Health in Motion

In contemporary, globalised, mobile times a correlation, of an axiomatic nature, synthesises national borders, borderlands, and border crossers within a state of crisis (Davitti, 2019: De Genova, 2016). Such associations are fuelled by political contestation and proclamation, alongside sensationalised media coverage of the hostile or humanitarian infrastructure positioned around borders (De Genova, 2013). Yet, individual details beneath the surface spectacle (Debord, 1995) of migration are often obscured. 

This was the opening paragraph of my thesis, and reading it now, there’s much to unpack before diving into the ethnography. For those unfamiliar, ethnography is the process of spending an extended period of time immersed in the everyday lives of your research participants. As first-year anthropology lectures fondly remind us, Clifford Geertz aptly described it as “deep hanging out.” The goal is to develop a nuanced and localised understanding of what’s happening in a given context—and if you’re particularly insightful—why.

Before getting into that, the above underlines the fact that borders carry significant political, social, and historical baggage. Amplified by sensationalised media coverage, these areas yield an impression of chaos and crisis. Yet, beyond the headlines, political rhetoric, and presidential soundbites, there is little recognition of what exactly is unfolding on the ground. These territories aren’t just backdrops for debates over sovereignty and security; they’re home to countless individual stories and lived realities that rarely see the light of day. My thesis aimed to explore one sliver of this complexity: how people conceptualise health in these contested spaces.

Now, for those with inflated expectations I must clarify that I am (or was) a medical anthropologist. Unlike some colleagues who took the scenic route via a BMedSc into this field, I didn’t come from a medical science background. My most “scientific” credential is an A in Higher (aka A-level, if you’re English) Biology, a triumph born of sheer luck and entirely irrelevant to this project. I wasn’t studying diagnostics, treatments, or preventative care. Nor was I collecting data on the prevalence or severity of illness. Whilst the above sounds exceedingly useful, I am entirely unqualified (despite my modest grasp of osmosis) to do any of it.

What on earth was I doing?

I was trying to highlight a key tension in how asylum seekers receive care: the disconnect between global frameworks for humanitarian aid and the specific needs of the people they’re meant to serve.

We put immense faith in large institutions—governments, NGOs, multinational alliances—to diagnose and solve global crises. In response, they produce frameworks and models that, on the basis of their unnervingly generic quality, fit neatly into glossy reports and campaigns. Universal solutions, after all, are far tidier than context-laden ones. The world of international development and humanitarianism thrives on these abstractions—on theories that are reassuringly grand in scale but distressingly indifferent to the jagged edges of lived experience. It is, in short, a system designed to speak fluently about crisis while often failing to understand the people caught inside it.

My critique here stands on the shoulders of an eclectic but formidable group of thinkers, each, in their own way, dismantling the comforting fictions of institutionally imposed frameworks. See Arturo Escobar, James Ferguson, David Harvey, Michael Barnett, James C. Scott, Achille Mbembe and Gayatri Spivak. The resulting chorus reminds us that well-meaning systems often do their greatest harm under the guise of benevolence.

Defining Health

Moving towards health, the concept has very different meanings and realities across time and space. Against such variety, the World Health Organisation (WHO) defines it as follows;

"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Now, setting aside my historic soft spot for Marlboro Golds and a willpower deficiency when it comes to French cuisine and red wine, I consider myself healthy. No serious illness, regular gym visits (Les Mills’ BodyPump, no less), a busy social life, a stable mental state. Yet, WHO’s definition still doesn’t sit right with me. The problem is its insistence on completeness—the implication that health is an all-or-nothing state, that every dimension of well-being must be in full attendance for one to be deemed healthy. In my experience, health is anything but static. It fluctuates, shifts in and out of focus in response to circumstance.

