Daphne Chouliaraki Milner

To begin, I’d love to hear what first sparked your interest in the connection between ecological systems and human health, and what ultimately led you to write a book about it.

Dr. Wendy Johnson

I had a bit of a winding path to medical school, which I touch on in the book. I actually started undergrad pre-med, but after struggling in chemistry, I switched to majoring in English and Political Science. After college, I worked in the Ohio legislature and then became the statewide organizer for the 20th anniversary of Earth Day. This was around 1990. So I was deeply involved in environmental and political organizing.

I came to feel that to really shift political conversations, you need to understand people’s lives at the grassroots level. So, in a somewhat unusual twist, I decided to go to medical school—to hear people’s stories. That was my way of becoming a better activist and policy thinker. I had to retake chemistry—this time with a woman professor in a smaller class—and did fine.

Even in medical school, I felt something was missing. So I pursued public health to better understand what I refer to in the book as “the other 80%,” all the factors shaping people’s health outside the clinical setting: their environments, their relationships, their sense of connection. But even in public health, the focus was often on individual behavior change, not on improving systems or environments.

And especially here in New Mexico, where I live, I feel deeply connected to the land and the community. That relationship supports my own well-being, and I wanted to explore how important that kind of connection is more broadly. Ultimately, I began to see this as the key to addressing personal health, as well as how we live more sustainably on the planet.

After 30 years of practicing medicine, I’ve become more frustrated with how constrained the U.S. health care system is: what it pays attention to, what it ignores, who has access. As I listened to patients’ stories, I began to realize how ill-equipped we are to address the root causes of ill health. That frustration is what motivated the book. 

People ask how long I’ve been writing the book, and I sometimes say, “My whole life.” I’ve always been a writer—I once contributed to a volume about international health activists—but writing a full book was a new kind of project. I started seriously working on it about 10 years ago.

Daphne

Congratulations. The book is a huge achievement. The title, Kinship Medicine, suggests a deeply relational approach to care, one we rarely see in Western medicine. What does “kinship” mean to you in a medical context? Why is it important?

Wendy

I think we have this myth of individual health, but it’s really not an individual attribute. It’s a collective one. Western medicine focuses heavily on biology, which of course matters—if you have cancer, you need someone who understands the disease. But that accounts for only about 20% of our overall health. The other 80% is relational. 

Our bodies are ecosystems. You can’t survive as an individual organism. We’re made up of trillions of microbes, and our microbiome contains 10 times more genetic material than our own human DNA. These relationships have to function well for us to be healthy. And our personal ecosystems are embedded in larger ones. If your air, water, and food are polluted, or if you can’t access green space to restore your microbiome, that affects your health. Similarly, if you’re isolated or lack supportive relationships, you suffer. We’re communal beings.

Western medicine has also separated mental and physical health, which doesn’t make sense. Behavioral and physical health are intertwined, and keeping them siloed doesn’t serve us. The book starts by making this case—why these connections matter—and then explores how we might begin to heal disordered systems. If our communities and ecosystems are unhealthy, we can’t be healthy either. The question becomes: How do we start rebuilding from that understanding?

Daphne

You’ve spoken so clearly about how disconnection—from our bodies, from others, from nature—fuels public health crises. For those less familiar with this intersection, how is that disconnection also tied to ecological degradation?

Wendy

Our capacity to think communally has atrophied. We’re not in the habit of asking how our actions affect others, human or non-human. There’s been a lot of critique of the idea that individual behavior alone can change climate outcomes, and I agree. This isn’t just about whether I use paper or plastic straws.

But as philosopher Timothy Morton writes, ecological thinking is about recognizing how we’re embedded in larger systems. When you’re part of a family, when you’re part of a community, you think about your actions and how they’re going to affect other members of that family or community. When you extend that idea of kinship to our whole ecosystem, we start to think more about our sense of responsibility to other beings.

That also means we start asking different questions. Do I really need this product? Is this decision good for my community or environment? Or is it just what consumer culture has taught me to want? We’ve been sold the idea of antiseptic, hyper-convenient living, but that comes with environmental and health costs. Living more communally—with plants, animals, even so-called “pests”—may be less convenient, but it’s more sustainable, and more in line with long-term well-being.

Daphne

Building on that, what might an ecosystem-based model of medicine look like in practice? In terms of training, diagnosis, and treatment, how would relational health care differ from the system we have now?

Wendy

Well, to start, we’d have to overhaul the entire system. The way health care is currently structured doesn’t allow time to hear patients’ stories; to really understand their lives, their histories, their environments, their relationships. That doesn’t fit into a 15-minute visit.

A better system would rely on teams, like health coaches, behavioral health specialists, nutritionists, community organizers, working together. There are promising models, like community medicine and lifestyle medicine, that move in this direction. The community health movement in the U.S., which was started by Jack Geiger and Count Gibson, envisioned clinics as spaces where people can go to access health care, yes, but also to address broader community needs. In the Mississippi Delta, for instance, the first community health centers helped residents build sanitation systems, improve housing, even run farms. Patients were on clinic boards. It was about local ownership and addressing root causes.

Today, we still have community health centers—over 1,200 of them, serving around 28 million people—but much of that early vision has been lost due to lack of funding and systemic barriers. To really shift things, we’d need to re-center the community and then build care around that.

Daphne

Speaking of broader care, what role do non-human relationships—plants, animals, land—play in kinship medicine?

Wendy

They’re central. That early community health center in the Mississippi Delta had a communal farm. At our clinic in Santa Fe, we had a community garden where families came together, grew food, and then used that food in cooking classes. We organized hikes in nature as a form of collective care.

In New Mexico. and really across the country, you can find deep knowledge about native plants, their medicinal and nutritional uses. Revitalizing that knowledge and sharing it connects people to the land. And that connection is good for health. Digging in the soil strengthens the microbiome. Moving your body outdoors reduces stress. Doing these things in community builds relationships. It’s all interconnected.

Daphne

If we embraced kinship medicine at scale, what kind of transformation might we see, both with regards to health but also across other sectors of society?

Wendy

I think we’d see major shifts. There are already small examples: walking clubs that bring people together for deeper conversations or communities building sustainable housing cooperatives where people live in connection with each other and the land. We are so isolated right now and that isolation has really fueled, I think, the disconnection and the polarization we see in our political systems. But face-to-face connection, especially through shared projects, does the opposite. In my neighborhood, we all work together to maintain centuries-old irrigation ditches. That collaboration builds relationships, even across political divides.

The pandemic deepened our disconnection, especially for young people. We need to rebuild the skills of being together. When we connect face-to-face, and especially in nature, something shifts. We fall in love with each other, and with the world. And when you feel kinship—with people, with land—you fight for what you love. I believe our politics would look radically different if more of us were grounded in that kind of connection.