This article was originally published here
Soc Sci Med. 2021 Sep 25:114422. doi: 10.1016/j.socscimed.2021.114422. Online ahead of print.
Despite increased attention in the health care field to the disparate health outcomes of Indigenous peoples, inequities persist. Analytical frameworks with the capacity to account for integrated systems analysis of power and domination are underrepresented yet vital to affecting change. Narratives represent Indigenous approaches to systems thinking, yet are often excluded from the literature on theorizing health systems. Recent theorizing in systems thinking provides a conceptual toolkit to interrogate health systems in a way that emphasizes ongoing histories of settler colonialism that underpin determinants of vulnerability, risks and poor health outcomes. Walby’s (2007) approach to complexity theory provides an opportunity to re-orient the way health system researchers and practitioneers approach systems of domination in the context of Indigenous peoples’ health, including viewing settler colonialism as a shapeshifter who abounds within the possibility of their environment and is a master of time and space. We explore the concepts of attunement and restraint in complexity theory and complex adaptive systems to better understand the movements of shapeshifters. Further, we demonstrate an application of Walby’s framework to a narrative, using the highly publicized story of Brian Sinclair, an Indigenous man who died in a Winnipeg Emergency department. Noting how this approach accounts for settler colonial logics in health care system performance, we establish linkages between Walby’s articulation of complexity and the fields of Indigenous and Settler Colonial Studies, anchoring this discussion in Indigenous ontology through the metaphor of shapeshifting. By focusing on the systems level, we elucidate the plethora of individual experiences as outcomes of settler colonialism played out within highly complex, adaptive social systems.