Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social The International Indigenous Policy Journal Volume 8 | Issue 1 Article 4 January 2017 Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social Javier Mignone University of Manitoba, javier.mignone@umanitoba.ca Recommended Citation Mignone, J. (2017). Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social. The International Indigenous Policy Journal, 8(1). DOI: 10.18584/iipj.2017.8.1.4 Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social Abstract This article provides a review of the book Determinants of Indigenous Peoples’ Health in Canada: Beyond the Social edited by Margo Greenwood, Sarah de Leeuw, Nicole Marie Lindsay, and Charlotte Reading. Keywords Indigenous Peoples, Aboriginal, First Nations, Métis, Inuit, Canada, health, well-being, social determinants Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/ Bo o k R e v i e w M a rg o G re e n w o o d , S a ra h d e L e e u w , N i c o l e M a ri e L i n d s a y , & C h a rl o t t e R e a d i n g ( E d s . ) . ( 2 0 1 5 ) . D e t e rm i n a n t s o f I n d i g e n o u s Pe o p l e s ’ H e a l t h i n C a n a d a : Be y o n d t h e S o c i a l . T o ro n t o : C a n a d i a n S c h o l a rs ’ Pre s s . 2 9 1 p p . $ 5 9 . 9 5 ( p a p e rb a c k) . I S BN : 9 7 8 1 5 5 1 3 0 7 3 2 9 . The central premise of Determinants of Indigenous People’s Health in Canada: Beyond the Social is, as stated in the introduction, “colonialism has yet to be fully and consistently accounted for as a significant determinant of health” (p. xi). This is the basis of the book and the ground it seeks to cover. No doubt this gap in the literature about social determinants of health is real and Determinants pulls out all the stops in trying to address it with a rich range of vantage points. Despite some shortcomings, it mostly achieves its purpose in its 23 chapters, which are written by 34 authors. The “beyond the social” of the book’s title is the key to understanding the common logic behind the varied chapters. While acknowledging the value of past and current social determinants of health frameworks, the editors argue that they are not “nuanced enough to fully conceptualize the disparities and inequities lived by Indigenous peoples” (p. xvi). I agree with their argument that these frameworks do not account for the fact that “colonialism is an active and ongoing force impacting the well-being of Indigenous peoples in Canada” (p. xii). The first of the book’s four sections sets the context by presenting several of the major themes that permeate the entire book. These are: • Structural determinants of Indigenous people’s health; • Two-eyed seeing in medicine; • Traditional knowledge systems; and • Spiritual dimensions of health. Part 2 explores determinants of Indigenous health that drive beyond the social, such as the relatedness of people, land, and health; cultural continuity and early childhood; cultural medicines; geography as a determinant; and transcending the gender binary. The section that follows contains chapters that delve into wellness as culture, language, and identity; Indigenous knowledges and traditions in education and health; reflections on the interconnections between the cultural, political, and historical drivers of health; early childhood development policies and program; and the relevance of stories and narrative genealogy. Chapters in the final section encourage readers to rethink the medical system through Indigenous eyes, in particular by “revisioning” medicine toward Indigenization and the understanding of medicine as a relationship. This section also addresses specific issues such as Type 2 diabetes (Chapter 21) and HIV/AIDS (Chapter 22) in Indigenous populations. Of note is the fact that each section includes several chapters that enrich Determinants in a way not common within the academic literature. These are chapters that are consistent with the book’s intention to offer Indigenous perspectives and ways of knowing. They include two poems by a Métis poet 1 Mignone: Determinants of Indigenous Peoples' Health in Canada Published by Scholarship@Western, 2017 (Chapter 5); Mi’kmaw Elders explaining two-eyed seeing (Chapter 2); an interview with a tribal chief talking about Indigenous relationships with the land (Chapter 11); a narrative about becoming a teller of traditional Haida stories (Chapter 12); a personal perspective on the politics of health—an amusing story about grandparents’ set of false teeth (Chapter 17); the sharing of the story of a Cree mother in need of medical procedures and of her son in his journey to become a Western-trained medical physician (Chapter 19); and stories of the experience of being one of very few Indigenous medical doctors (Chapter 20). A critique we can make of social determinants of health frameworks is that often the variety of determinants are presented as a list of factors with a relatively weak articulation of hierarchy and interplay. Not infrequently these frameworks bring to mind Jorge Luis Borges’ fictional