What is Health?

What is health? Where is health located? Is it in our individual cells? In our body parts – the liver, the kidney, the heart? Is it in each of us as individuals? Or is it located in our families? Our homes? Our gardens? Our kraals?

In conducting my research the question “What is health?” is very important. Indeed, it is fundamental to trying to understand how health and agriculture are related.

It is not, however, obvious.

From a biomedical perspective (the one that I am the most familiar with), health is located in the interaction between cells in individual bodies. To have HIV is to have a virus in your blood that attacks the CD-4 T-cells in your white blood cells, thereby compromising your immune system and making you more susceptible to opportunistic infections and ill health. If one could prevent this virus from replicating then one could stop HIV from affecting people. Medication is the answer.

But what about a public health perspective? From a public health perspective HIV is a sexually transmitted disease that needs to be addressed on the level of education and prevention. From this perspective working at the level of the community is crucial. Community education is the answer.

One would be loathe to find a medical professional that disagreed with either of these statements. Practitioners might not agree on where the emphasis should be placed, but they would agree that HIV must be addressed at the community, individual, and cellular levels. In this example, health is present on three levels.

As a geographer I spend a lot of time thinking about scale, and though it might take a moment of contemplation, I am confident that health can exists on multiple scales at the same time. This HIV-biomedical example makes this much clear. We can all see how microbes interact with individual bodies and individuals with each other to make an epidemic.

But what about other ways of understanding health and healing? What if a single medical practitioner, a sangoma, could treat an individual, a family, a garden, and a herd?

Last month, rather unexpectedly, I found myself interviewing a sangoma. We were talking about various health conditions and muthis (medicines) that she uses to treat them. More specifically, we were talking about how she protects the family; where she puts the muthi that helps prevent lightning and what she needs to do to spread it. And then I asked, “Is there a muthi to protect the garden?” And she said, “Yes.” And then, “Is there a muthi to protect the herd?” “Yes” again. Interesting. So the same medical practitioner that treats an individual’s illness also treats certain problems in the garden or with the livestock.

This, of course, makes less sense to my biomedically-oriented perspective. But surely there are alternative ways of understanding healing. And perhaps this sangoma provides a key link to help me understand how health and agriculture might be related

I am looking at nutrition, at the impact of vegetable gardens on people’s ability to fight of disease and on the relationship between home grown food, store bought food, and nutrition-related health. This is, of course, an important avenue for investigation, as nutrition has real affects on people’s health, and if agriculture is supplying those calories then agriculture has a real affect on people’s health.

So then, what about this notion that one healer can heal a person, a home, a garden, and a kraal? Does this idea even matter?

I would argue yes, if for no other reason than it motivates particular types of behavior, particular agricultural and herding decisions. Health affects agriculture.

If we accept the idea that understandings of health, which include agricultural health, for wont of a better term, can affect the decisions people make about their gardens and herds AND we accept that the nutrition people get out of their agriculture affects their health then we’re certainly moving toward some sort of agriculture-health relationship. However, we still haven’t answered the question: what is health?

Is it both biomedical and local understandings? Certainly. But what happens when the two come into conflict? Must we choose one over the other? Is one conception of health “more correct” than another? How can we combine them? Must we combine them?

The best answer I can give is that I don’t know. Surely at various moments one conception of health is better than another. But the conception that is better also surely changes depending on the particular moment. Both systems motivate practices, and the actions that result from those systems in turn affect agriculture and health.

So what is the way forward?

To talk to people. To stop talking to sangomas or doctors and to talk to the people who plant in their gardens, tend their livestock, and visit sangomas, inyangas, nurses, and doctors. For their understanding of health is more expansive than either the sangoma’s or the medical doctor’s; it includes both.