By Theresa Sommers
From July 27-29, 2015 I was lucky enough to attend a workshop entitled “Migration, Urbanization, and Health in Southern Africa: Interdisciplinary Conversations,” hosted by the African Centre for Migration and Society at the University of the Witwatersrand in Johannesburg, South Africa. This three day, interdisciplinary workshop and meeting brought together researchers – including graduate students – from across the Southern African region and beyond to discuss the intersecting issues of health, migration, and urbanization in the region. My fellow participants brought a breadth of expertise in differing fields of study to bear on these intersecting issues, including psychology, geography, sociology, anthropology, and public health. As a doctoral candidate in global governance and human security, and as one who has done previous work on migration and health in South Africa, I felt right at home in this interdisciplinary approach to understanding how the complex phenomena of migration, urbanization, and health interact with each other in South Africa and throughout the region.
Among the many topics presented were talks on urbanization and health, primary health care, securitization, discrimination against migrant pregnant women, and migration and health in Botswana. For my own presentation, I talked about some of the previous work I have done in Johannesburg with civil society on how migrants access – or do not access – public health care services in the city. Each of the presentations provided unique insights and perspectives on the themes of the workshop, which provided a useful platform for us to retool and expand our thinking on how migration, urbanization, and health interact in these Southern African settings. It was also was striking how many of these seemingly dissimilar research projects brought forth some similar ideas and themes. Many of our discussions focused on questions such as how to define a migrant and how to define health – questions that may, on the surface, appear simple and straightforward but in reality can be quite complex and highlight a potential difficulty in working across disciplines where definitions very often may differ.
In my own work, I have thought a lot about how to bridge these interdisciplinary divides – but have yet to find a clear cut answer. As someone with a professional and academic background in public health, who is trying to engage with broader issues of migration, public policy, governance, and marginalization, it is sometimes difficult to decide on methodology, conceptual and theoretical frameworks, and positioning in the literature. In my contribution to this conference and discussion, I looked to the concept of human security, applying this framework to the (in)accessibility of health care services to migrants in Johannesburg. The idea behind human security, first developed in a 1994 UNDP Human Development Report, is to bring the referent of security to the individual, rather than the State, and includes focus on the things that affect an individual’s every day life – access to food, a good job, and personal, community, and political security. In addition, the authors of the 1994 report identified health security as one of the components to overall human security. And while there is much being written on health security, there is – somewhat surprisingly – very little empirical work in the literature examining health as a component of human security or the intersections between health and human security more broadly.
Interestingly, I find that some of the concepts within the human security framework align closely with the social determinants of health framework, originally developed by a group of experts commissioned by WHO and released in 2008. Put simply, the social determinants of health look beyond health care services and the health sector to try to understand how an individual’s social, economic, and political position can affect their health. Income, education, gender, social class, and the political and socioeconomic context in which one lives are all significant contributors to health and well being. What both human security and the social determinants of health helps us to realize is that in order to develop a comprehensive understanding of health and wellbeing, we need to look beyond simply health care services and the health sector.
All of this brings up back to two of the questions that emerged from the conference and were posed earlier: how to define a migrant and how to define health? While these frameworks alone are not able to answer these questions, they do seem to provide tools for understanding the complexities of migration, health, and the interaction between the two. Migration is not a homogenous endeavor, nor are experiences and understandings of health. Both are greatly influenced by the social, economic, and political contexts in which they occur. An interdisciplinary approach allows us to critically engage with this complexity, and is the type of work that will continue with the newly formed regional network on migration, urbanization, and health in Southern Africa.