En los últimos años, las instituciones mundiales de salud y medio ambiente han reconocido cada vez más que los Pueblos Indígenas son centrales para la conservación de la biodiversidad, la salud humana y la resiliencia climática. Sin embargo, persiste una brecha entre el reconocimiento del liderazgo Indígena y los conceptos y marcos que estas lideresas y líderes utilizan para comprender la salud, el medio ambiente y la interconexión de todo lo que existe. El Marco de los Determinantes Indígenas de la Salud (IDH, por sus siglas en inglés) surgió como una herramienta práctica para orientar políticas, financiamiento e implementación con base en los principios de seguridad cultural y en la Declaración de las Naciones Unidas sobre los Derechos de los Pueblos Indígenas, con el fin de abordar esta brecha.
Patrocinado por el Foro Permanente de las Naciones Unidas para las Cuestiones Indígenas, el Marco IDH fue presentado en 2023 con el estudio “Los determinantes de la salud Indígena en la Agenda 2030 para el Desarrollo Sostenible”, que replanteó la salud más allá de los indicadores convencionales. El estudio estableció la Indigeneidad como un determinante amplio de la salud, que incluye 33 factores de riesgo y de protección que impactan específicamente la salud de los Pueblos Indígenas. Esta afirmación estableció que la salud Indígena no se define únicamente por el acceso a los servicios, sino por la integridad de las relaciones entre los Pueblos, las tierras, los sistemas de gobernanza y el conocimiento. En esencia, este estudio situó la autodeterminación como un determinante primario de la salud, desplazando la narrativa de la vulnerabilidad hacia los derechos.
El estudio de 2024 sobre los IDH, “Mejoramiento de la salud y el bienestar de los Pueblos Indígenas a nivel mundial: puesta en práctica de los determinantes de la salud Indígena”, amplió esta base de manera más extensa, reforzando que las cosmovisiones Indígenas están interconectadas con todos los aspectos de la vida y con la Madre Tierra. Este estudio marcó un cambio decisivo hacia una orientación estructural y operativa diseñada explícitamente para proporcionar herramientas a las entidades de la ONU, los Estados Miembros y otras instituciones, con el fin de implementar los Determinantes Indígenas de la Salud en las políticas y en la práctica. También describe las transformaciones institucionales necesarias para hacerlo, entre ellas reconocer a los Pueblos Indígenas como titulares de derechos, incorporar el consentimiento libre, previo e informado, garantizar una representación significativa en la toma de decisiones y desarrollar políticas y procedimientos organizacionales que apoyen enfoques liderados por Pueblos Indígenas.
Geoffrey Roth interviene en la Zona de Medios Indígenas del UNPFII. Fotografía de Jamie Malcolm-Brown.
The 2025 study, “Evaluating Institutional Structures to Improve the Health and Wellness of Indigenous Peoples Globally: The Indigenous Determinants of Health Measurement Instrument” introduced the IDH Evaluation Instrument to assess how well institutions are addressing Indigenous health risks and protective factors, and whether they are equipped to uphold Indigenous rights in practice. It expands evaluation to include governance, environment, and community well being, offering a scorecard tool to support culturally safe, rights-based approaches and institutional accountability.
The IDH Framework does not simply add new indicators: it redefines the system of analysis, requiring institutions to account for rights, governance, and relationships, not just outputs. For that reason, the 2026 IDH study, “Restoring Indigenous Health by Connecting Systems Through the Indigenous Determinants of Health: Local to Global Evidence,” focused on demonstrating how
Indigenous health is a systems integrator and an indicator of the outcomes across sectors. In other words, Indigenous health must be understood as a diagnostic indicator of the integrity of policies across sectors, reflecting how decisions related to land, environment, governance, culture, and knowledge systems directly shape Indigenous well being.
In 2023, 2024, and 2025, the UN Permanent Forum on Indigenous Issues put forward targeted recommendations urging member states and UN agencies to adopt the concept of Indigeneity, the IDH Framework, and its evaluation instrument as tools to advance Indigenous rights, promote peace, and support Indigenous-led environmental governance and global justice.
Following the 2023 World Health Organization’s Executive Board recommendation to recognize Indigeneity as a determinant of health, the WHO Report on the Social Determinants of Health Equity, released in 2025, officially recognized Indigeneity and acknowledged Indigenous Peoples’ specific determinants of health. Such recognition reflects the understanding that Indigenous health is holistic and encompasses all aspects of life beyond the clinical setting into the environment and the health of Mother Earth.
Mural by Jorge Vinueza in Ecuador commissioned by the Ministry of Public Health.
Subsequent to the UN Permanent Forum’s recommendation, the UN Convention on Biological Diversity issued Decision 16/19 in 2024, which officially references the IDH Framework as part of its Global Plan of Action on Biodiversity and Health. The implementation of the IDH Framework across UN agencies allows for Indigenous Peoples to have an encompassing platform to advance local Indigenous needs through a framework that respects, fosters, and protects Indigenous rights in all aspects of life.
One of the clearest examples of the relevance of the IDH evolution as a holistic platform is Indigenous midwifery. Indigenous midwifery is not limited to childbirth as a clinical event; it is a system of health, rooted in relationships between people, land, knowledge, and spirituality. Midwives serve as knowledge holders, caregivers, and community leaders, guiding not only the birthing process but the full integration of new life into cultural, territorial, and spiritual systems. This reflects a core principle of the IDH Framework: that health is relational, intergenerational, and grounded in Indigenous governance and knowledge systems.
Indigenous midwifery practices are deeply connected to territory. Birth is supported through culturally specific practices that draw on local ecosystems such as medicinal plants, traditional foods, and environmental conditions appropriate to each region. Indigenous midwifery demonstrates that people’s health is inseparable from the health of their land, biodiversity, and knowledge systems.
However, Indigenous midwives face many systemic barriers that reflect broader structural issues, including a lack of recognition of Indigenous governance, knowledge systems, and rights. Their ancestral knowledge is often subordinated and devalued by policies that treat the practice as auxiliary to biomedical systems, denying its autonomous character. Processes of professionalization and certification—often framed as ensuring safety or “inter-culturality”—can regulate and reshape Indigenous midwifery to conform with external standards. And in some areas, their practices are criminalized.
At the same time, Indigenous midwifery has shown resilience. During public health crises and in remote regions with limited biomedical access, midwives often serve as primary providers of care, sustaining community health through culturally grounded practices. Their work illustrates that Indigenous health systems are not peripheral, but fully functioning systems of care beyond clinical settings.
The IDH Framework helps make these realities visible. It underscores that strengthening Indigenous health requires not only improving access to services, but recognizing, protecting, and supporting Indigenous systems of care—including midwifery—as autonomous, rights-based systems fundamental to communities’ well being. It affirms that protecting Indigenous Knowledge, governance, and relationships to land is essential to sustaining health across generations.
--Geoffrey Roth (Lakota descendant of the Standing Rock Sioux Tribe) is Chair of the Indigenous Determinants of Health Alliance, and former UNPFII Expert Member and Vice-Chair. Dora-Lucia Mendez-Alfonzo (Tseltal) is a midwife from the Alianza Continental de Parteras Tradicionales e Indigenas de las Americas. Alejandro Bermudez-del-Villar (Mestizo) is part of the Cedar Rock Alliance and the Indigenous Determinants of Health Alliance.
Key aspects of the WHO-recognized Indigenous Determinants of Health
• Core Pillars: Indigeneity as an overarching determinant of health; Connection to traditional lands, territories, and resources; cultural continuity; language revitalization; and self-determination.
• Structural Factors: Impacts of colonization, systemic racism, and the need for Indigenous-led governance in health systems.
• Holistic Wellness: Balance of spiritual, environmental, physical, and mental dimensions, often viewed as a collective rather than purely individual right.
• Environmental Connection: The relationship with Mother Earth and the stewardship of biodiversity.
• Key Drivers: Intergenerational wisdom, traditional healing practices, and community resilience.
Photo Caption:
Geoffrey Roth speaking at the UNPFII Indigenous Media Zone.
Photo by Jamie Malcolm Brown.
Top photo: Drawings of midwives from the Área de Mujeres y Parteras de la Organización de Médicos Indígenas del Estado de Chiapas, Mexico.
