratively developed, culturally-relevant, health promotion intervention has supported increased CHA/P capacity and intent to interact with patients about cancer. In the words of a learner: "Doing all these courses makes me a ton times more comfortable in talking about cancer with anyone. I didn't know too much about it at first but now I know a whole lot. Thank you".

Culturally-Relevant Online Cancer Education Modules Empower Alaska's Community Health Aides/Practitioners to Disseminate Cancer Information and Reduce Cancer Risk.

To address a desire for timely, medically accurate cancer education in rural Alaska, ten culturally relevant online learning modules were developed with, and for, Alaska's Community Health Aides/Practitioners (CHA/Ps). The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. A total of 428 end-of-module evaluation surveys were completed by 89 unique Alaska CHA/Ps between January and December 2016. CHA/Ps shared that as a result of completing the modules, they were empowered to share cancer information with their patients, families, friends, and communities, as well as engage in cancer risk reduction behaviors such as eating healthier, getting cancer screenings, exercising more, and quitting tobacco. CHA/Ps also reported the modules were informative and respectful of their diverse cultures. These results from end-of-module evaluation surveys suggest that the collaboratively developed, culturally relevant, online cancer education modules have empowered CHA/Ps to reduce cancer risk and disseminate cancer information. "brought me to tears couple of times, and I think it will help in destroying the silence that surrounds cancer".

The Role of Alaska's Tribal Health Workers in Supporting Families.

Alaska's Community Health Aides/Practitioners (CHA/Ps) are often the sole medical workers in their communities in rural Alaska, and are instrumental in providing healthcare services and education to otherwise underserved individuals. This qualitative study explored how CHA/Ps support healthy families. Six CHA/Ps from two rural communities in western Alaska were interviewed about their scope of practice, interactions with mothers, infants, families, and teens, relationship to other medical providers, and perceptions of their work. Using grounded theory, verbatim notes were analyzed in Dedoose software and coded by thematic and structural components. Interviewed CHA/Ps shared how the CHA/P program is a culturally relevant way to deliver healthcare, and talked about the challenges of the work, rewards, and suggestions for improvement. CHA/Ps described their unique role as the on-the-ground health and wellness resource in their communities, and talked about consulting with other medical professionals to provide better care for individuals in rural Alaska. CHA/Ps described that they provided prenatal care, patient education during pregnancy, emergency delivery services when necessary, well-child visits, and outreach to teens to give fluoride rinses, vaccinations, and education about issues such as sexual health and drugs/alcohol. CHA/Ps also talked about patient education as a primary responsibility, which also reduced patient load and prevented burn-out. The CHA/P program is a comprehensive and innovative approach to providing healthcare education and services that promotes healthy communities, including positive parent-infant interactions, child wellness, and teen decision-making. The program is a healthcare delivery model translatable to other tribal and limited-resource contexts.

Co-Creating a Culturally Responsive Distance Education Cancer Course with, and for, Alaska's Community Health Workers: Motivations from a Survey of Key Stakeholders.

To gain input on a proposed culturally responsive, distance-delivered cancer education course informed by empowerment theory and adult-learning principles, Alaska's Community Health Aides/Practitioners (CHA/Ps) and CHA/P leadership were invited to take an online survey in February 2015. The proposed course will be developed as part of the "Distance Education to Engage Alaskan Community Health Aides in Cancer Control" project. The results of the survey demonstrate that respondents are both interested in taking the proposed class and engaging in course development. The results also indicate that respondents have the technological comfort and capacity to be engaged in online learning and have primarily positive experiences and perceptions of distance education. This survey is the beginning of the interactive development of the online cancer education course and part of a continuing endeavor to promote wellness with, and for, Alaska's people by empowering Alaska's CHA/Ps and inspiring positive behavioral change to both prevent cancer and support those who feel its burdens.

Print Material in Cancer Prevention: an Evaluation of Three Booklets Designed with and for Alaska's Community Health Workers.

