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 )

The COVID-19 pandemic exposed long-standing gaps in health service systems and realities of environmental changes impacting Native nations and Indigenous communities in the US and circumpolar regions. Despite increased awareness and funding, there is limited research and few practical resources available for the work. This is a scoping review of the current literature on social determinants of health (SDOH) impacting Indigenous peoples, villages, and communities in the US and circumpolar region. The review used the York methodology to identify research questions, chart, and synthesize findings. Thirty-two articles were selected for full review and analysis. The articles were scoping reviews, evaluations, and studies. The methods used were 44% mixed (n = 14), 31% quantitative (n = 10) and 25% qualitative (n = 8). The synthesis identified four areas for discussion: 1) systemic and structural determinant study designs, 2) strengthening Indigenous health systems, 3) mapping the relationship of co-occurring health conditions and SDOH, and 4) emergent areas of inquiry. While the scoping review has limitations, it provides a snapshot of broad SDOH and shared Indigenous social determinants of health (ISDOH) to create tailored frameworks for use by tribal and urban Indigenous health organisations, with their partners, in public health and system strengthening.

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The Human Immunodeficiency Virus (HIV) epidemic is a serious yet under-addressed health concern for Native American communities across Indian Country (a reclaimed governmental reference for the con...