Health and Medical Geography

• Health geography examines the interaction between people and their environment.
• Health geography considers health holistically, incorporating society, space, place, location, and geography in relation to health, well-being, and disease.
• Medical geography utilizes geographical concepts and techniques to study health-related topics, integrating social, physical, and biological sciences.
• It is viewed as an integrative, multistranded sub-discipline.

Location vs. Place

• Location as space is a geometric/fixed point on the Earth's surface
• Location as place is when a location is given meaning

Health

• Defined by the World Health Organization (WHO) as encompassing complete physical, social, and emotional well-being, not merely the absence of disease.
• Defined by the Ottawa Charter as a resource that empowers individuals to manage and even change their surroundings.

Health Geography Research Areas

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

Ecology

• Focuses on the relations and interactions between organisms and their environment, including other organisms.

Disease ecology

• Studies the interactions between pathogens or parasites and their hosts.
• Outbreaks of infectious diseases are frequently caused by changes to the ecology of the host, pathogen, or environment.

Disease Maps

• Maps are important surveillance and investigative tools for studying disease ecology.

Infectious Diseases

• Diseases are often geographically associated and can affect both the rich and poor alike.
• Disease mapping is effective for the analysis of disease ecologies.
• Recent infectious diseases include respiratory and diarrheal illnesses, AIDS, malaria, Ebola, influenza, SARS, MERS, and Coronavirus.

Factors affecting spread of disease (PHB)

• Population: gender, age, genetics
• Habitat: Natural environment (climate, location), built environment (sanitary services), social environment (public health, social support)
• Behaviour: Beliefs (culture, religion), social organization, technology

Ebola Case Study

• The Ebola epidemic in central Africa involves transmission from bats to land animals to humans via bodily fluids.
• Factors explaining the virus's success in Liberia include population demographics (many children and elderly), habitat (bats, lack of clean water and food storage), and behaviour (eating monkeys, funeral practices).
• Spot maps describe the number of cases in a certain region
• Darker shades show more case
• Investigatory mapping identifies where bats are and where people are getting bitten.

Epidemic vs. Pandemic

• Endemic: Disease in a certain area or among a set population
• Epidemic: Disease within a certain location/region
• Pandemic: Disease is world wide

Challenges and Opportunities for an Epidemic

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

Disease vs. Illness

• Disease: medical conception of pathological abnormality, diagnosed by experts.
• Illness: individual experience of pain and discomfort, which is subjective and influenced by social and psychological dimensions.

Disability vs. Handicap

• Disability: Poor function, impairment
• Handicap: A disadvantage due to societal structures preventing participation.

Social Construction of Disease

• Individuals and groups create their own understanding of reality and knowledge through social dynamics.
• Historical examples include the social construction of AIDS, homosexuality, drapetomania, and hysteria.

Development of Western Medicine

• Classical Greek period: Emphasized a healthy mind and body, clean water.
• Middle Ages: Church-dominated, sickness was considered a sin.
• Theoretical/Social Development: body and mind are separate
• 19th Century: Focus on hospitals, labs, and sanitary reform.
• 20th Century: Industrial medicine.

Emerging Concerns

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

Decline in Death Rate

• 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 is medicine's 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

• Focus is on tracking back to find more previous reasons

Population Health's Focus

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

Measuring Health

• Standard measures include life expectancy, child mortality, premature death, disease rate, and low birth weight.
• Psychological health, self-rated health, and self-esteem
• Behavioural factors: smoking, drinking, physical activities
• Function (Disability days and occupational injuries)
• Living and working conditions
• Social and physical environments: social support/relationships, crime, air quality, pathogens, or green space
• Health services: utilization rates, access, or prescription refills.

Ontology

• How people view the world, emphasizing that it is based on belief rather than proof.

Epistemology

• How people come to understand the world and the questions asked based on ontology.

Methodologies

• Coherent sets of rules and procedures to investigate a situation.