With increased internet access in rural Alaska and subsequent shifts in access to health information, we sought to understand the current role of printed cancer education booklets focused on recommended cancer screening exams. This evaluation reviewed three cancer education booklets specifically created with and for Alaska's Community Health Workers (CHWs) and the people in their communities. The booklets were created in an adaptation of empowerment theory, focused on working within a community-based participatory framework, in a culturally respectful manner, to shift cancer prevention norms by empowering CHWs to catalyze health behavior change for both themselves and their communities. The booklets incorporated traditional Alaska Native values and were designed to connect with readers at an affective and informational place that emphasized relationships. Since 2010, over 20,000 booklets have been distributed. Between January 2013 and March 2014, CHWs from throughout Alaska were invited to complete a three-page anonymous written evaluation of the booklets during community health trainings in Anchorage, Alaska. A total of 102 CHWs completed evaluations, with the vast majority indicating that they liked (100 %), and learned (96 %) from, the booklets. The evaluation results suggest that printed booklets designed in a culturally responsive manner, which both communicate medically accurate information and reach readers at an affective place to inspire action through raising awareness in relationship with others, are a helpful way to receive, discuss, and disseminate cancer screening information among Alaska Native people.

Evaluating arts-based cancer education using an internet survey among Alaska community health workers.

Cancer, considered a rare disease among Alaska Native people as recently as the 1950s, surpassed heart disease in the 1990s to become the leading cause of mortality. In response to Alaska's village-based Community Health Workers' (CHWs) desire to learn more about cancer for themselves and the people in their communities, cancer education that incorporated the expressive arts of moving, drawing, and sculpting was developed, implemented, and evaluated. Arts-based education integrates the dynamic wisdom and experiences of Alaska Native people and western medical knowledge to share cancer information in a culturally respectful way. Between May 2009 and March 2013, 12 5-day courses that included arts activities to support cancer information were provided for 118 CHWs in Anchorage, AK, USA. A post-course internet survey was conducted in April 2013, to learn how arts-based cancer education affected participants' knowledge, attitudes, and behaviors. Surveys were completed by 54 of the 96 course participants; 22 course participants were lost to follow-up. As a result of integrating the arts with cancer education, respondents reported an increase in their cancer knowledge and comfort with talking about cancer. Additionally, 82 % (44) of respondents described feeling differently about cancer. By integrating the arts with cancer information, participants reported healthy behavior changes for themselves (76 %), with their families (70 %), and in their work (72 %). The expressive arts of moving, drawing, and sculpting provided a creative pathway for diverse adult learners in Alaska to increase their cancer knowledge, comfort with talking about cancer, and wellness behaviors.

A qualitative exploration of the impacts of COVID-19 in two rural Southwestern Alaska communities.

This manuscript presents a qualitative exploration of the experiences of people in two Southwestern Alaska communities during the emergence of COVID-19 and subsequent pandemic response. The project used principles of community based participatory research and honoured Indigenous ways of knowing throughout the study design, data collection, analysis, and dissemination. Data was collected in 2022 through group and individual conversations with community members, exploring impacts of the COVID-19 pandemic. Participants included Elders, community health workers, Tribal council members, government employees, school personnel, and emergency response personnel. Notes and written responses were coded using thematic qualitative analysis. The most frequently identified themes were 1) feeling disconnected from family, friends, and other relationships, 2) death, 3) the Tribal councils did a good job, and 4) loss of celebrations and ceremonies. While the findings highlighted grief and a loss of social cohesion due to the pandemic, they also included indicators of resilience and thriving, such as appropriate and responsive local governance, revitalisation of traditional medicines, and coming together as a community to survive. This case study was conducted as part of an international collaboration to identify community-driven, evidence-based recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies.

Application of COVIDTracer to Inform Public Health Workforce Planning in Alaska During the COVID-19 Pandemic.

The COVID-19 pandemic has caused social and economic disruption worldwide and spurred numerous mitigation strategies, including state investments in training a large contact tracing and case investigation workforce. A team at the University of Alaska Anchorage evaluated implementation of the COVID-19 contact tracing and case investigation program of the State of Alaska Department of Health and Social Services, Division of Public Health, Section of Public Health Nursing. As part of that evaluation, the team used COVIDTracer, a spreadsheet modeling tool. COVIDTracer generated projections of COVID-19 case counts that informed estimates of workforce needs and case prioritization strategies. Case count projections approximated the reported epidemiologic curve with a median 7% difference in the first month. The accuracy of case count predictions declined after 1 month with a median difference of 80% in the second month. COVIDTracer inputs included previous case counts, the average length of time for telephone calls to cases and outreach to identified contacts, and the average number of contacts per case. As each variable increased, so too did estimated workforce needs. Decreasing the average time from exposure to outreach from 10 to 5 days reduced case counts estimated by COVIDTracer by approximately 93% during a 5-month period. COVIDTracer estimates informed Alaska's workforce planning and decisions about prioritizing case investigation during the pandemic. Lessons learned included the importance of being able to rapidly scale up and scale down workforce to adjust to a dynamic crisis and the limitations of prediction modeling (eg, that COVIDTracer was accurate for only about 1 month into the future). These findings may be useful for future pandemic preparedness planning and other public health emergency response activities.

