Infectious diseases in Indigenous populations in North America: learning from the past to create a more equitable future

Abstract

The COVID-19 pandemic, although a profound reminder of endured injustices by and the disparate impact of infectious diseases on Indigenous populations, has also served as an example of Indigenous strength and the ability to thrive anew. Many infectious diseases share common risk factors that are directly tied to the ongoing effects of colonisation. We provide historical context and case studies that illustrate both challenges and successes related to infectious disease mitigation in Indigenous populations in the USA and Canada. Infectious disease disparities, driven by persistent inequities in socioeconomic determinants of health, underscore the urgent need for action. We call on governments, public health leaders, industry representatives, and researchers to reject harmful research practices and to adopt a framework for achieving sustainable improvements in the health of Indigenous people that is both adequately resourced and grounded in respect for tribal sovereignty and Indigenous knowledge.

Figure 1

Infectious disease milestones in government history in relation to Indigenous populations across Canada (blue) and the USA (black) CDC=Centers for Disease Control and Prevention.

Figure 2

Framework for attaining sustainable improvements in Indigenous People's health