Introduction First Nations peoples in high-income countries experience significantly poorer health outcomes than non-First Nations populations, including higher incidence and mortality from head and neck cancer. Multiple, interrelated factors contribute to this, including systemic bias, limited institutional support, distrust of Western healthcare services, and reduced access to timely care. Similar disparities exist across Australia, New Zealand, the United States, and Arctic regions, where First Nations communities face persistent socioeconomic and healthcare barriers. Despite initiatives to address broader health inequities, targeted programs for head and neck cancer remain limited. Aims To systematically review the incidence and outcomes of head and neck cancer for First Nations peoples in high-income countries. Methods Medline, SCOPUS, and CINAHL were searched using predefined terms for head and neck cancer and First Nations populations. Two reviewers independently screened and assessed texts according to PRISMA guidelines. Eligible studies included quantitative or mixed-methods research from 2000 onward, with ≥10 First Nations participants with separately reported outcomes. Extracted outcomes included incidence, survival, mortality, and timely access to treatment. Results Over 2000 records were screened, from which XX studies were eligible. This review is expected to identify recurring disparities in disease burden, later-stage presentation, lower treatment access, and poorer survival among First Nations groups across high-income regions. Conclusions Findings aim to highlight persistent inequities in head and neck cancer affecting First Nations peoples in high-income countries. This review will help inform targeted strategies to improve access, early diagnosis, and outcomes for First Nations communities who continue to battle a range of systemic factors contributing to poorer health and wellbeing outcomes.