University of New Mexico

Conventional Social Determinants of Health frameworks fragment Indigenous drivers—culture, land, kinship, sovereignty, and history—into isolated variables, obscuring their relationships and diminishing their meaning. This separation hides how colonization, racism, jurisdictional complexity, food system disruption, and chronic underinvestment continue to shape health outcomes across generations. Public health systems often treat these drivers as individual exposures rather than structural conditions produced by policy and governance.

Guided by priorities identified by Tribal health experts—culture, place, and Tribal sovereignty—the study applied decolonizing methodologies to reshape the review process. The team conducted a comprehensive search of PubMed and Scopus, coded sixty eligible sources, and synthesized patterns across outcomes. The resulting systems map connects Indigenous Knowledge Systems, historical and structural conditions, community strengths, community‑defined social drivers, Tribal governance, and intergenerational health, offering a holistic, relational, and community‑centered understanding of wellness.