*2.1. Demystifying the Concepts of Land Tenure Security and Health*

Like many concepts, the concepts of land tenure security and health are fluid and, as expected in intellectual discourse, connote different meanings to different individuals and groups, including that it is referred to as housing tenure in some jurisdictions. While the semantics of the concept may be argued differently, we hold the view that land tenure security encompasses housing tenure security. Thus, variants of housing including mortgage, ownership, or rental housing as classified in some jurisdictions, are variants of tenure that come with varying levels of tenure security. Our use of land tenure security is to underscore the fact that land is the basic building block of housing and as such land tenure security and housing tenure security cannot be separated. Particularly in developing country context where real estate markets are dominated by private housing development, tenure in relation to land is mostly precedent to housing tenure. Notwithstanding varying conceptualizations of land tenure [61–66], it fundamentally denotes a rights-based social relationship, whether legal or illegal, between people, land, and society and the basis upon which land is held, used, or owned. The concept of tenure security has evolved in response to efforts to clarify investment incentives of property holders [67]. Varying views on the concept of land tenure security has led to its definition from two broad schools of thought—the assurance and the substance of rights school of thoughts. On the one hand, proponents of the assurance school of thought define security of tenure in terms of the uncertainty of rights, the probability of loss of all or part of the rights held, the expected time of residence before eviction, the uncertainty of changes in government policy, and the impacts of changes in policy on tenure attributes [62,64,68–71]. On the other hand, the substance of right school of thought defines land tenure security in terms of the duration of rights, legal title to land, renewability of rights, and the right to sell or transfer land [72,73]. This study shares the views of Bruce and Migot-Adholia [74] that land tenure security exists when an individual perceives that he or she has legitimate claims to a piece of land on a continuous basis, free from imposition or interference from outside sources, as well as the ability to reap the benefits of labor and capital invested in that land, either in use or upon transfer to another holder. Thus, land tenure security exists when one's land tenure is legally recognized through formal registration or documentation; socially recognized through informal, customary, and undocumented tenure arrangements; and/or symbolically recognized through anti-eviction, adverse possession, social legitimacy, and extra-legal means, as well as when such tenure is also perceived to be secure by the tenure rights holder. We acknowledge that tenure is socially constructed and that there are different lenses for looking at land tenure—either via the lens of degree of formality (continuum of land rights) or legality (legal titles to land) both of which confer varying social obligations of land ownership and use—rights, restrictions, and responsibilities. A focus on legality often excludes legitimate and intermediary tenures that proffer enough

security of tenure that are commensurate with people's circumstances of life. We hold the view that the legality of tenure by way of titles is not necessarily a precondition for land tenure security [75]. Instead, the individual's perception anchored on the degree of formality of tenure and the rights, restrictions, and responsibilities conferred by this formality, is the defining feature of land tenure security. The argument here is not that titles do not guarantee secure tenure, rather that there are multiple ways to achieving land tenure security that is not exclusive to land titles. Hence, we view land tenure security from a degree of formality perspective that enable us to capture the variants of tenure on the tenure continuum including but not limited to private rent, public rent, freehold, co-housing, and squatting.

The concept of health includes the traditional biomedical, ecological, holistic, and other universal concepts [16]. From the traditional point of view, health is the absence of disease and illness. That is a person is healthy if only all organs of the person are functioning normally [16]. From an ecological perspective, health is a relative concept that is influenced by the individual's quality of life and surroundings and depends on the individual's ability to adapt to a dynamic environment and society. Thus, health according to the ecological school of thought is the state of equilibrium between human beings and their environment. The holistic concept of health combines the traditional and ecological concepts by conceptualizing health as multi-dimensional concept that seeks to understand human health within the context of environment, which encompasses the physical and social environment.

Adopting a holistic approach to health, the World Health Organization (WHO) in 1986 defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". Critics [16,76,77] argue that WHO's definition of health lack specificity in defining well-being, for equating well-being to health, and for assuming health as a perfect state of being, which is practically not achievable. However, the various viewpoints of health articulated by the critics agree that the concept of health is multidimensional, involves the absence of disease, and is not influenced by a single criterion. Therefore, this study subscribes to the WHO's definition of health and multidimensionality of health, based on which the study envisions four dimensions of health—environmental, physical, social, and psychological, which can potentially be affected by land tenure security. The abstract question then is, what has a social science construct such as land tenure security got to do with a biomedical construct of health? A premise for answering this question is identifying a framework that allows for identifying and connecting the two interdisciplinary concepts.
