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Old & New Medical Geography: A Shift to Health Geography?

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Title: Old & New Medical Geography: A Shift to Health Geography?


1
Old New Medical Geography A Shift to Health
Geography?
Professor Mark W. Rosenberg Queens
University Department of Geography Department of
Community Health and Epidemiology Kingston,
Ontario, Canada, K7L 3N6 mark.rosenberg_at_queensu.ca

2
Introduction
  • What is Medical Geography?
  • Medical Geography Approaches
  • A Shift to Health Geography?
  • New Ways of Looking at Old and New Problems
  • Concluding Comments

3
What is Medical Geography?
  • The term was first applied in the 1700s to
    describe studies of the relationship between
    disease and the environment
  • Medical geography applies human geography methods
    and approaches to understand spatial influences
    on human health, such as
  • How regional differences explain geographical
    variations in disease
  • How changes to the physical environment affect
    rates of disease
  • Understanding patterns of disease as a tool for
    prevention

4
History of Disease
  • Medical geography has been strongly influenced by
    parallel developments in epidemiology and public
    health
  • The origins of medical geography are, therefore,
    tied to developments in these areas
  • Early beliefs
  • Ancient Greece - Hippocrates first to pursue
    rational bases for the presence of disease
  • Ancient China Yin and Yang
  • 1800s John Snow identified the source of
    cholera often seen as the first medical geographer

5
Cholera Deaths and the Broad Street Pump Map
6
Disease Mapping
  • Distinct for its interest in the incidence and
    prevalence of disease .
  • The mapping of morbidity and mortality at various
    geographic scales
  • Examples of disease mapping trace back to the
    spread of the plague in the 1600s.
  • A useful tool for exploring how diseases spread
    and identifying the locational origin of a
    disease.
  • Unless we have a good understanding of the cause
    of a disease the approach may be of limited use.
  • Tends to rely on large samples

7
Example of Disease Mapping at the Global Scale
8
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10
Disease Ecology
  • Disease ecology aims to understand the spatial
    and temporal patterns of disease
  • Rather than reducing disease into isolated
    influences the approach considers the system as a
    whole
  • Focus on the relationship between disease and the
    environment climate, plant and animal life etc.
  • Differs from epidemiology which seeks to
    understand the causes of disease
  • Cause rarely identified in medical geography
    usually we only get an indication of the strength
    of a relationship
  • Environment can also include the social and
    psychological environment meaning that place
    matters increasingly.
  • e.g., environmental inequality and circulatory
    disease

11
Access, Delivery, and Health Service Planning
  • The Geography of Medical Resources
  • Three key issues
  • Whether the geographical distribution of
    resources is equitable
  • How accessible are medical resources to various
    segments of a population
  • What are the social and economic impacts of
    locating medical resources at a particular
    location.

12
Access, Delivery, and Health Service Planning
  • The Geography of Medical Resources
  • Location and distance are key variables
  • An equal distribution of medical resources does
    not necessarily mean people have access to those
    medical resources
  • Distinguishing between geographical, economic and
    social-cultural access
  • e.g., womens access to cervical screening
    services
  • The focus on social and economic impacts of
    siting facilities in particular locations
    stimulated by the deinstitutionalization of
    mental health services in the 1970s

13
Location-Allocation Modeling
  • Location-Allocation modeling dates back to the
    1960s
  • Used in many aspects of geography, particularly
    retail studies to determine the optimal location
    of current facilities (hospitals, offices,
    warehouses, etc.) in order to minimize movement
    and other costs (Johnston et al., 1994345)
  • Key concepts demand, supply and capacity
  • This form of modeling was initially statistical
    now relies more on GIS
  • Medical geographers interested in the physical
    accessibility of medical clinics, hospitals,
    speed with which ambulances may reach patients
    etc.
  • e.g., optimization of location of emergency
    services

14
Access, Delivery, and Health Service Planning
  • Three trends in current research based on the
    geography of medical resources
  • Research much more closely tied to specific
    policy issues faced by governments
  • Research targeted towards particular groups who
    might be disadvantaged in accessing services
    specifically related to their health needs
  • Incorporation of qualitative research into
    studies of geographic access and the social and
    economic impacts of siting facilities

15
The Shift to Health Geography
  • The shift is characterized by the emergence of
    new themes and new ways of investigating these
    themes a methodological pluralism?
  • Greater interest in the socio-spatial and
    economic determinants of health has led to the
    stronger presence of theory than in medical
    geography.
  • Greater focus on the importance of place while
    space continues as an important theme.
  • Location is usually a fixed point in space
  • Space is more relative and often connected to
    time
  • Places are locations imbued with meaning

16
The Shift to Health Geography
  • Changing definitions of health
  • Alma Ata Declaration defined health as
  • a state of complete physical, mental and
    social wellbeing, and not merely the absence of
    disease or infirmity
  • Health seen as a fundamental human right
  • Underlined the importance of social, economic,
    and political equity in health
  • Growing influence of the population health
    perspective

17
(1) Population Health Approach
  • population health refers to the health of a
    population as measured by health status
    indicators and as influenced by social, economic,
    and physical environments, personal health
    practices, individual capacity and coping skills,
    human biology, early childhood development, and
    health services. As an approach, population
    health focuses on interrelated conditions and
    factors that influence the health of populations
    over the life course, identifies systematic
    variations in their patterns of occurrence, and
    applies the resulting knowledge to develop and
    implement policies and actions to improve the
    health and well being of those populations (Dunn
    and Hayes).

