Health and Medical Geography

Health Geography

• Concerned with the interaction between people and their environment
• Looks at health from a holistic viewpoint, considering society and space
• Conceptualizes how place, location, and geography affect health, well-being, and disease
• Focuses on the interaction between people and their environment, the role of space and place, and a holistic view of health
• Aims to support informed decision-making

Medical Geography

• Applies geographical concepts and techniques to study health-related topics
• Integrates facts, concepts, and techniques from social, physical, and biological sciences
• Is an integrative, multi-stranded sub-discipline

Location

• Location as Space: A geometric or fixed point on Earth's surface
• Location as Place: A location that is given meaning

Defining Health

• World Health Organization (WHO) defines health as complete physical, social, and emotional well-being
• Health, according to the Ottawa Charter, is a resource that enables people to manage and change their surroundings

Health Geography Research Areas

• Services, infrastructures, and land-use planning
• Disease surveillance, modeling, and mapping
• Study of disease etiology and determinants of health
• Environmental health risk factor assessment
• Health service use
• Inequalities in health outcomes
• Therapeutic and healthy landscapes

Ecology and Disease

• Ecology: The relationships and interactions between organisms and their environment
• Disease ecology: The study of interactions between pathogens or parasites and their hosts
• Outbreaks of infectious diseases are often caused by changes in the ecology of the host, pathogen, or environment

Disease Mapping & Infectious Diseases

• Disease maps are important tools for surveillance and investigation in disease ecology
• Infectious diseases are linked to specific places
• In the 17th and 18th centuries, infectious diseases like measles, smallpox, and plague were associated with specific locations and affected both the rich and poor
• Disease mapping is effective for analyzing disease ecologies and can prompt communal responses

Recent Infectious Diseases

• Respiratory and diarrheal diseases are major causes of death
• Recent infectious diseases include AIDS, malaria, Ebola, influenza, SARS, MERS, and Coronavirus

Factors Affecting Disease Spread (PHB)

• Population: Factors include gender, age, and genetics
• Habitat: Consists of the natural environment (climate, location), built environment (sanitary services, clean water, food storage), and social environment (public health, social support)
• Behavior: Influenced by beliefs, culture, religion, social organization, and technology used to treat or screen diseases

Ebola Case Study

• An epidemic in Central Africa involved bats, land animals, and humans
• Transmitted via bodily fluids
• Three factors explain the virus's success in Liberia: population (many children and elderly), habitat (lots of bats, lack of clean water, poor food storage, handling raw meat, lack of public health, and social support), and behavior (eating monkeys, lack of medical technology, funeral practices)
• Spot maps described the number of cases in a certain region, where darker shades indicated more cases
• Investigatory mapping was performed to find where the bats are and where people are getting bitten

Epidemics and Pandemics

• Endemic: Disease existing in a certain area or among a set population
• Epidemic: Disease within a certain location/region
• Pandemic: Disease that is worldwide

Epidemics: Challenges and Opportunities

• Challenges encompass population growth, conflict, poverty, antibiotic resistance, distrust in authority, misinformation, and panic
• Opportunities include increased surveillance, more experience, evolving science, improved communication, and improved public health

Disease vs. Illness

• Disease: A medical conception of pathological abnormality diagnosed by experts using objective signs and symptoms
• Illness: An individual's experience indicated by personal feelings of pain and discomfort, which has subjective, social, and psychological dimensions

Disability vs. Handicap

• Disability: Poor function or impairment
• Handicap: A disadvantage due to societal structures

Social Construction of Disease

• Individuals and groups create their understanding of reality, and this knowledge is a product of social dynamics
• Historical examples include viewing AIDS and homosexuality as diseases as well as drapetomania, hysteria in women, and homosexuality

Development of Western Medicine

• Classical Greek period (Hippocrates): Focused on a healthy mind, healthy body, and clean water
• Middle Ages: Church-dominated with sickness equated to sin, and cure seen as turning to God
• Theoretical/social development: Separation of body and mind
• 19th century: Development of hospitals, labs, and sanitary reform
• 20th century: Industrial medicine with mass production

