Much has been written about the links between education and health, highlighting education as a social determinant of health. Such discussions mainly align to the recognition that higher formal educational attainment contributes to better health and well-being. Those with lower levels of formal education seem to experience poorer health and quality of life. But this remains a single narrative.
Narratives of people who experience poorer health and poverty remain marginalised in this area. Further missing is a conceptualisation of social determinants that employ epistemologies from these marginalised groups. It is only formal education (which also still marginalises indigenous knowledges) that is recognised as the influencer of better health. The increasing body of literature worldwide showing the positive influence of indigenous cultures and knowledges on holistic wellbeing remains marginalised.
A recent study revealed that indigenous people see the introduction of formal education as having brought ill-health. These findings bring a new unexplored spin to the link between health and formal education which digs deeper to the order of knowledges in the education system and its influence to the persisting poor health status among indigenous people.
Yet, the majority of indigenous people worldwide experience poorer health compared with the general population, regardless of their geographical location and sociopolitical situation. South Africa, specifically, remains with a persisting quadruple burden of disease 25 years after democracy. My doctoral study aimed to describe amaBomvane’s rural experiences of the influence of the formal education system on their Indigenous traditions and knowledges and their links to health and wellbeing.
A South African example
AmaBomvane of Xhora in the Eastern Cape experience formal education as divisive, classist and interfering with the parent-child relationship. Three divisions emerged as linked to interactions with formal education. These are: (i) a group who have not gone through formal schooling (amaqaba); (ii) those who went to school (amagqobhoka); and (iii) those who dropped out of school (the uncomfortable in-betweeners).
Historically, formal education was introduced by missionaries, and converts were referred to as amagqobhoka, which refer to an assimilation of missionary ways and ideologies, forgetting previously-held values, traditions and norms.
The connotations of the term amaqaba, paradoxically, are similarly negative. This term refers to people who resisted formal schooling and Christianity and were viewed as backward and inferior to more Westernised people. Amaqaba were and are often excluded from mainstream opportunities afforded by the colonial and postcolonial systems.
The complex struggle here revolves around being unable to be yourself both in the formal school space because of the imposed assimilation and the home space because of the identity that is being demonised and stripped by the dominant hegemonic school system.
Consequently, a third category, which is clearly manifested in the struggles of attempting to navigate these imposed binaries, emerges and exacerbates the divisions. These divisions threaten the individual and collective identities, sense of self-esteem and collective self-determination that make up the cultural connectedness and knowledge as cultural determinants of health in indigenous groups. These findings are not unique to South Africa; they have been noted in other indigenous health studies in Australia, Norway, Canada and North America.
The disruption of a cultural identity and social fabric leads to an imposed individuality, breaking down a sense of caring and social responsibility towards one another’s growth. There is almost no autonomy left for learners and children start not only hating themselves but also their localities, a colonial characteristic that influences how people live and sustain themselves. The conflicting identities and imposed ways of being, values and doing destroy the communal social fabric and are harmful to indigenous ways of being, doing and living.
Cultural dislocations, akin to colonial education, produce learners who are deeply alienated from themselves, their lands, cultures, ancestors, languages and knowledges. This alienation in turn gives rise to emotional, psychological, physical, and social ills which are debilitating. These include high rates of alcohol consumption as a form of an analgesic for existential pain, increased violence, neglect of communal and household responsibilities such as food production, disintegrated families, unruly children, and pressure to mimic and assimilate to a particular urban and modernised lifestyle.
Such an education is deeply colonial, feeds inequities and emerges as a significant contributor to the persisting ill-health.
Why the findings matter
The findings show a multifaceted source of inequality in South Africa. The understanding of the link between colonial education and ill-health deepens a diverse understanding of social determinants. When schoolchildren are not healthy, they cannot learn and if they cannot learn, they are less likely to do well in life, which later translates into poor health.
This is not just an issue of physical, financial, and skills. It is a deeply personal and psychological issue which forces people to internalise indigeneity as inferior and backward and disrupts a sense of an ongoing cultural, familial and personal lineage.
What should be done
The conceptualisation of social determinants of health should centre these contextually situated voices, if we are to achieve the sustainable development goals and social justice. The suggested inextricable link calls for urgent structural and systemic work.
First, health and wellbeing should be a core learning area of curriculum and centre indigenous health literacies. Centring indigenous knowledges and cultures may contribute to strengthening positive indigenous identities, thus contributing to better physical, social, mental, emotional and spiritual health and well-being for all.
Equally important is a need to prepare educators who are socially conscious and competent to facilitate a health-enhancing curriculum that enables learners to live well now and in the future.
Second, coloniality and colonial education should be named as broader social determinants of ill-health. Practically, meaningful collaborations between health and education departments that centre communities are key to socially responding to the multifaceted nature of ill-health and could improve the often top-down disease prevention, health promotion and education programmes through the school health programmes.
Dr Lieketseng Ned, one of the Mail & Guardian’s 200 Young South Africans for 2019, is a lecturer at the Centre for Rehabilitation Studies in the faculty of medicine and health sciences at the University of Stellenbosch