Title: Old & New Medical Geography: A Shift to Health Geography?
1Old 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
2Introduction
- What is Medical Geography?
- Medical Geography Approaches
- A Shift to Health Geography?
- New Ways of Looking at Old and New Problems
- Concluding Comments
3What 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
4History 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
5Cholera Deaths and the Broad Street Pump Map
6Disease 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
7Example of Disease Mapping at the Global Scale
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10Disease 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
11Access, 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.
12Access, 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
13Location-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
14Access, 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
15The 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
16The 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).
18The 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
21Social 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
26New 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
27New 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)
28Conclusions
- 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
29Conclusions
- 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