Lower life expectancy and the disproportionate disease burden exist because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity and poor social conditions. Further research and action, driven by indigenous peoples themselves is required at the international and national levels but most importantly at the local levels as well. Indigenous peoples' approaches to health are often rooted in a healthy balance of four elements or aspects of wellness: physical, emotional, mental and spiritual.