G IS a n d h e a lt h g e o g r a p h y
What is health geography?
Geog 471
Medical Geography
In order to understand 'health geography,' we should first
consider the past, when medical geography was the norm.
Some definitions of medical geography:
Medical geography is the application of geographical
perspectives and methods to the study of health, disease and
health care.
Johnston et al., (1994) Dictionary of Human Geography, p.374.
Medical Geography
Medical geography uses the concepts and techniques of the
discipline of geography to investigate health-related topics.
Subjects are viewed in holistic terms within a variety of cultural
systems and a diverse biosphere. Drawing freely from the
facts, concepts and techniques of other social, physical, and
biological sciences, medical geography is an integrative, multistranded subdiscipline that has room within its broad scope for
a wide range of specialist contributions.
Mead and Earickson (2000) Medical Geography, p.1
Health Geography
The new generation of health geographers, in reaction to the
previous medical geographer's view of the discipline, state:
Our reply is that this dominant biomedical viewpoint is both
flawed and limited.
There is an urgent need to go outside the body, to develop an
alternative social and environmental perspective on health in
which geography can play an important part, along with other
social sciences.
Jones and Moon (1989) Health, Disease and Society: An
Introduction to Medical Geography, p 1.
Health Geography
Local variations in health status and health care provision are
certainly important, but the principal concerns of medical
geography as currently practised--access to and the location of
and utilisation of health facilities, the use of quantitative
techniques for spatial analysis in health care planning, or the
socio-political determinants of health and access to health
care--are limiting. Medical geography requires radical surgery if
it is truly to come to grips with such issues.
Mohan (1989) Medical geography: Competing diagnoses and
prescriptions, Antipode21(2), p. 176.
Health Geography
In the marriage of humanistic geography and contemporary
models of health suggested by these writers, we have an
incipient post-medical geography of health.
Kearns (1993) Place and health: Towards a reformed Medical
Geography, Professional Geographer, 45(2): p 141
Perspectives
In so far as it is possible to distinguish clearly between the areas
of work labeled traditional and contemporary, we suggest that
the traditional strands accept disease as a naturally occurring,
culture-free, and real entity, where the problems posed by
questions of accurate measurement and distribution are
assumed to be technical and solvable.
In contrast, the other contemporary strands adopt a stance
which argues, in various ways, that notions of health, disease,
and illness are problematic, and intimately linked to power
relations in society. Thus, the assumption of health
professionals as invariably caring, neutral scientists is
questioned, and the different roles they fulfill in maintaining the
current social order become subjects for scrutiny.
Curtis and Taket (1996) Health and Societies, p. 22.
Perspectives
Five Strands of Health Geography
Spatial patterning of disease and health
Spatial patterning of service provision
Humanistic approaches to medical geography
Structuralist / materialist / critical approaches to medical
geography
Cultural approaches to medical geography
Perspectives
Spatial patterning of disease and health
Approaches
Assumptions
patterns of disease + patterns of topography, meteorology
medical cartography (e.g. mortality atlases)
early work actually conducted by physicians (Snow, 1855)
diffusion
quantitative
diseases = facts
role = understand ecology of diseases (Jacques May, 1958 - father of medical
geography)
ecological fallacy = main analytical enemy
examples: cholera in Soho London - 1854 (Snow); malaria
US Cancer Atlas
[Link]
Perspectives
Spatial patterning of service provision
Approaches
Assumptions
spatial patterns of health service facilities (mainly hospitals)
patterns of utilization
patterns of inequity in supply and use (demand) of services
quantitative
disease = fact
people are optimizers - re: rationality
health care = major determinant of health
distance decay
Build it, and they will come.
Examples: optimal ambulance shed locations - location/allocation models; spatial
patterns of childhood immunization
Health care service provision
[Link]
Perspectives
Humanistic approaches to medical geography
Approaches
understand lay rationality
qualitative - e.g., grounded theory, phenomenology
Assumptions
illness = socially constructed
people are satisficers - re: rationality
perception of health = major determinant of health
social context influences perception
meaning can be understood from stories
Examples: lay perceptions of health (Eyles and Donnovan 1986); impact of
environmental policy on the health of communities
Limitations: what about social constraints on human action?
Environmental justice
[Link]
[Link]
Perspectives
Structuralist / materialist / critical approaches to medical geography
Approaches
inequalities in health
Marxist critiques of capitalism
Assumptions
structure of social/political/economic system is the key determinant of health and
variation in health
macro-scale analysis is important
understand links between h/c professionals and reproduction of unequal power
relations
Examples: community-based childcare; health inequalities in Canada
Limitations: what about human agency/creativity to overcome social constraints?
Socio-economic factors
[Link]
[Link]
Perspectives
Cultural approaches to medical geography
Approaches
therapeutic landscapes
health promotion
Assumptions
reframe health in positive terms
place important determinant of health
Examples: Hokianga district New Zealand - rural health centres (Kearns,
1993); culturally sensitive health promotion (Manson-Singer et al., 1996)
Limitations: what about social constraints on human action?
[Link]
Health Geography
Conclusion
medical geography = too narrow -- health geography
preferred
now, much more in tune with debates in social theory and
policy
special role for place - physical space, place in
the world, sense of place, cultural space
Resources
BC Health Atlas
The BC Atlas of Wellness
