Colonialism as a Broader Social Determinant of Health

Author's Abstract, Page 1:

"The social determinants of health are the environmental causes of ill health that affect populations. They point to evidence that highlights higher susceptibility to illness and disease as a product of particular socio-economic and physical environments. Considering these environments are socially constructed, it seems reasonable to conceptualize addressing these determinants through the generation of social welfare policy and infrastructural adjustments. However, the causes of ill health can stem from deeper social structures and processes that operate at the national and global levels, as identified in the Commission on the Social Determinants of Health (SDoH) most recent report (2008). "The inequity [in daily living conditions] is systematic, produced by social norms, policies and practices that tolerate or actually promote unfair distribution of and access to power, wealth and other necessary social resources" (Ibid). This statement acknowledges that there are larger causes of causes, or distal determinants, of unhealthy life conditions.

The Commission's report (2008) provides a greater breadth for appreciating how some groups are more likely to suffer from poor health, but it is limited in failing to accurately define the structures and processes that produce vulnerabilities. This omission highlights one of the mechanisms by which this unfair distribution of power, wealth and resources goes unabated: by refusing to expose the guiding ideologies that result in the disproportionate social burden for some. Labelling these mechanisms underlines a component missing from the mainstream SDoH analysis that would involve tracing the birth and pervasiveness of these mechanisms: stressing the effects of history and the notion that history is still in the making. When the health gap between Indigenous populations and settler populations persists globally, their shared history becomes all the more significant with regards to the aforementioned “unfair distribution”.

At the International Symposium on the Social Determinants of Indigenous Health (2007), it was demonstrated that the determinants of Indigenous health differ from those of the mainstream population. This is in part due to how health is conceptualized amongst Indigenous populations compared to Western, biomedical definitions, but also that some of these previously cited mechanisms are actually identified as distal determinants. That an Indigenous SDoH framework would be different from the conventional framework stresses that the latter's indicators are limited and not reliable for all (Intl Symp., 2007). "Research and dialogue at the international level has demonstrated a common element that exists for all Indigenous peoples and affects every issue confronting them as a collective: the history of colonization and the associated subjugation of Indigenous peoples" (Ibid, p. 24). Since the SDoH themselves point to the very fact that the mechanisms that "influence health are humanly factored, socially influenced and unequal" (Lang, 2001, p. 162) and that the Commission (2008) acknowledges the unique "social exclusion" circumstances of Indigenous peoples, colonialism should really be allowed into the debate (Loppie-Reading & Wien, 2009; NAHO, 2006; Lang, 2001). With an emphasis on discourse analysis and Indigenous mental health research in Canada, this piece explores what it means to understand colonialism as a distal determinant of Indigenous health." (1).