Indigenous people have always had ecological perspectives on health, which have only recently entered ‘mainstream’ discourse, and the scope now is planetary health, writes Rebekah Jaung.
Good intentions pave the road to inequity in health systems around the world. Whether it’s healthy eating guidelines that would require poor families to spend almost all their income on food, or programmes that remove disadvantaged children from their communities, a host of ostensibly well-meant initiatives can foment and perpetuate injustices and racism.
The disconnect between wanting to promote health in theory versus impacts in practice came into sharp focus at a recent health conference hosted here in Aotearoa. For me these ideas coalesced into the concept of “administrative evil”, in which well-meaning people who are good at their jobs may perpetuate harms because of the nature of the institutions and society we live in.
Colonisation, racism, commercial interests, peace, human rights, democracy and access to justice were all identified as factors which influence health, and it was acknowledged that protecting the health of people and planet would require radical, societal change. Promoting health in the 21st century was presented to be motivated by justice, not charity – and this value was clear in the way in which matters of planetary survival were discussed.
As Professor Sir Mason Durie put it, “Human health is dependent on interconnected elements: natural, cultural, political and familial.” The Māori health expert was opening the 23rd World Conference of The International Union for Health Promotion and Education, held in Rotorua last week. Around 1200 people in the field of health promotion gathered to share ideas for keeping the world healthy, under the banner “WAIORA: Promoting Planetary Health and Sustainable Development for All”.
Climate change, and the impact of inequity were recognised as the biggest threats to the health of all people and the natural environment. The slowing down of gains in life expectancy, and even reversal in wealthy countries like the UK and the US, together with the already significant health impact of climate and environmental breakdown, were described as symptoms of dysfunctional systems and ways of doing things. Regulating the commercial determinants of health (including the influence of unhealthy food industries and extractive industries), redistributing global wealth and ensuring that everyone would live with dignity were put forward as essential for health.
Although the threats discussed at times appeared impossibly large, multifarious and complex, the solutions that were presented suggested potential for synergy. To summarise many of the talks I attended, solutions involved breaking down silos of action and knowledge, restructuring power dynamics which cause harm, engaging communities, shared purpose across professions/disciplines, and working in ways that protect what we value as a society. Solidarity and collective action were seen as vital steps for success. Even though this was a health conference not an activism workshop, in many ways it was both.
These concepts came together at multiple sessions which focused on indigenous perspectives, models and actions to promote health. A paper by Māori health expert Dr Rhys Jones, Climate change and Indigenous Health Promotion, published in conjunction with the conference, approaches indigenous health promotion from a kaupapa Māori positioning. Although I can’t do justice to the depth and diversity of the knowledge that was shared, indigenous health workers, community leaders, and scientists presented many examples of how holistic concepts of health, indigenous knowledge and practices were being applied to health and wellbeing in their communities. As a non-indigenous person living in colonised Aotearoa, this challenged my years of lived experience in a society which continues to privilege Pākehā culture and beliefs above that of Māori.
Indigenous people have always had ecological perspectives on health, which have only recently entered “mainstream” health discourse. The scope now is planetary health – approaches which benefit all people and the natural environment. Ideas we have learned from indigenous people include seeing climate breakdown as a symptom of non-reciprocal and exploitative relationships with land, and acknowledging that such a relationship exists. Ways of honouring the land will not only restore it, it will lead to good health for the people who live on it. This is not just a nice sentiment but the approach on which cutting edge thinking on global climate action is structured.
Climate change has been described as an intensifier of the impacts of colonisation and inequity, and conversely decolonisation is inherent to climate justice. The two greatest threats to our health are intertwined and share common solutions. Collective interests, decision-making and action are also part of indigenous practice and will guide the collaborative work that is required to divert us from a catastrophic path. The many flaxroots activists who work to eliminate poverty, march out of school for climate change, work to secure the rights of marginalised communities or challenge racism to create an inclusive society are already participating in this work. Health promotion in this sense is no longer something that is done by health workers to a target group, it is something that we will achieve collaboratively.
Having received this message, the 1200 delegates have now returned to the real world. We return to places which may be resolutely racist, value commercial interest over health and wellbeing, be comfortable to stick to business as usual and continue to push for isolated actions and individual responsibility. It will take more than these delegates to disrupt the global systems which cause poor health by design or inaction. However, we can find hope in knowing that it is not a task that belongs to health workers alone. In 2019, health is everybody’s business.