There is more to consider here. Definitions of health have a long history, vestiges of which are found in our contemporary ideals. In Hippocratic medicine – that of Hippocrates and his followers -  health was seen as a state of balance among the four bodily humors (blood, phlegm, yellow bile, black bile), while disease stemmed from imbalance. Over time this yielded affirmative definitions of health, understood in terms of balance, equilibrium and harmony between the body, the soul (Plato’s addition) and the environment (Galen’s contribution). Negative definitions of health focused on identifying and rectifying disruptions, dysfunctions, or imbalances in the body.  

The latter approach – defining negative health -  is unsurprisingly more straightforward. Symptoms and scars offer tangible proof of illness, or another observable deviation from the norm. Defining health affirmatively, however, is a trickier affair. I am yet to meet someone who exudes an air of perfect harmony and equilibrium. “You seem like a shining embodiment of physical, mental, and social well-being” is not, as far as I’m aware, a common compliment.

These affirmative aspects of health are harder to pinpoint, let alone measure, because they are both deeply contextual and constantly shifting. From an institutional standpoint, endorsing them is also fraught—any attempt to prescribe a vision of well-being risks veering into moral paternalism.

While WHO’s attempt aspires to balance affirmative and negative stances—outlining both what health should include and what it should exclude—it ultimately loses the battle to universalism. The result is a static checklist, elegant in theory but detached from lived experience. Those who fail to meet its criteria are, by default, cast as unhealthy, stripped of a healthy identity, and ushered into the domain of institutional attention, intervention, and control.

Health in context

My research participants are among those for whom the WHO’s definition rings hollow. When I asked them what ‘health’ meant, their answers were neither medical nor corporeal; instead, they spoke of stability and safety. When I asked about threats to their health, they didn’t list diseases or symptoms but rather criminal networks, kidnappings, rapes, physical assaults, and robberies. And when I asked the simplest question of all—‘how are you?’—after the exhaustion of a gruelling migratory journey, their response was remarkably consistent: they just needed to keep moving.

For them, health was not a static state but an ongoing capacity—the ability to keep going, to press forward. Progression was not just movement; it was the promise of security, an escape from the violence, instability, and economic precarity of their pasts. In this sense, they were not only seeking asylum but health itself.

Taking a step back, why do conceptions of health matter?

Because definitions shape practice. They dictate how care is organised, administered, and, crucially, received. One of the dilemmas in humanitarian sites, particularly along migrant routes, is the low or hesitant uptake of available care. Look closely, and the reasons become obvious. For those whose health is bound to the long-term pursuit of safety, stopping for treatment can feel like a risk, not a remedy. It can mean engaging with institutions that might detain you, falling behind the group you rely on for protection, or losing pace with those whose presence feels more vital to your survival than any doctor. As such, care itself can become a liability—an interruption in the relentless forward momentum that, for many, defines what it means to live.

This brings us to the core question of my thesis: what does health mean in circumstances of life or death?

To answer this, we need context. We need to ask what drives people to think, act, and endure in different ways. It’s not just biology (and here I depart from my high school teachings); it’s an entanglement of spirituality, culture, economy, geography, politics, and history that speaks to specific ways of being. Military history, in particular, is littered with examples of what happens when we fail to grasp the forces shaping human difference. Not understanding the people you engage with—whether in war or humanitarian efforts—is a dangerous game. Yet time and again institutions attempt to analyse displaced people through rigid health metrics that have never applied to them.

So instead, I turned to anthropology’s toolkit. Through it, I was able to show how the violent, precarious, and exhausting realities of migration shape the value attached to health itself. While by institutional measures, my interlocutors would be excluded from a state of health, they did not see their experiences in those terms. Their stories, explanations, and survey responses revealed something deeper: is it that in these journeys—where fear and trauma are explicit, constant companions—health is bound to progression, to the endless movement away from danger and toward an imagined safety. Health, for them, was about maintaining forward momentum.

In many ways, this doesn’t feel so different from the rest of us. Health, in its truest sense, is processual, unstable, and always negotiated. Recognising this opens the door to a far broader understanding of what it means to pursue health, wherever that pursuit may lead.

Next up, ethnography!