Causality by Other Means: Constructing the Settler Colonial Determination of Health

Settler colonialism is increasingly recognized as a structural force shaping Indigenous health, yet analytic frameworks in the health sciences have limitations in representing its causal dynamics. While Indigenous communities have long identified settler colonialism as foundational in shaping health and wellbeing, conventional epidemiologic approaches rely on causal assumptions—linearity, discrete exposures, and stable pathways—that are misaligned with its theorized properties as a dynamic, transtemporal, and adaptive social process. This misalignment contributes to epistemic exclusion, whereby insights from Indigenous epistemologies and settler colonial studies cannot be represented, remaining analytically unobservable within dominant methodological paradigms. We argue that addressing this gap requires achieving epistemic fit across three interdependent layers: teleological—orienting inquiry toward relationality rather than dominance; ontological—mapping settler colonialism’s higher-order functions onto context-specific forms; and epistemological—selecting causal representations adequate to the phenomenon’s complexity. Drawing on theory construction methodology, we develop a provisional framework for the settler colonial determination of health and outline how its causal architecture may be represented through multi-causal, feedback-informed approaches. We further identify concrete implications for empirical research, including the use of configurational causal logics and dynamic modeling strategies to capture interaction, emergence, and historical dependence. By positioning settler colonialism as a conditioning causal structure rather than a discrete determinant or indecipherable past episode, this framework extends existing public health approaches and provides a foundation for developing empirically tractable models that better align with Indigenous epistemologies and lived experience. Advancing such approaches is essential for generating explanations—and ultimately interventions—adequate to the complexity of health inequities in settler colonial contexts.