Approaches to Geography of Health

• A relative concept that may be different for different people - depends on context
• e.g. some illnesses might make people more unhealthy than others, it is a spectrum (you can be more/less healthy)
• WHO definition - "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Shows that one of the first things that comes to mind is the absence of disease.

• It is often difficult to measure health. Ways that we measure it often don't match up with our views of what health is (absence of disease).
• Can be measured by mortality (e.g. IMR), morbidity (incidence/prevalence), physical indicatiors (BMI, obesity, malnutrition, memory), mental health indicators (psychiatric reviews).
• Health can also be self-rated.
• It can also be measured by happiness/life satisfaction/well-being. These make comparaisons between countries tricky.

• Healthy behaviours e.g. exercise rates, diets, alcohol consumption, smoking, sleep
• Environmental quality e.g. air/noise pollution, access to safe water
• Access to healthcare e.g. doctors per person, medical technology, healthcare cost/uptake, hosptial bed occupancy, vaccinations
• Quality of life e.g. HDI

• First health data collected tended to be mortality data - easy to collect because people only died once and it was clear to see when someone was dead
  • e.g. burial records (Bills of Mortality - lists death by cause, 1664), civil records of death (some countries have incomplete/non-existent civil registration systems)
• Data on morbidity and illness was much more difficult to collect as not everyone who catches a disease dies from it and many cases don't come into contact with medical professionals as people might die early/not want to contact authorities
• Data can also come from physical indicators e.g. blood pressure.
  • These have to be taken from healthy people too to set the benchmark
  • Rarely collected in surveys as it is expensive and time consuming
• It has become common to ask about self rated health and well-being
  • Census questions e.g. 'do you have any physical or mental health conditions or illnesses lasting/expected to last 12 months or more?'
  • Surveys can also ask about a rangeof life satisfaction and happiness aspects

Spatial epidemiology

• In 1854, John Snow worked out that cholera was water-borne by mapping deaths
• Hypothesis wasn't immediately accepted by public health establishment, but he is still often regarded as the father of modern disease mapping and spatial epidemiology
• William Farr established urban-rural differences in mortality in the 1800s too, comparing urban areas with rural 'healthy districts'
  • One of the first people to think about geographical differences in mortality and what underlay them

Medical geography in the 20th century

• The sub field of medical geography had two main themes in the 20th century: spatial epidemiology/disease ecology and health services research.

1. Spatial epidemiology,disease ecology

• Spatial patterns in disease and mortality and how diseases spread through time/over space
• Characteristics of areas with different disease patterns, revealing influences on patterns
• Methods such as mapping, regression, spatial statistics, multi-level modelling

2. Health services research

• Spatial perspectives on planning, help-seeking behaviour, health services provision
• Looked at immunisation, demand for health services (for children/elderly/mental health) and the impact of spending cuts

Gradually the two strands began to overlap.

• The cultural turn - increasing focus on culture and meaning, away from positivism and causality
• Geography of health proposed to incorporate the construction of issues of place, identity and health
  • Fleuret and Atkinson speak about the 'increasing use of wellbeing in contemporary health debates' (2007)
  • Kearns and Moon speak about place and its role in the suggested 'new geography of health' (2002)
• Some argued that the change from 'medical geography' to 'health geography' was accompanied by a move away from a focus on specific diseases, perhaps implying the absence of disease definitions and towards broader definitions of health and wellbeing
• Others argued that the change was more about the importance of place in the student of health and the need to recognise place as an operational, living construct rather than a receptacle for people
• General recognition that the quantitative and qualitative provide complementary perspectives and both remain strong parts of the discipline
  • Qualitative approaches (health)- insights into micro-geographies and experiences
  • Quantitative approaches (medical)- needed for context and to test hypotheses/theories
• Both are still used - health geography has resisted dichotomisation unlike other disciplines

• Used to be treated as receptacles for humans - simply lines on a map that divides people
• This meant that places with poor health only had poor health because the population is composed of people with characteristics associated with poor health (health of a place was seen as the sum of the health of all the people in the place) - composition
• In the 1990s there was a re-emergence of the idea that place matters - context
  • Aspects of place matter for health over and above the effects of the characteristics of the inhabitants e.g. physical environment, products of the people (social capital, community ties), residential sorting (housing stock/location)
• Relationship between composition and context is complex - people create places but places also create/effect people