James R. Cochrane

Healthworlds: Conceptualizing Landscapes of Health and Healing

People think about health and illness in multifaceted ways, evidencing a conceptual complexity that corresponds to equally complex behaviours in relation to a diversity of healing practices. Stimulated by fieldwork in Lesotho and elsewhere, and engaging principally with Jürgen Habermas, we set out to introduce, explain and develop a conceptual innovation: healthworld. We argue that this notion describes and provides a key analytical tool for the field of health in its social context; a tool that can explain the empirical complexity of health beliefs (importantly, including religion) and behaviours, thereby illuminating possibilities for improving health practice and outcomes. Framed in relation to Habermas’s notion of lifeworld, the healthworld is identified as a distinctive ‘region’ of the lifeworld defined by a particular telos — that of comprehensive well-being, a lifeworld without dysfunction.

Against the Grain: Responsible Public Theology in a Global Era

In commenting on William Storrar’s distinction between theologies of public anger (liberation theologies) and theologies that reflect public spirit, the latter being for him more properly understood as public theologies, this article considers the roots of critical theology in South Africa. The former are neither homogeneous nor as distinct from post-apartheid public theologies as Storrar’s formulation might suggest. Thus this article argues for rethinking what seems too narrow a view on what constitutes public theology, an argument against the grain starting from theologies against the grain. To make the argument clear, the article considers the global order within which the liberated state now sits, and proposes that three key issues place the greatest demands on a responsible contemporary public theology today: a revised view of human being; the ordering of society in the polis; and the management of the well-being of the (global) household, that is, the international economy—all in relation to the contemporary erosion of the public sphere proper.

Health and the Uses of Religion: Recovering the Political Proper?

With the rise of the nation-state and the great corporate ventures of industrial and ?nancial capitalism, especially when considered alongside the decline of religious authority in both of these spheres under conditions of modernity, the role of the citizen has moved to the fore. As the idea of citizenship has expanded, ?rst excluding certain classes, racially de?ned groups and women, later including them, so too has the question of the role of citizens in society. Speci?cally, given the expansion of complexity in the spheres of both economy and polity, driven by scienti?c, technological and managerial innovations, the role of citizens has grown increasingly unstable. It is sometimes attacked or even crushed, sometimes reduced to little more than expressing an opinion now and again through a public vote, and most commonly expressed through the multiple kinds of associational and organizational structures that citizens have themselves built – what we general call civil society (see Cohen & Arato, 1995).

Thinking about Complexity: Transdisciplinarity and Research on Religion and Health in Africa

Reflecting on research on “religion” and “health” in Africa, one quickly confronts the challenge of what we might call “the complex real”. Adequately to understand and act upon the complex real requires multiple disciplines and interlocking theoretical constructs that transcend any particular discipline. Here the issue of transdisciplinarity arises and, with it, the relationship between knowledge and ethics. Does this have relevance for African Studies, where the intellectual task of asking “what do we know” is hard to separate from the practical one of asking “what should we do”? Here we pursue that question using Max-Neef’s seminal understanding of transdisciplinarity.

Conceptualising Religious Health Assets Redemptively

The role of faith-based organisations in health is the focus of the African Religious Health Assets Programme (ARHAP), which seeks to understand the scope, scale and significance of religious health assets. This article discusses the link between health and the notion of redemption, which also broadens our understanding of health. It argues that health discourse is helpfully inclusive in ways that other discourses are often not. Finally, distinctions between religion, assets and faith-based organisations are clarified and the conclusion is reached that religious health assets are redemptive elements of our life together in society, and in need of development and strengthening.

Identifying and Mobilising Factors That Promote Community Peace

The identification and mobilisation of factors that promote peace is central to peace promotion. Through a community-based participatory research project, SCRATCHMAPS (Spiritual Capacity and Religious Assets for Transforming Community Health through mobilising Males for Peace and Safety), a grounded-theoretical study in a low-income community in South Africa, including both quantitative and qualitative methods and forms of analysis, was conducted to explore community members’ perceptions of factors that promote peace. The findings presented in this chapter reveal a major emphasis on ‘intangible’ factors, many of them linked to a new concept of ‘spiritual capacity’, that the community believe play a central role in promoting peace. In line with initiatives that combine research and action in efforts to promote peace, the authors briefly describe how these findings were used to direct a community intervention aimed at mobilising religious assets and enabling spiritual capacity to promote peace. Structural factors such as employment and economic security are centrally important in any attempts to promote peace, but the authors argue that more attention should be focused on understanding and mobilising factors such as compassion, respect, and hope, at different levels of the social system. This raises a number of challenges to those involved in peace psychology.

