Indigenous Peoples worldwide experience higher rates of cardiometabolic related chronic diseases, such as obesity, hypertension, and diabetes, compared to European settlers and those of other ethnic groups in their ancestral homelands. For example, the risk of diabetes for Indigenous Peoples are between 5 to 10 times greater, and they develop it and die from related complications a decade sooner, ... [Show full abstract] than people of our ethnic groups. Much attention has been given to the biological and behavioral determinants of chronic diseases in explaining their higher risk, but little attention has been paid to the social and cultural determinants, or the ”upstream” factors, such as the role of historical trauma, cultural loss and compulsory acculturation strategies resulting in marginalization and psychological trauma, and racism on chronic disease risk. This presentation will provide a brief overview of historical trauma and detail the contemporary social and cultural determinants of chronic diseases for Indigenous Peoples. Using Native Hawaiians, the Indigenous People of Hawai’i, as a case example, several empirical studies will be reviewed that illustrate how social and cultural determinants increase their risk for obesity, hypertension, and diabetes above and beyond biological and behavioral determinants. Focusing on the effects of racism, the pathway from a psychosocial stressor to the development of chronic diseases, to include the psychological and physiological processes involved, will be outlined to illustrate how historical and current cultural trauma can get ”under the skin” of Indigenous Peoples. Overall, this presentation will highlight the importance of taking a bio-psycho-social-cultural approach to addressing health inequities experienced by Indigenous Peoples worldwide.