Examining the Spaces and Scales of Well-Being : Exploring Aboriginal Perspectives of Health and PlaceÉchelles et espaces de bien-être : Une etude exploratoire des perspectives des Premières nations sur le lieu et la santé

Kathi Wilson (kathi.wilson @ utoronto.ca), Department of Geography, University of Toronto at Mississauga, 3359 Mississauga Rd. N., Mississagua, Ontario, CANADA, L5L 1C6

Introduction

Historically, health research within geography has been characterized by spatial and locational analyses of the links between place and well-being. However, within the past decade a series of critiques have been leveled against these approaches to space and place (see Kearns, 1993 ; Kearns and Joseph, 1993 ; Jones and Moon, 1993). Most notably, Gesler (1991) and Kearns (1993) have been instrumental in promoting and emphasizing the need for a post-medical geography (i.e., Geography of Health) in which place is viewed as more than location and geographers strive to understand the dynamic relationship between health and place. Critiquing spatial analytic viewpoints of health and place, Gesler (1991, p.167) argues that : 
Geographic studies rarely pay attention to the meaning of places in health care delivery…In fact, most geographic studies of health care delivery are based on an abstract analysis of space as opposed to an analysis of place. Where a hospital lies within a spatial distribution of hospitals is given more importance than what goes on within that particular hospital (original emphasis). 
Situating himself between the new cultural geography and health geography, Gesler introduced geographers to the term ‘therapeutic landscapes’ in his 1991 book The Cultural Geography of Health Care. Gesler (1993, p.171) defined therapeutic landscapes as places with “an enduring reputation for achieving physical, mental, and spiritual healing” and argued that by incorporating theory from cultural geography such as sense of place and symbolic landscapes, health geographers could begin to examine ‘locations of healing’ as symbolic systems. The introduction of this concept within health geography has been influential is moving research beyond location-based analyses of health to in-depth examinations of spaces and places as sites of meaning and healing. Since Gesler first introduced this concept in 1991, geographers have applied its use to study the healing benefits associated with the symbolic and material aspects of hospitals, parks), cities, spas and places of pilgrimage (Frazier and Scarpaci, 1998 ; Geores, 1998 ; Geores and Gesler, 1999 ; Gesler, 1996, 1998 ; Kearns and Barnett, 1999 ; Madge, 1998). 
This paper contributes to an expanded understanding of the links between place and well-being by examining the different scales at which therapeutic landscapes are produced and experienced, a particularly underresearched area of study within health geography. Indeed Parr is amongst the first to acknowledge that therapeutic landscapes can exist at different scales. Drawing upon the work of Smith (1991, 1993), and others, the paper emphasizes the importance of acknowledging and examining the different scales at which links between well-being and place are manifested. To illustrate the approach, Aboriginal conceptualizations of well-being and place are presented through the results of in-depth interviews conducted with Aboriginal peoples from one community in northern Ontario, Canada.1 The purpose of the interviews was to understand Aboriginal perceptions of the land, how it contributes to well-being, and how relationships between the two are manifested geographically. In presenting the results of in-depth interviews conducted with First Nations peoples, this paper demonstrates that that the link between health and place (the land) for First Nations peoples is manifested across interconnected physical, symbolic and spiritual scales.

Scaling the Links between Health and Place

Smith (2000, p.724) defines scale as “one ore more levels of representation, experience, and organization of geographical events and processes.” Further, Howitt (1998, p.52) argues that scale must be conceptualized in terms that recognize it as being more than just ‘size’ or ‘level’ but as a relational tool for examining the interconnections between such things as geopolitics, territory, structure, and culture. Building upon this theory, this paper presents indigenous perspectives of the land and health to demonstrate the ways in which links between well-being and health are produced across multiple scales. In applying Howitt’s (1998) relational conceptualization of scale to this research, the paper documents three particular scales in which relationships between the land and health are manifested in connected symbolic, social and physical spaces.

The Research Setting

In-depth interviews were conducted with individuals living on one First Nations reserve in Northern Ontario, Canada. The First Nations population living on the reserve is of Odawa and Ojibway ancestry. Odawa and Ojibway peoples, like many Algonquin peoples, use the term Anishinabek, meaning ‘First Peoples’ to refer to themselves. The research was conducted over a six month period split between the fall of 1998 and the spring of 1999. A total of 17 in-depth interviews were conducted, fourteen of which were with community members. Nine of the community interviews were with women and five were with men. 
Three additional interviews were conducted with a traditional healer, a medicinal harvester and a former fish and wildlife director. The purpose of the interviews was to understand the ways in which relationships to the land contribute to Anishinabek health and how these links are manifested geographically. Each interview started by asking individuals to describe their relationship with the land and then moved on to ask questions about the importance of the land for health.