18
The Social Determinants of Health
  • income inequality
  • social inclusion and exclusion
  • employment and job security
  • working conditions
  • contribution of the social economy
  • early childhood care
  • education
  • food security
  • housing
  • (Public Health Agency of Canada)

19
(2) Therapeutic Landscapes
  • Therapeutic landscapes are places that have
    achieved lasting reputations for physical,
    mental, and spiritual healing (Kearns and
    Gesler, 19988)
  • Intends to gain an understanding of historical
    sites as places of healing unique to the
    experiences of the individual
  • The social/cultural reputations of these places
    are built on the physical environment (e.g., spa
    towns)
  • Ethnographic (e.g., the representation of former
    asylums in contemporary landscapes) vs.
    experiential studies (e.g., the meaning of
    therapeutic places to seniors)

20
(3) Social Capital Theory
  • Social capital consists of the actual or
    potential resources that inhere within social
    networks or groups for personal benefit
    (Carpiano, 2006166)
  • All social connections are not equal resources
    available through one persons family or friends
    may differ with socio-economic status
  • Those with greater social capital also experience
    better health status
  • At the group level social capital can lead to
    greater access to resources

21
Social Capital Theory Health Geography
  • Linking Health and Place
  • place effects versus individual factors in
    understanding geographic variations in health
    status
  • At the micro-level detailed studies of
    neighbourhood attributes comparing rich and poor
    neighbourhoods and people in good and poor health
  • At the macro-level large scale statistical
    studies using multi-level modeling to estimate
    the contributions that individual factors and
    place effects make separately and in combination

22
(4) Embodied Geographies
  • Cartesian mind/body dualism 15th C
  • Biological determinism
  • e.g., human genome project
  • Social constructionists have highlighted how
    dangerous biological determinism can be
  • Social constructionists argue that the body is
    shaped by the social and cultural meanings
    ascribed to it.
  • Hall (2000) explains that a womans subordinate
    position in society is seen to be a function of
    social processes rather than inferior biology.

23
(5) Critical Disability Studies
  • The approach frequently aims to include people
    living with disabilities in research and activism
  • Dismisses the need for resources to be
    distributed equally (as advocated by the welfare
    state) to instead ensure individuals and groups
    are enabled to participate in the mainstreams of
    social life in meaningful ways (Gleeson,
    1997205)
  • Academia criticized for not providing an enabling
    environment for persons with disabilities.
  • e.g., Parallel Transit Service

24
(6) Health and the Environment
  • Linking Health and the Environment
  • Impacts of high profile environmental disasters
  • Psycho-social impacts of living near potential or
    real sources of environmental contamination
  • How the environment in which we live affects
    particular health behaviours (e.g., smoking)
  • Influenced by the new cultural geography,
    public health and health promotion research
  • Climate change research and its impacts on health

25
(7) Activist Epistemologies
  • The emergence of activist epistemologies
  • Critical Perspectives
  • Distinct for their focus on producing social
    change through research
  • Research is viewed as a means of giving voice to
    political and social movements
  • Prevalence of Health Geography literature focused
    on health inequalities
  • The role of participatory research approaches
  • e.g., critical disability studies

26
New Ways of Looking at Old New Problems
  • Developments in the Geography of Disease Mapping
  • New impetus because of new emerging diseases
    (e.g., HIV/AIDS and SARS)
  • Improvements in data gathering
  • Importance of improved electronic databases and
    population health surveys
  • New techniques for analysing data
  • GIS
  • Spatial Statistics
  • Multi-level modeling

27
New Ways of Looking at Old New Problems
  • New geographies being created through experiments
    with telehealth
  • Public sector restructuring, the growth in
    importance of supra-national bodies (e.g., the
    World Bank) and globalization
  • New social theories and qualitative methods
    (e.g., participant observation, interviews, focus
    groups, photovoice, participatory action research)

28
Conclusions
  • Medical/health geography is on a growth
    trajectory within geography and health research
  • Remains rooted in classic geographic questions
    about identifying and explaining the geographic
    distribution of diseases and medical resources
  • Recognition of the importance of the latest
    quantitative and qualitative methodological tools

29
Conclusions
  • Medical geography is recasting itself as health
    geography by taking up the challenges of linking
    health and the environment, health and place and
    health and health care to public policy
  • Greater focus on vulnerable groups and their
    everyday lives in which health and health care
    play themselves out in developing and developed
    countries
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