Indigenous Determinants of Health & Equity Framework
The Indigenous Determinants of Health & Equity Framework recognizes that individual health is not an isolated experience but is deeply connected to family, community, ancestors, and future generations. At the center of the framework is individual health, which is nurtured by emotional, physical, mental, and spiritual wellness. Surrounding this is the health of the community, which provides the foundation for individual and collective wellbeing. The outer rings of the framework represent the broader contextual and systemic factors that shape Indigenous health, including history, land, and culture, political and socioeconomic conditions, socioeconomic position, and health systems. These determinants are not just external forces acting upon Indigenous people; they are interwoven with the very fabric of wellbeing and self-determination.
History, Land, and Culture as Determinants of Health
Indigenous health and wellbeing are rooted in relationships with history, land, and culture. Colonization, forced displacement, and the suppression of Indigenous languages and spiritual traditions have disrupted holistic health systems that sustained Indigenous nations for generations. Despite these harms, Indigenous peoples continue to draw strength and healing from their lands, languages, and cultural practices.
Land is not merely a resource but a living relative that provides sustenance, identity, and spiritual connection. The forced removal of Indigenous peoples from their ancestral lands, combined with environmental destruction and legal barriers to traditional food systems, has contributed to disparities in chronic disease, mental health, and overall community wellbeing. Reconnecting with the land, reclaiming traditional food sovereignty, and restoring Indigenous ecological knowledge are essential steps in improving health outcomes.
Cultural continuity plays a central role in resilience. Communities that maintain strong cultural identity, language preservation, and traditional healing practices experience better health outcomes, including lower rates of suicide and substance use. By revitalizing ceremonies, strengthening access to traditional medicines, and ensuring intergenerational transmission of knowledge, Indigenous peoples reaffirm their pathways to healing and wellness.
Political and Socioeconomic Context as a Determinant of Health
Indigenous health cannot be understood outside the broader political and socioeconomic forces that have shaped Indigenous lives for centuries. Policies governing land, economic development, and tribal sovereignty directly impact Indigenous health by influencing access to resources, employment, education, and healthcare.
Federal and state policies have long undermined Indigenous self-determination, from forced removals to the chronic underfunding of healthcare and infrastructure. Indigenous communities have been systematically excluded from wealth-building opportunities and subjected to policies that reinforce systemic racism and health disparities. At the same time, Indigenous nations continue to exercise sovereignty through self-governance and policy advocacy, fighting to reclaim control over healthcare, public health, and education systems. Strengthening tribal sovereignty and increasing tribal jurisdiction over health and social services are critical steps toward reversing structural inequities and improving Indigenous health outcomes.
Socioeconomic Position as a Determinant of Health
While broad political and economic structures shape Indigenous health, the socioeconomic position of individuals and families within Indigenous communities also plays a significant role. The historical and ongoing marginalization of Indigenous peoples has contributed to persistent disparities in employment, income, education, and housing, all of which influence access to healthcare, nutritious food, and safe living environments.
For many Indigenous people, poverty, housing insecurity, and limited access to education create chronic stress that affects overall health. Economic and social policies that restrict opportunities for Indigenous economic self-sufficiency further entrench disparities. However, Indigenous economic development, including tribally owned enterprises, workforce development programs, and community-led initiatives, presents opportunities to create sustainable, culturally grounded economic systems that support health and wellbeing.
Health Systems as a Determinant of Health: The Indian Health System
The Indian Health Service, along with Tribal and Urban Indian Health Programs, serves as the primary healthcare system for many Indigenous people. However, the Indian health system is underfunded compared to other federal healthcare programs, resulting in provider shortages, limited specialty care and clinics and hospitals that need repair. Many Indigenous people, particularly those living in urban areas, face additional barriers in accessing culturally responsive healthcare.
Despite these challenges, Indigenous healthcare facilities have developed innovative models of care that integrate traditional healing practices, community health workers, and harm reduction strategies. Expanding Indigenous-led healthcare models, increasing funding for IHS and tribal health programs, and incorporating traditional medicines into clinical settings are critical steps toward achieving health equity.
Impact on Spiritual, Emotional, Mental, and Physical Health
The broader social determinants of health—history, land, culture, political and socioeconomic conditions, socioeconomic position, and health systems—shape the core aspects of Indigenous wellness: spiritual, emotional, mental, and physical health. These dimensions of health are interconnected and reflect the holistic nature of Indigenous understandings of wellbeing.