Concerns Emerging in modern medicine

• Changing nature of diseases
• Increasing cost of medicine
• Growing recognition of social determinants

Decline in Death Rates

• First decline (1750s): Improved nutrition
• Second decline (1850s): Improved sanitation
• Third decline (1950s): Improved medical care and vaccination

Iatrogenesis

• Sickness produced by medical activity
• An example of medicine producing side effects

Determinants of Health

• Social, economic, and physical environments
• Personal health practices
• Individual capacity and coping skills
• Human biology
• Early childhood development
• Health services

Upstream Determinants

• Focuses on tracking back and finding more previous reasons and causes

Focus of Population Health

• Focuses on interrelated factors influencing health over the life course
• Moves beyond individual factors and healthcare
• Identifies systematic variations in patterns (inequities in society)
• Informs decision-making

Measuring population Health

• Standard measures include life expectancy, child mortality, premature death, disease rate, and low birth weight
• Considers function (disability days, occupational injuries), well-being (psychological health, self-rated health, self-esteem), behavioral factors (smoking, drinking, physical activities), and living/working conditions
• Includes social support/environment, physical environment (air quality, pathogens, green space), and health services (utilization rates, access)

Philosophical views

• Ontology: Our view of the world, nature, and reality based on belief, not proof
• Methodology: Utilizes coherent rules and procedures to investigate a situation
• Epistemology: How we understand the world and the questions we ask, based on our ontology

Qualitative vs. Quantitative Inquiry

• Qualitative: Emphasizes interpretation, observation, notes, and is inductive, moving from specific to general. Analysis is challenging and involves categorizing words
• Quantitative: Emphasizes numerical and quantitative data, uses a deductive method moving from general to specific

Epistemological Approaches

• Positivist
• Social Interactionist (= social constructionist)
• Structural
• Structurationist
• Post-structuralist

Positivist Approach

• Focuses on quantitative, statistical data and emphasizes observable, measurable phenomena
• Establishes testable hypotheses and uncovers causal relationships
• Prioritizes space over place
• Asserts objective reality can be discovered through direct observation
• Believes material explanations are sufficient

Key Assumptions of the Positivist Approach

• Knowledge is neutral, and the observer is objective
• Criticism: It fails to capture the complexity of human behavior as observations can have biases and errors, and it doesn't explain "why"

Social Interactionist Approach

• It is social constructionist and humanistic
• Focuses on how people understand their health
• Qualitative in research style
• Aims for an ultimate understanding of people by seeking expertise from interviewed individuals
• Emphasizes understanding that people are different
• Researchers' positionality matters as their identity, values, and background affects interpretation

Criticisms of Social Interactionist Approach

• Results are hard to verify and can't be generalized
• Neglects wider structural factors

Structuralist Approach

• Identifies the underlying cause of problems as social, economic, and/or political systems
• Looks for explanations for differences in health/ill health, access to quality care
• The main question is how individual health choices are constrained by structure and power
• Criticisms of this approach include methodological concerns and minimal attention to the role of personal choice

Structurationist Approach

• A "middle ground" between structure and agency
• Structures shape social practices and actions, but in turn, these actions may shape and recreate structures

Post-Structuralist Approach

• Approach is Post-modernist
• Concerned with how knowledge and experience are constructed in the context of power relations
• Emphasis on difference or otherness, that there's no one truth
• Focuses on how domination of knowledge = power

Risk as Discourse in Northern Saskatchewan

• Uranium mine overseen by federal bodies, the Nuclear Control Act, and the Government of Saskatchewan
• Focus given to raising the northern public's understanding of technical issues related to uranium mining

Equality vs. Equity

• Equality: Everyone gets the same, regardless of need
• Equity: Everyone gets what they need to be successful and fairness

Body Mass Index (BMI)

