Context: The Marginalized Indigenous People
The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development [1]. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate burden of poverty, disease, and mortality compared to the general population [2,3]. These inequalities have persisted, and in some countries have even worsened, despite the overall improvements in health indicators in relation to the 15-year push to meet the Millennium Development Goals [4,5]. Attention garnered by the social determinants of health framework has enriched the understanding we have of the complex conditions that give rise to inequalities in indigenous health. This lens has brought into focus the structural and socio-political factors that contribute to health inequalities, illuminating the intersecting conditions of poverty, social and political exclusion, discrimination and land loss that shape indigenous people’s health [6,7,8]. Historically, indigenous health has been framed as a problem of poor health indicators to be solved through targeted service delivery.  This approach is simplistic and ignores the political and legal barriers described above. Our argument is that an accountability framework offers a better approach and strategies to tackle the political, social, economic and legal causes of inequitable indigenous health.
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