Developing the Feast for the Future Program through a Community Visioning Process.

BACKGROUND: Three tribal communities in the Southwestern United States have a long-standing partnership with the Johns Hopkins Center for Indigenous Health (JHCIH). OBJECTIVES: In response to community concerns about obesity, three tribal communities and Johns Hopkins Center for Indigenous Health partnered to develop culturally relevant plans for a new program. METHODS: Using a "community visioning" process, a community advisory board (CAB) from each community identified opportunities, challenges, goals, and visions for their communities. The CABs consulted with experts in pediatrics, nutrition, food distribution, agricultural restoration, and community and school gardening. RESULTS: The CABs developed seven components for Feast for the Future: 1) Edible School Gardens; 2) Traditional Food-ways Education Program; 3) Community Gardens, Orchards, and Greenhouses; 4) Farmers Markets; 5) Farmers Workshops; 6) Family Gardens; and 7) a Mobile Grocery Store. CONCLUSIONS: A community-based participatory action research (CBPAR) process was critical to developing a culturally appropriate program that built on community strengths.

Diverse methodological approaches to a Circumpolar multi-site case study which upholds and responds to local and Indigenous community research processes in the Arctic.

This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.

Feasibility of a Supportive Text Messaging Intervention in Northwest Alaska.

Suicide disproportionately impacts young Alaska Native people in the northwestern region of Alaska. As part of its efforts to address this challenge, Maniilaq Association developed a program to determine the feasibility of sending short text messages of caring and support. Process evaluation measures included the number of enrollees and the number of text messages sent each month. To determine participant satisfaction and seek recommendations for improvements, a short, online survey was disseminated to enrollees via text message in 2021 and 2022. Between January 2020 and September 2021, text messages were sent each month to about 100 participants, each with an accompanying image. Messages included "You are capable of amazing things" and "You are enough". Twenty-five individuals completed the 2021 survey and 11 the 2022 survey; three quarters lived in Northwest Arctic. Respondents said the messages improved their mood and made them feel like they mattered a lot or a great deal. The intervention was well-received by participants, inspiring individuals to reach out to others and reach out for help for themselves. Recommendations for improvements included increasing culturally relevant and meaningful quotes and the frequency and consistency of messages. Due to concerns around confidentiality, it is unclear if the initiative reached those most at-risk for suicide. However, participants sharing the messages among the small population of the region may have facilitated a broader reach than would otherwise be expected. Supplementary Information: The online version contains supplementary material available at 10.1007/s41347-022-00293-z.

Public health restrictions, directives, and measures in Arctic countries in the first year of the COVID-19 pandemic.

Beginning January of 2020, COVID-19 cases detected in Arctic countries triggered government policy responses to stop transmission and limit caseloads beneath levels that would overwhelm existing healthcare systems. This review details the various restrictions, health mandates, and transmission mitigation strategies imposed by governments in eight Arctic countries (the United States, Canada, Greenland, Norway, Finland, Sweden, Iceland, and Russia) during the first year of the COVID-19 pandemic, through 31 January 2021s31 January 2021. We highlight formal protocols and informal initiatives adopted by local communities in each country, beyond what was mandated by regional or national governments. This review documents travel restrictions, communications, testing strategies, and use of health technology to track and monitor COVID-19 cases. We provide geographical and sociocultural background and draw on local media and communications to contextualise the impact of COVID-19 emergence and prevention measures in Indigenous communities in the Arctic. Countries saw varied case rates associated with local protocols, governance, and population. Still, almost all regions maintained low COVID-19 case rates until November of 2020. This review was produced as part of an international collaboration to identify community-driven, evidence-based promising practices and recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies.