Reframing Global Health through Indigenous Eyes: Three Cornerstone Resources from the UNPFII

The Permanent Forum on Indigenous Issues (UNPFII) has taken a bold and necessary step forward in transforming how global institutions understand, support, and evaluate Indigenous Peoples’ health and wellbeing. In a trilogy of interlinked studies released between 2023 and 2025, the Forum has outlined a visionary yet practical framework for placing Indigenous rights, knowledge systems, and self-determination at the centre of health policy and practice.

Together, the three studies form a dynamic, interconnected roadmap for advancing Indigenous health globally—not as a subset of minority or diversity policy, but as a self-determined, rights-based, and cosmologically distinct approach to collective wellbeing. For governments, NGOs, UN agencies, funders, and Indigenous leaders, this trilogy offers a new standard: one that prioritizes healing over harm, relational accountability over extractive metrics, and sovereignty over simplification.

1. A Foundational Framework: The 2023 Study on Indigenous Determinants of Health

The 2023 report, Indigenous Determinants of Health in the 2030 Agenda for Sustainable Development (E/C.19/2023/5), lays the conceptual groundwork. It identifies Indigeneity itself as an overarching determinant of health, and names 33 interrelated protective and risk factors—ranging from intergenerational healing and ancestral medicine to environmental dispossession and forced assimilation.

These determinants are grouped under three central themes: intergenerational holistic healing, the health of Mother Earth, and decolonizing and re-Indigenizing culture. This report asserts that colonialism and its ongoing expressions—legal, institutional, environmental—remain the core drivers of Indigenous health inequities. It calls on UN Member States and agencies to adopt culturally grounded approaches that acknowledge Indigenous cosmologies and systems of care.

2. From Framework to Action: The 2024 Operationalization Study

The 2024 follow-up, Improving the Health and Wellness of Indigenous Peoples Globally: Operationalization of Indigenous Determinants of Health (E/C.19/2024/5), turns ideas into actionable structures. This report outlines how UN agencies, governments, and institutions can embed the 33 determinants into their systems through policy change, evaluation, staffing, and data sovereignty. Key elements include:

• ​Free, prior, and informed consent as a prerequisite to any health-related intervention;
• Recognition of Indigenous knowledge systems as valid, distinct, and non-comparable to Western evidence hierarchies;
• The creation of Indigenous-led advisory bodies and institutional roles across all levels of governance;
• Integration of planetary health and eco-centric models that respect Indigenous stewardship of biodiversity.​​​

This report also emphasizes that Indigenous Peoples are rights holders, not stakeholders, and that their representation must be central and enduring across the entire policy cycle.

3. Measuring Change: The 2025 Indigenous Determinants of Health Evaluation Instrument

To assess whether institutions are walking their talk, the 2025 study introduces a scorecard-based measurement tool: Evaluating Institutional Structures to Improve the Health and Wellness of Indigenous Peoples Globally (E/C.19/2025/5). This tool provides a 20-point scoring system structured across four sections:

1. Intergenerational holistic healing
2. Health of Mother Earth
3. Decolonizing and re-Indigenizing culture
4. Institutional compliance with Indigenous rights​

Each item is grounded in specific determinants, with criteria for assessing policy implementation, cultural safety, data practices, Indigenous representation, and the protection of land and identity2025 IDHEvaluation Inst…. The tool offers not only a way to track institutional progress but also a process for community-led adaptation, piloting, and refinement.​

Implications for Indigenous Evaluation

Together, these three resources challenge the foundations of mainstream evaluation practice. They call for a paradigm shift away from deficit-based, Western-centric metrics toward an Indigenous-led evaluation movement that centres Indigenous values, worldviews, and priorities. These reports:

• Validate Indigenous evaluation as its own field—distinct from participatory or community-based approaches, grounded instead in sovereignty, whakapapa (genealogy), relationality, and Indigenous knowledge systems.
• Provide international legitimacy for Indigenous evaluation frameworks such as Kaupapa Māori (by, with and for Māori), Indigenist CBPR (community-based participatory research), and Land- and language-based models.
• Offer practical infrastructure for Indigenous evaluators, including policy templates, staffing principles, and culturally safe protocols.
• Reinforce the need for data sovereignty and the use of Indigenous-defined indicators to measure what matters—whānau (families) flourishing, cultural revitalisation, and self-determination.
• Invite a reimagining of evaluation as a tool of resurgence and planetary care—not just accountability or performance.

For Indigenous evaluators, researchers, funders, and communities, these resources are not just reports. They are scaffolds for re-Indigenizing the entire evaluation ecosystem—from the questions we ask, to who holds the power to answer them.