The role of religious leaders in anti-Apartheid mobilisation: implications for violence prevention in contemporary South Africa

ABSTRACT This study examines how South African religious leaders mobilised spiritual capacity and religious assets to resist and fight against state and structural violence during the 1970s and 1980s. Document analysis and qualitative in-depth interviews were conducted with six key informants who were directly or indirectly involved in an interfaith Peace March in 1989 in Cape Town. Our analysis was aimed at identifying and understanding the factors, which enabled individuals from diverse religious backgrounds to work together to combat the Apartheid state and structural violence, drawing out possible roles for interfaith leadership within the prevention of direct violence in South Africa. The analysis shows that interfaith leadership was enacted as five kinds of performances: of safety in sacred spaces, solidarity and community, non-violence, voice and representation, and humanitarian relief and healing. These performances relied on specific religious assets, spiritual capacity and psychological and interpersonal qualities characteristic of transformative leaders. In conclusion, we offer some suggestions for how interfaith leadership alongside other social actors may contribute to the prevention of interpersonal violence.

Fundamental Evaluation Criteria in the Medicine of the Twenty-First Century

Based on ongoing research and analysis by a transdisciplinary, international collaboration of non-formal health services in the context of health challenges such as HIV and AIDS, congestive heart failure, diabetes, palliative care, and interpersonal violence, this paper addresses the question of evaluation criteria for medicine in the twenty-first century. It offers no detailed discussion of specific legal frameworks, medical choices, or standard financial challenges. Rather, it suggests that crucial to their resolution may be a different way of looking at them. This is expressed via four interrelated but discrete notions: health assets, healthworlds, causes of life, and deep accountability. To contextualize these notions, two themes that are central to questions of prioritization in medicine and health care are first considered: the lure and allure of science and aspects of rational choice theory and the question of the common good. Health assets are then explained and their relevance illustrated with reference to research conducted in Zambia and Lesotho for the World Health Organization. From this research arises the idea of healthworlds, which articulates the crucial agency of the health seeker in most, if not all, medical or health interventions. Healthworlds reflect ways of understanding health and healing that exceed clinical perspectives but that nonetheless have clinical relevance. The significance of these concepts is illustrated with reference to an innovative, community-based partnership established by a major health system in Memphis, Tennessee, that has attracted national interest and that offers insights into the question of criteria for evaluating medicine in formal health systems. Finally, this leads to the suggestion that we would be well served to grasp the crucial health and health care in terms of what we might call “leading causes of life.” This conceptual framework emphasizes that which is generative of health; it seeks to balance the overwhelming stress on pathology which is taken as normative but which might be precisely where we are failing. The paper ends by calling for a “deep accountability” that surpasses, without setting aside, financial and operational accountability, placing the question of prioritization in medicine within a larger framework of criteria for evaluating medicine in the twenty-first century.

The Challenge of Systems

The paradigm we have outlined for understanding religion and the health of the public rests partly on the credibility of each component idea, and partly on how those components as a whole serve the work of better reflection and action. Here we reflect on one last critical component, the link between the health of the public on one hand, and polity and economy on the other. This link seems obvious, as farming is to weather and climate. However, no aspect is as challenging or contested, and we tread warily in this respect. Faith, health, politics, and economics: each is an aspect of human life that might be designed to rule the others, each has appeared to do so in different times and places, and each is complex beyond measure.

The Health of the Public and the Religious Mind: Connections and Disconnections

The history of religion can barely be separated from that of health. Most, if not all, religions are bound up with some comprehensive conception of health and well-being, whether cast in cyclical or linear patterns of redemption, salvation, or fullness of life. Health, here, means more than medicine.1 However, even the term “medicine” has a deeper meaning than most realize, with surprising etymological origins in the pharaonic language of Egypt: the mediation (medi) of the healer (sine).2