Qualitative Inquiry

• Involves interpretation, observation, notes
• Analysis is challenging and is based on categorization of words

Quantitative Inquiry

• Associated with numbers and quantity, employing a deductive method from general to specific.

Epistemological Approaches

• Positivist: Emphasizing observable and measurable data and statistical analysis.
• Social Interactionist: Focuses on interpretations, observations, etc.
• Structural: Underlying social, economic, or political systems
• Structurationist: "Middle ground" between structure and agency
• Post-structuralist: Emphasizing difference or otherness

Positivist Approach to Research

• Emphasis is on quantitative statistical analysis
• Focuses on observable and measurable data to establish testable hypotheses.
• Aims to uncover causes, treating space as important, not place.
• Direct observation is the best way to discover it.
• Knowledge is neural and the observer is objective.

Social Interactionist Approach to Research

• Social constructionist, humanistic approach.
• Focuses on how people understand their health qualitatively.
• Ultimate goal is to understand people by seeking their expertise through interviews.
• Researchers' positionality affects how interviewees interpret questions and access to people.

Structuralist Approach to Research

• The underlying cause of problems is the social/economic/political system.
• Focuses on explaining differences in health.
• Questions how individual health choices are constrained by structure and power.

Structurationist Approach to Research

• It finds "middle ground" between structure and agency influence.
• Structures shape social practices and actions, but these actions may shape and recreate structures.

Post-structuralist Approach to Research

• Concerned with constructing knowledge and experience within power contexts.
• It emphasizes difference or otherness

Equality and Equity

• Equality: Everyone gets the same, regardless of need.
• Equity: Everyone gets what they need, in order to be successful.

BMI (Body Mass Index)

• BMI = Mass (kg) / (Height (m))^2
• Normal: 18.5-25, Overweight: 25-30, Obese: >30.

Obesity

• Factors are gene/biology, behaviours/agency, and healthcare.
• Thrifty gene hypothesis is a potential genetic determinant for Gene/Biology.

Social Determinants of Health

• Acknowledge that economics can affect health
• Contextual vs. Compositional Determinants:
  • Compositional: aggregated characteristics of individuals in an area.
• Contextual: the effects of place.
• Common SES (Socioeconomic status) factors are education, income, and occupation.
  • Education and income are associated with health

Environmental Health

• The study of conditions in the natural and human-made environment.
• Hazards: Anything causing injury, death, disease, or destruction with focuses two areas: lack of access to necessities and exposure to environmental hazards.

Risk

• Probability of suffering a loss from exposure to a hazard.
• Exposure vs. susceptibility: while everyone can be exposed, some are more susceptible.

Risk Pathways

• Physical hazards: natural disasters
• Biological hazards: bacteria, fungi and viruses, often due to crowding and contamination
• Socio-environmental hazards: cultural hazards related to risky behaviours.
• Chemical hazards: chemical are linked to diseases and can be anthropogenic or natural such as pesticides or asbestos.

Risk Assessment and Risk Management

• Epidemiology: study of health and disease distribution and determinants in populations.
• Toxicology: measurement of toxins in a person’s body.

Epidemiological Study Designs

• Randomized Control Trials (RCT): Clinical trial (limit bias, expensive, ethical issues, harm exposure)
• Case Control Study (Retrospective): Study people with disease (cheap, fast, recall bias)
• Cohort Study (Prospective): Follow exposed (can establish timeline, expensive)
• Cross-Sectional (Retrospective): Random sample (cheap, easy, no timeline, recall bias)
• Ecological (Retrospective): Study rates (cheap, no timeline)

Risk Management

• Follows risk assessment and considers cost-benefit, risk-benefit analysis and public preference.

Environmental Health Risk Management

• Best: Regulations to reduce emissions and better product testing
• Second best: Educate individuals
• Integrated strategy: research and law/policy to establish protections beyond individual control
• On-the-ground protection: Fostering awareness among parents, families, and staff
• Involves informing the public to reduce them.
• Goals: awareness, hazard avoidance, reduce concern