Health Geography: Definitions and Key Concepts

• The presentation includes an introduction to health geography, definitions, and key concepts.
• Aisha Giwa is the professor, with Kruti Mehta as the teaching assistant.
• The presentation was given on January 6th, 2025.

Indigenous Affirmation

• Acknowledgment is given to the Algonquin people as the traditional guardians of the land.
• Respect is paid to all Indigenous people in the region from all nations across Canada who call Ottawa home.
• The affirmation acknowledges traditional knowledge keepers, both young and old.
• Honour is given to courageous leaders of the past, present, and future.

House Keeping

• Be respectful of yourselves and shared spaces.
• Place your phones on Do Not Disturb or silent.
• Attendance for each in-class session is not mandatory.
• If you anticipate leaving the class at some point, please sit at the periphery of the classroom
• Lectures require the involvement of students

Course Learning Outcomes

• Main objectives of the course include understanding social science and biomedical models of health.
• Understanding theoretical approaches and methods used in health geography is key.
• Social, economic, environmental, health care, and other factors influence health.
• Understanding the changing global context of health is an objectve.
• Learning patterns and trends in health care delivery is essential.
• Identifying factors affecting healthcare access and health outcomes across populations is critical.

Required Materials

• All learning materials will be provided by the professor via Brightspace in the weekly lecture folders.
• Students will not incur additional costs in this course.
• Refer to the syllabus for more details.

Assessment Strategy

• A paper based research assignment will be 15% of the total grade and is due February 10th, 2025.
• The mid-term quiz will be a combination of multiple choice, true/false and short answer questions weighted at 20% and on March 12, 2025.
• The Research Assignment and Group project is a paper, videos, and group presentation accounting for 25% of the grade, due March 31, 2025.
• The final in-person written exam is worth 40% and has a date TBD.

What is Health Geography?

• Geography and health are intrinsically linked.
• Health Geography involves the interaction between people and the environment.
• Health geography views health from a holistic perspective encompass society and space, well-being and disease.
• Health depends heavily on where we live.

Place and Life Expectancy

• Life expectancy measures how long a person is expected to live.
• Alarming disparities in life expectancy exist.

Concepts of Health

• The World Health Organization(WHO) defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity (2014).
• A shift in focus is required from complete well-being to the availability of resources that help achieve individual potential.
• Social well-being is an important aspect of health.
• Illness is a subjective experience whereas diseases are objective abnormalities.
• The study of disease in a population is epidemiology.
• Health data is collected on mortality (death) and morbidity (sickness, illness or disease).
• Age-standardized rates are used to compare populations with differing age structures.
• Incidence rates measure new cases within a time interval as a proportion of the at-risk population.
  • There were 1,833 new HIV diagnoses in 2022, a 24.9% increase since 2021
• Prevalence rates are the number of people with a disease or illness at any one point in time.
  • An estimated 39.9 million people were living with HIV at the end of 2023.
• Chronic diseases include heart disease, while acute diseases can include overdose.
• Infectious diseases are caused by organisms that can spread directly (e.g., COVID-19).
• Impairment refers to the inability to physically or mentally function in a space.
• Disability is a socially or culturally constructed form of exclusion.

Geographical Concepts

• Location is a fixed point.
• Example location, 45°25'24.0″N 75°41'08.7"W
• Place is a location with attached meaning or emotion.
• Therapeutic landscapes encompass meanings of place and the relationship between place and health.
• Distance separates places.
• Scale ranges from neighborhoods to global levels. E.g COVID-19.
• Environment is the physical world and its impacts.
• Disease Ecology studies the relationship between disease distribution and local ecologies.

Assignment (15% of total grade)

• The due date is February 10th, 2025.
• An essay of 1000 words is to be written on the relationships between place and health outcomes of a population.
  • Use Frumkin (2003) as the framework.
  • Critically discuss concepts using real-world examples.
  • Include evidence-based policy and practice recommendations.
  • Cite at least 5 reliable sources.
• This assignment will be graded on thesis/focus of the topic, analysis and critical thinking, organization of work, writing style/referencing/grammar and word count.

Concepts of Health and Disease

• The landscape of health concerns is ever-changing.
• Infectious diseases have been controlled or eradicated in Canada through various means.
• Decreased mortality and increased life span are common.
• Emerging health concerns include cancer, COVID-19 and drug poisonings.
• In 2023, the leading causes of death in Canada included cancer (84,629), heart disease (57,890), unintentional injuries (20,597), and COVID-19 (7,963).
• Health is multidimensional, according to the World Health Organization (WHO, 1948).
• Health emphasizes social and personal resources as well as physical capacities.
• Gartrell and Elliot's (2015) definition of health considers the availability of resources, both personal and societal, to achieve individual potential.
• Measures of health must incorporate the distinct dimensions of the human experience.
• Determinants of health are more than biological.
• Maintaining health is a collective responsibility.

