Constructing the settler colonial determination of health: Causality by other means

Indigenous communities have long identified settler colonialism as foundational in conditioning health and wellbeing, and its role as a structuring force is increasingly recognized within population health. Yet analytic frameworks in the health sciences have limitations in representing its causal dynamics, with dominant epidemiologic approaches relying on causal assumptions-linearity, discrete exposures, and stable pathways-that are misaligned with its theorized properties as a dynamic, transtemporal, and adaptive social process. To investigate settler colonialism, we argue for epistemic fit across three interdependent layers: teleological clarity regarding the purposes orienting inquiry and the competing social visions at stake, including commitments to relationality rather than domination; ontological precision in mapping settler colonialism's functions to their context-specific manifestations; and methodological approaches capable of representing feedback, emergence, conditioning, and historical dependence. Drawing on theory construction methodology, we develop a provisional framework for the settler colonial determination of health. Within this framework, settler colonialism is conceptualized not as a discrete determinant among others, but as a conditioning and transtemporal social formation that shapes institutions, processes of racialization and gendered power, and ultimately health outcomes. We outline implications for empirical research, highlighting configurational, dynamic, and systems-oriented approaches as strategies for representing settler colonialism's multi-causal and adaptive impacts on health. By extending existing population health frameworks, this approach provides a foundation for developing empirically tractable models that more adequately represent settler colonialism's relational and historical dynamics. Advancing such approaches is essential for generating explanations-and ultimately interventions-commensurate with health inequities in settler colonial contexts.