Developing Indigenous-Centered Healing, Health, and Wellness Frameworks to Strengthen Indigenous Health Systems, Decolonize Public Health, and Achieve Health Equity.

Abstract

Over the past 20 years, national and global health initiatives have increasingly used resources, implemented tools, and proposed policies to change the social determinants of health contributing to health inequities. The World Health Organization and the US Centers for Disease Prevention and Control have applied their evidence-based frameworks to these efforts. Yet, for tribal nations and Indigenous communities in the United States, these frameworks' relevance and applicability are limited. The disproportionate impact of the COVID-19 pandemic (e.g., incidence and mortality rates) highlighted Indigenous epistemologies and realities (e.g., tribal sovereignty, strained state-tribal health systems) that were either missing or did not conceptually fit in these social determinants of health frameworks. We describe findings from the 2018 to 2024 Indigenous Social Determinants of Health Project completed by Seven Directions, an Indigenous public health institute. We propose constructs for Indigenous healing, health, and wellness frameworks developed by and for tribal nations and Indigenous communities. Practitioners and policymakers may use these tailored frameworks in collaboration across sectors (e.g., public health, social services, behavioral health) to align systems for transformational change, decolonize public health, and achieve health equity. (Am J Public Health. 2025;115(5):726-731. https://doi.org/10.2105/AJPH.2024.307958).