often indigenous peoples are included in broader categories such as vulnerable groups or the poor obscuring the particularities of their situation furthermore this recognition entails the structural reforms necessary to exercise selfdetermination which in the case of health corresponds to supporting the development of indigenous health systems while also ensuring full and effective participation in the health services offered by the state third there must be political will since the mere existence of policies aimed at improving the health of indigenous peoples is insufficient ifthey are notsuccessfully implemented finally there must be a conscious decision on the part of the national society to engage in an exchange and sharing of knowledge values and customs which if practised on a daily basis would overcome monoculturalist structures