As of January, 2007, we were two years into the second United Nations International Decade of the World's Indigenous Peoples. This may be a surprise, as this type of pronouncement of the importance of the rights and equality of the world's Indigenous peoples tends to capture media attention for only a short time before fading from the headlines. The average conditions of Indigenous peoples are generally well below national levels and disparities between Indigenous and non-Indigenous populations in health, social, and economic outcomes exist worldwide, in rich and poor countries alike, despite widely differing geographic, historical, and cultural contexts [1, 2]. Among highly-developed countries, Canada, the United States, Australia, and New Zealand are often seen as natural comparators in terms of Indigenous well-being. These countries consistently place near the top of the United Nations Development Programme's Human Development Index (HDI) rankings, yet all have minority Indigenous populations with much poorer health and social conditions than their non-Indigenous compatriots . First Nations (Registered non-status Indians), Métis and Inuit in Canada, Australian Aboriginal and Torres Strait Islander peoples, New Zealand Māori, and American Indians and Alaska Natives in the U.S. have each been subjected to loss of culture, paternal protectionism, and occasional violence that have characterized Indigenous-settler state relations in these former British colonies [4, 5].
In the past thirty years, Indigenous populations in these countries have recovered from the very high mortality rates seen over much of the 19th century. Although there are differences in morbidity and the major causes of mortality in these populations, there are also considerable similarities. They have mainly passed through demographic and epidemiological transitions whereby infectious diseases, although still much more prevalent than in the mainstream societies, have declined as causes of death, and mortality is now increasingly related to lifestyle or man-made causes . Rates of smoking are high, as are rates of alcoholism and substance abuse. Obesity and Type II diabetes are now major health problems in each of these populations, as are deaths due to suicide, accidents and violence [7–9]. Clearly, these poor health conditions are closely related to social and economic context. Indigenous peoples in each of these countries are more likely to be unemployed, to leave school early, and to live in poverty than are other citizens. This is particularly true for those who live in discrete Indigenous communities, but also the case for the growing proportion who live in other urban or rural areas .
In these countries, recent decades have seen changes in the relationships between Indigenous peoples and the state. Beginning in the 1960s, strong Indigenous rights movements were influential in bringing Indigenous issues to public attention and, although we cannot list all of them here, there have been important legislative changes and legal decisions affecting Indigenous rights. In Canada, Indigenous rights were included in the Constitution Act of 1982, and the Royal Commission on Aboriginal Peoples, which ran from 1991 to 1996, examined the social, economic, legal and health status of Indigenous peoples . This prompted a statement of reconciliation from the Canadian government in which it acknowledged the role it played in the development and administration of Indian residential schools  and Canadian courts have recently approved payment and funding for programmes for former students and their families for healing, truth, reconciliation, and commemoration of the residential schools and the abuses suffered . In addition, there have been in Canada important judicial decisions confirming Indigenous rights, such as the 1999 Marshall decision regarding fishing rights and the 2006 Gray decision regarding the right to harvest wood on Crown lands for domestic uses . In the U.S., tribes were granted new taxation powers in the 1980s, allowing them to better fund their own social programs and, as in Canada, there has been devolution of control over health and social services to Indigenous communities since the mid-1980s .
In Australia, Indigenous peoples were granted rights to equal pay in 1965, and a 1967 referendum transferred some powers in respect to Indigenous peoples from the states to the federal government, leading to the establishment of an Indigenous representative body, the Aboriginal and Torres Strait Islander Commission (ATSIC). In 1992, the High Court decision in the Mabo case recognised the native title rights of Aboriginal Australians, and the 1993 Native Title Act established a legal basis for land claims. In New Zealand, the Treaty of Waitangi Act was amended in 1985 to strengthen the mandate of the Waitangi Claims Tribunal to hear claims of historical breaches of the treaty, and the 1993 Māori Land Law Act strengthened Māori land claims. New Zealand is the only one of the four countries in which there are a number of dedicated parliamentary seats for Indigenous people, and this number of Māori seats was increased in 1995 .
There have been some recent indications of a possible retrenchment of Indigenous rights. Australia has recently dissolved the ATSIC, and amalgamated government services to Indigenous communities into mainstream government agencies. The New Zealand parliament is currently considering a bill that would set September 1, 2008 as the cut-off date for the lodgement of historical treaty claims. However, in general, the recent changes in all of these countries can be seen as part of a slow and often contentious shift towards increasing the rights of Indigenous peoples and communities, including control over the provision of health and social services, although stopping well short of Indigenous self-determination [5, 14].
Despite these changes, it remains generally unknown whether the overall conditions of Indigenous peoples are improving and whether the gaps between Indigenous peoples and other citizens have indeed narrowed in recent decades. There is unsettling evidence that they may not have. For example, advances in infant mortality among Indigenous people in Western Australia have not kept up with the non-Indigenous Australian population . In Canada, there is evidence that the difference in average income between Registered Indians and other Canadians was rising in the late 1990s . In this paper we examine how the broad social, economic, and health status of Indigenous populations in these countries have changed since the 1990s, using an adaptation of the United Nations' Human Development Index (HDI).