Results

The concept of health or living the good life is a complex notion and its basic tenets are explained through the medicine wheel. The medicine wheel is divided into four sections that represent the four directions : Giiwednong (North), Waabnong (East), Zhaawnong (South), and Epngishmok (West). According to beliefs, all four elements of life, the physical, emotional, mental and spiritual, are represented in the four directions of the medicine wheel. They key teaching of the medicine wheel is that balance between all four elements is essential for maintaining and supporting mno bmaadis. If one element within the wheel is neglected or receives too much attention then health suffers in all four areas. 
The interviews revealed that the land is perceived to be a female entity and a provider of all things necessary to maintain mno bmaadis and as such is referred to as Shkagmik-Kwe (Mother Earth). Further, the interviews revealed that a relationship to the land is believed to shape holistic health at three different scales (for a further discussion of the links between land and health see Wilson, 2004). The first scale is represented by a relationship that is manifested across a large, unbounded place, as denoted by Mother Earth in its entirety. This relationship includes Aboriginal perspectives of the earth as a provider and the land as ‘Mother’. The second category refers to relationships that exist within large but bounded places such as the community and traditional territory. The third category constitutes relationships that are bounded within smaller places. This refers to particular places or landscape features that hold cultural significance and meaning at mainly an individual level. 
During the interviews, Anishinabek discussed the ways in which the land contributes to physical, emotional, mental, and spiritual health at all three scales. For example, at the largest scale, the land in its unbounded form as Mother Earth is perceived to be the provider of all things necessary to sustain health. Mother Earth provides both traditional foods and medicines in the forms of plants and animals. The nutritional and spiritual components of food and medicines are believed to be an integral part of the healing process. The community and traditional territories are large bounded places to which individuals feel a strong sense of belonging. Many individuals state that living in their community and having access to their traditional territory is important for their emotional and mental health because of the sense of belonging they feel within these places. Finally, small bounded places like rocks and trees are important because they are the sites within which Anishinabek physically and spiritually connect to the land. Landscape features are believed to be alive and contain spirits and therefore it is at these sites that individuals feel very strong connections to the land. Individuals often communicate with the spirits of these landscape features when dealing with problems and/or conflict. This communication with spirits aids in sustaining emotional, mental, and spiritual health. Scale, as Smith (1993) argues, contains both social activity and provides a partitioned geography within which social activity takes place. In this sense, scale is a useful tool for examining relationships to the land because it allows us to understand the different geographies within which relationships are contained. While relationships to the land are manifested and contained across scales, it is not enough to acknowledge the importance of scale as size or level for shaping the relationship between the land and health. It is necessary to understand the relational character of connections to the land.

Discussion and Conclusions

For Anishinabek, links between health and place exist concurrently at three different scales, each of which are important for health. These findings are similar to Hay’s (1998) research on Maori sense of place, which shows that ties to place, based on culture and spirituality, develop across different scales : home, family, community, and culture. From a geographical perspective, while the land represents Mother Earth on a large unbounded scale, relationships to the land are also actively pursued within small and large bounded scales. More specifically, relationships to the land are fluid and cannot be limited to one geographic location. For example, Anishinabek can feel the strongest connection to the land, in the image of Mother Earth (large scale, unbounded), when communicating with spirits at a particular landscape feature, such as a rock (small scale, bounded), located within their reserve (large scale, bounded). Thus, relationships to the land are simultaneously manifested within and across large, small, bounded and unbounded locations. 
In thinking about place, Massey (1993) argues that geographers require a more progressive sense of place - one that recognizes them (places) as more than just areas with boundaries placed around them. While relationships to the land are manifested within physically bounded geographic locations (e.g., reserve), one must acknowledge the symbolic importance of those places. The reserve and the traditional territories are not only physical locations within which Anishinabek live and relationships to the land are manifested. They are also symbolic representations of culture, and spirituality. The importance of the land for culture and spirituality does not cease to exist outside the borders of the reserve. While physical boundaries do exist, the significance of the land for health transcends beyond those borders. This has important implications for current conceptualizations of health and place. The concept of therapeutic landscapes is important for moving geographic research beyond locational analyses, yet much of the current research remains focused on physically, bounded locations of healing and at the same time overlooks the ways in which the links between health and place may be manifested across multiple scales. To move forward, research conducted within the framework of therapeutic landscapes must make room for the exploration of the multiple scales at which links between health and place are experienced in the daily geographies of individuals.


Notes

The term Aboriginal refers to the descendants of the original inhabitants of Canada, as defined by the Constitution Act 1982 ; Indians, Inuit and Métis. Many ‘Indians’ prefer the terms First Nations when referring to themselves as a collective group. Therefore the term First Nations peoples is used when referring to this segment of the Aboriginal population.



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