Honoring Indigenous self-determination, and Canada's responsibility to address health inequities: Reflections on the Lalonde Report

The Lalonde report's limited references to Indigenous Peoples primarily address federal responsibilities for healthcare service provision and identify Indigenous Peoples as high-risk populations. However, the report paved the way for robust frameworks to address the social determinants of Indigenous Peoples' health inequities. Colonialism and structural racism, as distinct social determinants, constrain opportunities for Indigenous Peoples to achieve health equity relative to the general Canadian population. Decolonizing relationships that center Indigenous Peoples' self-determination and lands is foundational for achieving health equity. The Kahnawà:ke Schools Diabetes Prevention Program (KSDPP) exemplifies Indigenous health promotion and the Kahnawà:ke community's self-determination to take control over their health determinants. Declining incidence of type 2 diabetes (T2D) may indicate promising impacts. However, the impacts of community-level programs will be limited if Canada fails to advance Indigenous self-determination as the path to health equity.