Inequity in health status and in access to health services are pervasive, largely unrecognized, and poorly addressed in American Indian and Alaska Native communities.  Understanding the origins of historically entrenched patterns of oppression and relationships between present-day practices and policies governing tribal health sites can inform the nature and scope of clinicians’ individual and collective obligations. Innovating health professions education and research partnerships with Native communities can also motivate equity. This theme issue considers ethical, social, and cultural complexities of what it means to deliver just care to Native patients living on sovereign tribal land and everywhere in the United States.