Medical Pluralism in Practice: A narrative review of community-based integration of indigenous healing traditions in U.S. healthcare settings

Medical pluralism remains a lived reality in many Indigenous communities, where people move between biomedical services and Indigenous healing traditions in ways that reflect culture, spirituality, history, and community-defined understandings of wellness. In U.S. healthcare settings, however, formal integration of Indigenous healing traditions remains limited, uneven, and often constrained by biomedical norms, weak policy recognition, and colonial structures that continue to shape health systems. This narrative review synthesizes the provided literature on community-based integration of Indigenous healing traditions, with a primary focus on implications for U.S. healthcare settings and with comparative lessons drawn from Canada, Australia, and broader Indigenous health scholarship. The review shows that integration works best when it is community-led, grounded in self-determination, supported by Elders and Knowledge Holders, and structured around holistic models of health rather than narrow disease-focused care. The evidence also points to persistent barriers, including racism, biomedical dominance, policy gaps, tokenistic inclusion, and attempts to make Indigenous healing conform to Western standards. The review identifies five convergent themes: the shift from biomedical exclusivity to holistic care; community governance as the foundation of integration; practical integration through ceremonies, traditional foods, cultural supports, and Indigenous practitioners; structural barriers within mainstream institutions; and the emergence of Indigenous frameworks such as the Medicine Wheel and nation-based determinants of health. A conceptual framework of community-governed medical pluralism is proposed to guide more respectful and effective integration in U.S. healthcare settings.