encyclopedia where animals are classified as “those that belong to the Emperor; embalmed ones, those that are trained, suckling pigs, mermaids, fabulous ones, stray dogs, those included in the present classification,” and so on (Borges, 1975)—that is, a lack of clear inner logic. This brings us to the strengths and limitations of Determinants. A particular strength is the explicit articulation of how colonialism is a structural determinant of Indigenous peoples’ health in Chapter 1: Structural Determinants of Aboriginal Peoples’ Health. Within an Indigenous paradigm, the chapter presents the tree as an appropriate metaphor to explore social determinants of health, turning upside down the more conventional view of “structural determinants as upstream forces, creating conditions that flow down to affect population health” (p. 10). What would be considered distal determinants, “resources from the surrounding environment are taken up by the roots of the tree . . . trunk system (intermediate determinants) and into the crown (proximal determinants)” (p. 10). This makes for a potentially more relevant framework to capture how colonial structures operate as root causes that flow upward in the shaping of determinants of Indigenous health. Although the book’s sections do not follow this framework in an articulated manner, there are indirect connections. As a response to colonialism in health, there is an exploration of Inuit knowledge systems and the role of holistic thinking (Chapter 3), as well as a reflection on the spiritual dimension of holistic health (Chapter 4). The role of culture and identity are also explored—for instance focusing on early childhood development of Indigenous children and their role in cultural continuity (Chapter 7), as well as how cultural wounds demand cultural medicines (Chapter 8). The role of land is strongly present in chapters that discuss geography as a determinant of Indigenous people’s health, the importance of taking care of land, and stories from Anishinabe Elders on the relatedness of people, land, and health (see for example Chapters 6, 9, & 11). Again, as a counter to colonialism, several chapters provide particular examples of processes of Indigenization of medicine (see for example Chapters 19-23). In terms of style, despite some discrepancies in writing quality, most chapters are well written and clear. As tends to occur with edited books, there is a degree of repetition in content across several chapters. Furthermore, some of the research-based chapters could have provided more consistent empirical evidence to substantiate their claims. More importantly, it would have been helpful if the editors had included a concluding chapter that weaved together the main threads of the chapters in a coherent picture by returning to address the idea of “beyond the social” and integrating the rich material offered by the different authors. A major difficulty with edited books is that the main thrust is often lost due to writing that comes from distinct 2 The International Indigenous Policy Journal, Vol. 8, Iss. 1 [2017], Art. 4 http://ir.lib.uwo.ca/iipj/vol8/iss1/4 DOI: 10.18584/iipj.2017.8.1.4 angles and authors. While this in itself is not negative (in fact it tends to enrich), the book must offer places of synthesis that incorporate these varied perspectives to make explicit how they support its central arguments. While the introduction does a good job of presenting each chapter, Determinants seems to lack proper conceptual closure. A more specific and integrated conceptual framework of “colonialism [as] an active and ongoing force impacting the well-being of Indigenous peoples in Canada” (p. xii) would have been useful as a final chapter. Determinants of Indigenous People’s Health in Canada: Beyond the Social, despite some limitations, is a valuable book. It offers new light in questioning the social determinants of health framework from a variety of Indigenous perspectives. It is a creative text that provides different vantage points not frequently found in books in this subject area. For anyone in the social determinants of health field, it is a must read. As well, it is a unique resource for post-secondary courses that teach community health, population and public health, health promotion, Indigenous studies, and Indigenous policy. 3 Mignone: Determinants of Indigenous Peoples' Health in Canada Published by Scholarship@Western, 2017 R e f e re n c e s Borges, J. L. (1975). Other inquisitions, 1937-1952. Austin: University of Texas Press. 4 The International Indigenous Policy Journal, Vol. 8, Iss. 1 [2017], Art. 4 http://ir.lib.uwo.ca/iipj/vol8/iss1/4 DOI: 10.18584/iipj.2017.8.1.4 The International Indigenous Policy Journal January 2017 Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social Javier Mignone Recommended Citation Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social Abstract Keywords Creative Commons License Book Review: Greenwood, M. et al. (Eds.). (2015). Determinants of Indigenous Peoples' Health in Canada: Beyond the Social