Three in ten Indigenous adults meet criteria for healthy functioning, and financial security is a key reason why

Most research on Indigenous health in the United States focuses on what goes wrong: higher rates of chronic disease, shorter life expectancy, disparities in access to care. These findings are real and important, but they tell only part of the story. A new study from the University of Toronto asks a different question: what factors support healthy functioning among Indigenous adults?

The answer, drawn from nationally representative CDC data covering more than 11,000 Indigenous respondents, points strongly toward structural conditions rather than individual behavior. Financial security -- the ability to reliably pay bills and access transportation -- was among the most powerful predictors of well-being. So were physical activity, never smoking, and the absence of depression.

Measuring what works, not just what fails

The study, published in the Journal of Indigenous Well-Being, used data from the 2022 and 2023 Behavioral Risk Factor Surveillance System (BRFSS). Rather than measuring disease prevalence or mortality, the researchers defined a composite measure of "healthy functioning" and examined which factors predicted meeting that threshold.

Nearly 30% of Indigenous respondents met the criteria for healthy functioning. That figure challenges deficit-focused narratives that portray Indigenous communities primarily through the lens of disadvantage. It also establishes a baseline: three in ten are thriving, and understanding why can inform efforts to expand that proportion.

"Understanding wellness among Indigenous Peoples requires recognizing both the structural barriers created through colonization and the remarkable strengths our communities continue to embody," said lead author Ashley Quinn, an Assistant Professor at the University of Toronto's Factor-Inwentash Faculty of Social Work.

Financial stability as a health determinant

Respondents who could reliably meet basic financial needs -- paying bills, accessing transportation, securing food and housing -- had substantially higher odds of healthy functioning. The association was strong enough to stand out even after adjusting for other factors.

"Financial security is not simply an economic indicator -- it is a health determinant," said co-author Teagan Miller. "Stable access to food, transportation, and housing meaningfully increases the likelihood of healthy functioning, which reinforces the need for policy interventions that address systemic inequities."

The finding reframes the conversation about Indigenous health from individual responsibility to systemic conditions. Poverty, inadequate infrastructure, and limited access to services are products of policy decisions and historical processes, not personal failings. Addressing them requires structural change, not lifestyle advice.

Depression and the mental health dimension

Chronic physical and mental health conditions were strong negative predictors. Most notably, respondents without depression had more than four times the odds of meeting the healthy functioning criteria compared to those with depression. That multiplier underscores how central mental health is to overall well-being.

"Mental health cannot be separated from community, family, land, and cultural identity," said co-author Philip Baiden, an Associate Professor at the University of Texas at Arlington. "Interventions that incorporate Indigenous worldviews are essential to supporting emotional wellness and healing."

Healthy behaviors in context

More than half of respondents had never smoked, and roughly three-quarters were physically active -- figures that push back against stereotypes of poor health behaviors in Indigenous populations. Both factors were significantly associated with healthy functioning.

"This study flips the script -- shifting the narrative from deficits to the strengths and resilience of Indigenous Peoples," said co-author Esme Fuller-Thomson, Director of the Institute of Life Course and Aging at the University of Toronto. "Healthy functioning among Indigenous Peoples is not rare -- it's real, measurable, and deeply shaped by social and economic conditions."

The two-thirds who did not meet the threshold

The researchers note that while the 30% figure is meaningful, it also means approximately two-thirds of respondents did not meet the study's criteria for healthy functioning. That gap points to a need for expanded public health initiatives that address both structural inequities and culturally meaningful pathways to wellness.

The study's limitations include its reliance on self-reported data and the use of Western-derived health measures that may not fully capture Indigenous conceptions of wellness, which often encompass community, cultural, spiritual, and environmental dimensions. The authors call for future research incorporating Indigenous-defined measures of health.