Approaches to Health

• The three main approaches to health include Biomedical, Behavioral, and Socio-environmental.
• The biomedical view focuses on biological causes and treatments, and has reduced mortality and morbidity.
• The behavioral view focuses on individual responsibility and changing behaviors for better health.
• The socioenvironmental view focuses on the ability to identify to satisfy needs and to change or cope with the environment

Determinants of Health

• Determinants of health are the broad range of personal, social, economic, and environmental factors that determine health.
• They include conditions in which people are born, grow, live, work, and age.
• Main determinants include income/social status, employment/working conditions, education/literacy, childhood experiences and physical environments.
• Additional determinants of health include social supports/coping skills, healthy behaviors, access to health services and biology/genetic endowment.
• Further determinants are gender, culture, and race/racism.
• Social determinants refer to social and economic factors within the broader determinants of health relating to income, education and employment.

Interventions

• Interventions targeted towards upstream determinants have more equitable impacts on people's health
• 3 Broad categories of disease prevention:
• Downstream - Primary Care
• Midstream - Lifestyle and behavioural factors
• Upstream - Social determinants

The Health Belief Model

• The HBM was developed in the early 1950s by social psychologists at the U.S. Public Health Service.
• There are six components: perceived severity, susceptibility, benefits, barriers, cues to action, and self-efficacy.
• One's readiness to take action (cues to action) and the belief that the action will have positive consequences, one requires the individual to be in a state of readiness.
• The individual needs to feel susceptible to the disease (perceived susceptibility) with a significant impact (perceived severity).
• Beliefs encompass the benefits of the action (perceived benefits), such as time, cost, and inconvenience.
• The HBM does not adequately address individual factors or environmental factors.
• Behavior change requires attention to education, environmental support, economic levers and enforcement of regulations and legislation.

Rogers' theory of diffusion

• Rogers' theory of diffusion (1995) conceptualizes a population as being innovators, early adopters, an early majority, a late majority.
• This has been used to explain how health innovations spread.
• Health education facilitates voluntary actions conducive to health.
• Social and economic influences affect behavior.

Health Communication

• Health Communication uses communication strategies to inform and influence individual and community decisions that enhance health.
• Risk communication is communication about hazards and risks between experts, policymakers, organizations, and the public.
• Social marketing delivers health information using customer-centered and science-based strategies.
• It applies the 4 Ps of marketing: Product (COVID-19 vaccine), Price (free), Place (nearest pharmacy), Promotion (social media, CBC news).
• Communication and mass media can be communicated effectively.
• Social marketing is another health promotion strategy.
• This strategy generates discussion and promotes information attitudes, values and behavior changes.

Health Promotion

• In 1986, the Ottawa charter for health promotion emphasized the social and physical aspects of the health environment, community education for advocacy.
• A healthy lifestyle must incorporate social responsibility as well as individual patterns.
• The decisions that individuals make result in favorable or adverse consequences for health.
• Health promotion strategies in the Ottawa charter involve reorientating health services, enhancing personal skills, strengthening community and building public policy.
• These strategies can include education, communication, legislation, and fiscal measures.
• The Population Health Promotion (PHP) model explains the relationship between population health and health promotion.
• It provides evidence-based decision making and three sources should be consulted regarding research studies, experiential knowledge and evaluation studies.
• The Jakarta declaration in health promotion offers peace shelter, wealth and income as the components.

Analyzing Geographical Health

• Research paradigm defines assumptions that provide a conceptual framework for a worldview.
• A research question must be asked in a precise and testable manner, and requires a consideration of the place and time scale of the work.
• The research question determines the type of data to be collected.

Research Design

• Six key considerations for designing a research study revolve around developing your research question.
• Approaches to the Geography of Health include Positivist explanations, Social Interactionist analysis, structuralist explanations etc..
• All research should factor ethics into account.
• Positivist explanations claim that the social world can be understood objectively by looking at spatial data patterns.
  • Quantitative data relies on surveys and modeling.
  • This approach is used in service delivery for healthcare.
  • limitations include reducing individuals to numbers on a map.
• A case study of Gould and Wallace (1994) mapped the spread of HIV identifying how the virus spread in urban areas/ smaller cities.
• A case study was also preformed by the Substance use cost and harms from the Canadian Centre.
• Social Interactionist explanations see the world through the lens of the individual.
  • Studies are non-generalizable and focus on the experience of place using qualitative survey data with mixed methodology.
• A panel of 40 adult women and men were involved when addressing smoke legislation from the public.

Social Determinants of Health

• The WHO Commission (2008) defined as " the conditions in which people are born, grow, live, work and age”
• Influence health and what factors shape those influences.
• Upstream is equal to "fundamental drivers.
  • Interventions targeted towards upstream determinants have more equitable impacts on people's health
• Economic and social forces are essential.
• Downstream factors are generally more easily observed because they occur closer to the health outcomes in time and space.
• Health-harming factors such as stress and environmental hazards.
• Some historical perspectives include Friedrich Engle on the working class conditions and Rudolph Virchow on the role politics play.
• Social determinants include income and wealth distribution, education, unemployment and job security and early childhood development.