Health geography

Hepatitis A prevalence worldwide, 2005.

Health geography is the application of geographical information, perspectives, and methods to the study of health, disease, and health care.

Overview

The study of health geography has been influenced by a shift from a medical model to a social model, which advocates for a redefinition of health and health care away from prevention and treatment of illness to one of promoting well-being. Under this model, new illnesses (e.g., mental ill health) are recognised, and other types of medicine (e.g., complementary or alternative medicine) are combined with traditional medicine. This shift changes the definition of care, no longer limiting it to spaces such as hospitals or doctors offices. Also, the social model gives primacy to the intimate encounters performed at spaces of non-traditional medicine and care as well as to the individuals as health consumers.

This alternative methodological approach means that medical geography is broadened to incorporate philosophies such as Marxian political economy, structuralism, social interactionism, humanism, feminism and queer theory.

History of health geography

The relationship between space and health dates back to Hippocrates, who stated that "airs, waters, places" all played significant roles impacting human health and history. A classic piece of research in health geography was done in 1854 as a cholera outbreak gripped a neighborhood in London. Death tolls rang around the clock and the people feared that they were being infected by vapors coming from the ground. John Snow thought that if he could locate the source of the disease, it could be contained. He drew maps showing the homes of people who had died of cholera and the locations of water pumps. He found that one pump, the public pump on Broad Street, was central to most of the victims. He figured that infected water from the pump was the culprit. He instructed the authorities to remove the handle to the pump, making it unusable. After that the number of new cholera cases decreased.

Areas of study

Health geography is considered to be divided into two distinct elements. The first of which is focused on geographies of disease and ill health, involving descriptive research quantifying disease frequencies and distributions, and analytic research concerned with finding what characteristics make an individual or population susceptible to disease. This requires an understanding of epidemiology. The second stream of health geography is the geography of health care, primarily facility location, accessibility and utilization. This requires the use of spatial analysis and often borrows from Behavioral economics.

Geographies of Disease and Ill Health

Health geographers are concerned with the prevalence of different diseases along a range of scales from the local to global, and inspects the natural world, in all of its complexity, for correlations between diseases and locations. This situates health geography alongside other geographical sub-disciplines that trace human-environment relations. Health geographers use modern spatial analysis tools to map the diffusion of various diseases, as individuals spread them amongst themselves, and across wider spaces as they migrate. Health geographers also consider all types of spaces as presenting health risks, from natural disasters, to interpersonal violence, stress and other potential dangers.

Geography of Health Care Provision

Although health care is a public good, it is not equally available to all individuals. Demand for public services is continuously distributed across space, broadly in accordance with the distribution of population, but these services are only provided at discrete locations, therefore, there will be inequalities of access in terms of the practicality of using services, transport costs, travel times and so on. Geographical or 'locational' factors (e.g. physical proximity, travel time) are not the only aspects which influence access to health care. Other types (or dimensions) of accessibility to health care except for geographical (or spatial) are social, financial and functional.

Social accessibility to health care depends on race, age, sex and other social characteristics of individuals, important here is also the relationship between patient and doctor. Financial accessibility depends upon the price of a particular health care. Functional accessibility reflects the amount and structure of provided services. These factors can vary among different countries or regions of the world. Access to health care is influenced also by factors such as opening times and waiting lists that play an important part in determining whether individuals or groups can access health care – this type of accessibility is termed 'effective accessibility'.

The location of health care facilities depends largely on the nature of the health care system in operation, and will be heavily influenced by historical factors due to the heavy investment costs in facilities such as hospitals and surgeries. Simple distance will be mediated by organisational factors such as the existence of a referral system by which patients are directed towards particular parts of the hospital sector by their GP. Access to primary care is therefore a very significant component of access to the whole system. In a universal health care system, one would expect the distribution of facilities to fairly closely match the distribution of demand. By contrast, a market-oriented system might mirror the locational patterns that we find in other business sectors, such as retail location. We may attempt to measure either potential accessibility or revealed accessibility, but we should note that there is a well-established pattern of utilisation increasing with access, i.e. people who have easier access to health care use it more often.

Health geographers

Notable health geographers include:

• Jonathan Mayer
• Melinda Meade
• Ellen Cromley
• Anthony C. Gatrell
• Jim Dunn
• Robin Kearns
• Sara McLafferty
• Graham Moon
• Gerard Rushton
• Nancy Ross
• Simon Gifford
• W.F. (Ric) Skinner

See also, North American Health Geographers Profiles and International Health Geographers Profiles on the Association of American Geographers, Health & Medical Geography Specialty Group web site (http://userpages.umbc.edu/~earickso/Index.html). There were over 200 profiles in this archive as of January 2009.

See also

• Cluster (epidemiology)
• Geographic Information System
• Spatial epidemiology
• Social model of disability

External links

• International Journal of Health Geographics (journal)
• Health and Place (journal)
• Geospatial Health (journal)
• Health Geomatics (free online e-learning module)
• Social and Spatial Inequalities
• GeoHealth Laboratory