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Shapeshifters, systems thinking and settler colonial logic: Expanding the framework of analysis of Indigenous health equity 

This resource is available in English only.


Focus on inequitable population health outcomes: 

The authors of this paper argue that a sole focus on inequities in population health outcomes between Indigenous Peoples and non-Indigenous peoples will not address underlying drivers of power and inequity including settler colonialism and racism.  

They state that, “The health inequities of Indigenous peoples are etched within the agenda of colonial conquest, whereby policy and practice perpetuate racism and discrimination against Indigenous peoples and mark their bodies for erasure. The healthcare system is implicated in this process and remains a site where racism is embedded in its structures which when left unchecked perpetuate the status quo” (Ray, et al, p. 2).  


Expanded analytical framework: 

Instead, the authors propose a broad integrated application of settler colonial, systems, and complexity theories to critically analyze systems of domination experienced by Indigenous Peoples in health care contexts. 

They suggest the metaphor of settler colonialism as a shapeshifter across time and space. The authors illustrate use of this expanded framework through a case study of how larger systems of oppression led to the death of Brian Sinclair, an Indigenous man who died of a treatable illness in a Winnipeg emergency room while waiting for thirty-four hours to access care. The case study analysis notes the racist assumptions grounded in settler colonial logic made by healthcare and security staff that Mr. Sinclair must be both drunk and homeless and therefore not deserving of care. He was neither.  

This framework focuses on the need to transform colonial healthcare system structures, instead of requiring Indigenous Peoples to “fit” within Western colonial healthcare institutions, through use of an integrated systems analysis of power that draws on a diverse range of theories and forms of Indigenous knowledge. 


Use this resource to:  

  • Expand health equity approaches to incorporate a critical analysis of how larger systems of oppression interact with and drive health inequities experienced by Indigenous Peoples  
  • Review how systems theory, complexity theory and settler colonialism can be integrated into a critical analysis of larger systems of domination  
  • Facilitate discussion about ways in which public health and healthcare institutions can decolonize their systems, structures, and practices  


Related Resources:

Oppression: A social determinant of health (2021)

Implementing anti-racism interventions in healthcare settings: A scoping review (2021)

Let’s talk: Whiteness and health equity (2020)

Reflections of a Black woman on racism, Indigeneity and Otherness in Canada (2019)

Let’s talk: Racism and health equity (2018) 

Key public health resources for anti-racism action: A curated list (2018)


Ray L, Wylie L, Corrado AM. Shapeshifters, systems thinking and settler colonial logic: expanding the framework of analysis of Indigenous health equity. Soc Sci Med. 2021 Sep 25:Article 114422 [7 p.]. doi: 10.1016/j.socscimed.2021.114422.   

Tags: Access to health services, Indigenous health, Racism/racialization, Structural determinants, Document, Journal Article