• Calculated as mass in kilograms divided by height in meters squared (BMI = Mass (kg) / (Height (m))^2)
• Normal BMI: 18.5-25, Overweight: 25-30, Obese: >30

Obesity

• Behavior is a key factor in maintaining health
• Economic costs of obesity: Hospital care, pharmacy care, loss of work, decreased productivity, and premature death

Top 3 Health Determinants for Obesity

• Gene/biology: Includes the thrifty gene hypothesis, metabolism, and hormonal characteristics
• Behaviors/Agency: Includes food consumption, personal choice, and hormonal regulation
• Healthcare: Education, awareness, etc.
• Other factors: Built environments, socioeconomic status/environments, income/education/position in society, economic and policy structures

Solutions to Obesity

• Complex, and need to look beyond individuals
• Focus given to Population-based approaches: Public education, modifying food and activity, policy planning

Social Determinants of Health

• Contextual vs. Compositional Determinants:
  • Compositional: Aggregated characteristics of individuals in an area
  • Contextual: The effects of place
• Common SES (Socioeconomic status):
  • Education, income, occupation
  • Education: Higher education, less death
  • Income: Higher income, higher life expectancy
  • Occupation: Job satisfaction, unemployment, high-risk jobs
• Sex and health:
  • Individual level: Psychological stress, linked to effort-reward balance, job insecurity, sense of control, jealousy, and health-threatening coping behaviors

"The Great Leveller"

• Wealth doesn't determine health
• The gap between rich and poor does

Inequality and Health

• Income inequality is associated with depression among Americans
• Income inequality on poor self-rated health
• Income inequality associated with self-reported health
• Social cohesion (= Social capital) and Health

Environmental Health

• The study of conditions in the natural and human-made environment that can influence health and well-being

Hazard

• Anything that can cause injury, death, disease to personal and public property, or destruction of environmental components
• Two ways to look at hazards: Lack of access to necessities and exposure to environmental hazards

Risk

• Risk measures the probability of suffering a loss as a result of exposure to a hazard

Exposure vs. Susceptibility

• Exposure: Everyone can be exposed, but some have increased risk and higher susceptibility

Risk Pathways

• There are four pathways for risk
• Physical Hazards: Natural disasters (tornadoes, floods, wildfires), risk avoidance, risky population, poverty increases risk and exposure
• Biological Hazards: Pathogenic bacteria, fungi, worms, viruses, which are affected by crowding and water or food contamination, risky populations
• Socio-environmental Hazards: Cultural hazards related to risky behaviors, socio-environmental hazards: Smoking, alcohol, drug, unsafe sex
• Chemical Hazards: Linked to disease, from anthropogenic and natural sources, exposure via ingestion, inhalation, absorption

Risk Assessment and Toxicology

• Risk assessment includes epidemiology, which is the study of the distribution and determinants of health and disease
• Toxicology measures and analyzes potential toxins, intoxicating substances, and prescription medications present in a person's body

Epidemiological Study Designs

• Includes Randomized Controlled Trials (RCTs)
• Randomized controlled trials (RCTs) limit bias, show strong causal relation, and have little confounding
• Case-control studies are retrospective and study people with a condition, interview them, and go back in history. Positive due to being cheap, fast and needing less subjects
• Cohort studies: Follow exposed and unexposed groups, test condition
• Cross-sectional (retrospective): test condition and expose random sample
• Ecological: Study rates by area and environment

Risk Management

• Follows risk assessments and review of evidence
• Includes cost-benefit analysis, risk-benefit analysis, and public preference
• Innocent until proven guilty vs. precautionary approach: Risk-benefit must always be taken into account, and a cost-benefit performed

Environmental Health Risk Management

• Prevent exposures through regulations (best) and educating individuals (second best)
• Includes research, law and policy, and on-the-ground protection

Risk Communication

• Involves informing the public about risks and strategies to reduce them
• Goals are awareness, hazard avoidance, and reduced concern