Spiritual health is grounded in relationships with land, ancestors, and cultural practices. Land dispossession, environmental destruction, and restrictions on traditional ceremonies have disrupted Indigenous spiritual health. Reclaiming land-based practices, traditional medicines, and ceremonial spaces fosters spiritual wellbeing and strengthens resilience.
Emotional health is influenced by the historical trauma of colonization, forced family separations, and systemic discrimination. Racism, socioeconomic stress, and the criminalization of substance use all contribute to emotional distress within Indigenous communities. Indigenous-led healing approaches, such as talking circles, traditional counseling, and cultural interventions, provide avenues for restoring emotional balance.
Mental health is shaped by intergenerational trauma, systemic inequities, and access to mental healthcare. Indigenous communities experience high rates of suicide, depression, and substance use, often as a response to structural oppression and social stressors. Mainstream mental health services frequently fail to acknowledge the colonial roots of these issues, but Indigenous models of mental health that incorporate traditional knowledge, community support, and land-based healing offer effective pathways to recovery.
Physical health is deeply tied to social and economic conditions. The disruption of traditional food systems, lack of access to healthcare, and environmental racism have contributed to high rates of chronic disease in Indigenous communities. However, efforts to restore traditional diets, revitalize Indigenous food sovereignty, and integrate cultural health practices into clinical care are creating new opportunities for improving physical health outcomes.
Reciprocity and Intergenerational Health: The Relationship Between Family, Community, Ancestors, and Future Generations
The Indigenous Determinants of Health & Equity Framework recognizes that health is not an individual experience but a collective and intergenerational process. The health of one person is connected to the health of their family, community, ancestors, and future generations in a reciprocal relationship.
Family serves as the foundation of health. Traditional kinship structures provide emotional, spiritual, and physical care, ensuring the survival of Indigenous knowledge and healing practices across generations. However, colonial policies such as boarding schools and forced adoptions have disrupted family systems, creating long-term trauma. Rebuilding Indigenous family structures through cultural revitalization and community support is essential for restoring health.
Community health is a reflection of collective wellbeing. Strong communities provide safety, identity, and resilience, fostering healing through shared experiences and mutual care. Policies that prioritize community-led solutions, such as tribal self-determination in health governance and culturally grounded public health initiatives, reinforce the ability of communities to thrive.
Ancestors continue to guide Indigenous health through knowledge and teachings that have been passed down for generations. Every effort to reclaim land, language, and cultural practices is an act of honoring ancestral resilience. Healing from historical trauma is not just about the present—it is a responsibility to both those who came before and those who will follow.
Future generations depend on the choices made today. Indigenous worldviews emphasize long-term thinking, ensuring that the health of the land, water, and communities is protected for future Indigenous children. Sustainable health initiatives, environmental stewardship, and language revitalization are all acts of intergenerational responsibility that strengthen the framework of Indigenous health.
Walking Together in Wellness
The Indigenous Determinants of Health & Equity Framework offers a holistic approach to understanding health, one that moves beyond individualistic models to recognize the broader social, political, and cultural determinants that shape Indigenous wellbeing. Healing is not just about addressing disparities; it is about restoring balance, reclaiming knowledge, and ensuring that future generations inherit a world where they can thrive spiritually, emotionally, mentally, and physically. Through collective action, Indigenous-led solutions, and a commitment to self-determination, Indigenous health equity can be realized in a way that honors the past, sustains the present, and protects the future.
Note on Perspective and Representation
This framework is informed by my experiences, relationships, and ways of knowing as they relate to Indigenous health and wellness. It reflects my understanding of the interconnected determinants that shape health equity in Indigenous communities, but it should not be assumed to represent all Native perspectives. Indigenous nations, cultures, communities and individuals hold diverse teachings, traditions, and worldviews that inform their approaches to health and healing. This work is offered with respect for that diversity and with the understanding that Indigenous knowledge is always evolving through relationships, lived experiences, and collective wisdom.
Suggested citation: Jessica Leston and Alicia Edwards (2025). Indigenous Determinants of Health & Equity Framework. Shared with permission via The Raven Collective. https://www.theravencollective.org/resources/indigenous-determinants-of-health-amp-equity-frameworknbsp