 Greetings everyone. It's a pleasure to be able to make this presentation and it's unfortunate that I'm not able to be there physically but I'll do my presentation online and let's see how it goes. So my name is Salome Bukachi, I'm an associate professor in the Institute of Anthropology, Gender and African Studies of the University of Nairobi. I'm the lead multiplier for Cohesa, Kenya and I'll be taking you through navigating health beyond diseases and sickness, welcoming justice and equity. So I'll start by just asking why do you think it's important to define health and is it really important for us to define health and why do definitions matter? So definitions are important and it's important to define health because they're different understandings of health, illness and disease and this inform how we explain and manage ill health. The different definitions we'll have will affect various factors for example, they will affect how we view the causes of ill health. Our perception and definition of health will affect how we perceive the individual as responding physically, psychologically to the causes of ill health or disease. Again, the definitions also affect what we accept as appropriate action to be taken. And lastly, how we view those who are well or ill. So definitions are important because they will guide the interactions that we undertake, they will guide the decisions that we make and the directions that we take in relation to health, illness and disease. And so with this presentation we'll just look at various factors in relation to health and see how we can look at it from a different perspective than that that has always been fronted. So as we ask ourselves what is health, I'd like to share a short story I love stories because they help conquer some of the points that we talk about. So when I was in college some years back, we used to define good living as taking a good cup of tea, milk tea. So we would make tea with milk with my friends, sit back with tea and bread and enjoy drinking that tea and eating the bread and we would call it good living. To date we still make jokes about good living. Whenever we find ourselves in different places together and we are taking a cup of tea, we say this is good living. So is good living related to health? Let's see health has a component of well-being. And well-being is a positive state experienced by individuals and societies. Similar to health, well-being is a resource for daily life and is determined by social, economic and environmental conditions. So would you say that me and my friends back in campus were experiencing well-being? What do you think? Well you may have thought of various aspects but one of the things we also realized is that not everyone in campus would afford this cup of milk tea that we would drink. So it was not everyone who would be able to afford it or get it. And so there was those, some people did have, some people did have. And we'll talk about that even as we talk about health. So health has been defined a lot. Whenever we talk about health, what comes to mind and what usually is the focus of health is disease. And when we look at this word cloud on my right side, it has different aspects of disease, sickness, death, protozoa, pathogens, tuberculosis, infections, smallpox, and the list goes on and on. But this aspect of disease when we talk about health and it's defined from the disease perspective normally takes the jump theory which dictates that disease is about pathogens, is about jumps that have infected the body that need to be dealt with. And of course based on that decision then we will deal with the disease from a perspective of curative to try and restore, clear the pathogens and restore person back to their normal functioning. But we'd also like to look at the definition of health. And what comes to mind when you hear the word health? Is good living one of those aspects when we talk about health? Within this word cloud we have several words that have been used to define health, ranging from good health, good, okay, I almost said good living, but it just means good, the satisfaction, there is well being, there is vigor, welfare, prosperity, cheer, ease of doing things, safety, state of mind, victory, mentor, victory process, progress. And the list goes on and on and on success as part of the aspects of health. So this just shows us that health is not just about disease because we cannot see any disease related aspect here when we talk about health. So that then leads us to the definition of health. According to the WHO definition of 1947. And from this definition, which states that health is a state of complete physical, mental, social well being, not merely the absence of disease or infamity. It implies that health is not purely a pathogen related phenomenon, but is influenced by social cultural, economic, psychological, ecological factors. So health therefore is not just the absence of disease. It is something positive. It is about being joyful. It is about a positive attitude to life. It's about cheerful acceptance of the responsibilities that life puts upon the individual. And the list goes on and on and on, bringing in the aspect of well being and not just the aspect of pathogen related physical ailment. So a healthy individual is a man or a woman who is well balanced, bodily, mentally, and well adjusted to his or her physical and social environment. So when we look at this, it relates to the fact that health is not just about clearing pathogens from one's body, but it's a composite of other factors that relate to the mental and social environment of the individual. So I had already asked about what is health? And is it good living? We have talked about that. So I will skip that. But I'd like us to now look at the social and the ecological aspects. When we talk about health as being state of not just the physical aspects, but also the social, the mental aspects, it brings in the aspect of the social and ecological determinants of health. So when we look at health from a social perspective, it entails analyzing the social cultural ecological reasons for disease, illness and well being. And this provides information starting from the onset of the condition, which brings in the aspect of preventive measures and management. So it's about the social determinants of health. And the social determinants of health are the non medical factors that influence health outcomes. And these are the conditions in which people are born, conditions in which they grow, they work, they live the environments, the wider sets of forces and systems shaping the conditions of daily life. And so we need to look at health from that aspect, looking at those social determinants of health and seeing if these social determinants of health are okay, then everyone can be considered to be healthy. And as we look at that aspect, we see the social determinants of health cut across various factors, from economic stability, education, social context, the built and neighborhood environment. So it's about our ecological aspects and ecological setups. So besides the social determinants of health, something that we're also looking at increasingly is the aspect of the social justice and equity approach to health. And social justice is the view that everyone deserves equal rights and opportunities. This includes a right to good health. It's important that these equal opportunities and equal rights are taken into considerations, avoid the inequities in health and the unnecessary and adjust aspects that may render other people at an equal access of rights and opportunities. The inequities that arise as a result of an equal access to right to health are as a result of policies and practices that create an unequal distribution of money, power and resources among communities based on different characteristics that could relate to race, class, gender, place and other factors. So to assure that everyone has the opportunity to attain their highest level of health, we must address the social, the ecological determinants of health and equity, besides addressing the physical aspects of health. So health is a holistic aspect as we have said, and our focus on health then should not be on disease and negative things, but also about well-being and positive things. How do we improve the positive things? So even as we discuss along the theme of the conference this week, may we bear in mind that health is about social justice and equity in access to factors that contribute to good health? And when we use a holistic view to health, it enables us to tackle health from a holistic perspective, hence also embracing the one health approach. And in the concept of one health, it is about a healthy forest or ecosystems, healthy animals, healthy people living harmoniously together in a sustainable manner. So even as we discuss about health and disease, it's important that we bring in the aspect of this holistic aspect that will enable us bringing the aspects of tackling the other social aspects, the inequity aspects, and the ecological aspects that may contribute towards ill health. So some points to ponder as I come to an end is that we need to focus on salutogenesis. And salutogenesis is the study of the origins of health. And it focuses on factors that support human health and well-being, rather than on factors that cause disease, which is termed as pathogenesis. So as we think through this week, let's think about focusing on salutogenesis, health from a salutogenesis perspective, which will focus on well-being vis-à-vis just disease. It will focus on holistic perspective. It will focus on preventive versus curative. And it will focus on social justice and equity to the access of the social determinants of life. And so as we wind up, think through all this, as we think of health, not just as about pathogens, but also as about the social aspects of health, and also about the positive things that we can contribute to make well-being and human living much more engaging and more profitable for everyone. So I acknowledge the consortium and OCCAPSRI for funding this study. Thank you.