Geographies of Health

Setting out the debates and reviewing the evidence that links health outcomes with social and physical environments, this new edition of the well-established text offers an accessible overview of the theoretical perspectives, methodologies, and research in the field of health geography

• Includes international examples, drawn from a broad range of countries, and extensive illustrations
• Unique in its approach to health geography, as opposed to medical geography
• New chapters focus on contemporary concerns including neighborhoods and health, ageing, and emerging infectious disease
• Offers five new case studies and an fresh emphasis on qualitative research approaches
• Written by two of the leading health geographers in the world, each with extensive experience in research and policy

Anthony C. Gatrell is Professor of the Geography of Health at Lancaster University. His research interests include applications of spatial analysis and GIS in health and medicine, health inequalities, and associations between mobility and health. He is the author of Distance and Space: A Geographical Perspective (1983), Interactive Spatial Data Analysis (with Trevor Bailey, 1995), GIS and Health (edited with Markku Löytönen, 1998), and Geographies of Health, second edition (Blackwell, 2011).

Susan J. Elliott is the Dean of the Faculty of Applied Health Sciences at the University of Waterloo, Canada where she is actively involved in research related to integrated knowledge translation in the area of environment and health research. She has published extensively around relationships between health and the built environment, health and the socially constructed environment, and health and the physical environment. Her research activities span the globe, with current activities related to access to safe water and sanitation in Africa.

List of Figures ix

List of Tables xii

Preface xiv

Part I Describing and Explaining Health in Geographical Settings 1

Chapter 1 Introducing Geographies of Health 3

Health and Geography: Some Fundamental Concepts 6

Concepts of health 7

Geographical concepts 10

Geographies of Health: Five Case Studies 15

Neighborhoods and obesity in New York City 16

Public places after the introduction of “smoke free” legislation 18

The health of Aboriginal populations in Canada 19

Habitus and heart health: The collision of place, body, and health 21

Mental health in Australian immigration detention centers 23

Concluding Remarks 25

Chapter 2 Explaining Geographies of Health 29

Positivist Approaches to the Geography of Health 30

Positivist explanation 30

Further examples of positivist approaches 31

Social Interactionist Approaches to the Geography of Health 37

Social interactionist explanation 38

Further examples of social interactionist approaches 39

Structuralist Approaches to the Geography of Health 41

Structuralist explanation 42

Further examples of structuralist or conflict-based approaches 43

Structurationist Approaches to the Geography of Health 50

Structurationist explanation 50

Further examples of structurationist approaches 52

Post-structuralist Approaches to the Geography of Health 53

Post-structuralist explanation 54

Further examples of post-structuralist approaches 54

Concluding Remarks 59

Chapter 3 Quantitative Methods and Geographical Information

Systems (GIS) 65

Visualizing and Exploring Health Data in a Spatial Context 66

Modeling Health Data in a Spatial Setting 78

Geographical Information Systems and Health 86

Concluding Remarks 96

Chapter 4 Qualitative Approaches to Interpreting the Geography of Health 101

Interviews 102

Focus Groups 110

Other Qualitative Methods 112

Qualitative Data Analysis 113

Rigor in Qualitative Research 116

Concluding Remarks 117

Part II Health and the Social Environment 123

Chapter 5 Health Inequalities I: Global Patterns and Regional Contrasts 125

Health Inequalities in the Global South 126

Health inequalities: Africa 130

Health inequalities: The BRIC countries 132

Health Inequalities in the Global North 139

Regional divides in the global north 139

Explaining inequalities in health outcomes in the global north 145

Concluding Remarks 152

Chapter 6 Health Inequalities II: Neighborhoods and Health 157

A Chicago Story 159

Neighborhood Context or Social Composition? 161

The Obesogenic Neighborhood 163

Psychosocial Health and Well-being 167

Housing and Health 169

Infectious Disease 170

Neighborhoods and Access to Care 174

Concluding Remarks 178

Chapter 7 Systems of Health Care 184

Principles of Health Service Delivery 185

Levels and types of health care provision 185

Promoting health, preventing illness 186

Health Care Systems 190

Geographies of rationing 192

Efficiency and equity 193

The need for health care 195

Inequalities in the Provision of Health Services 196

Health care provision in the global south 196

Health care provision in the global north 202

Geographies of Care 205

Concluding Remarks 208

Chapter 8 Inequalities in the Utilization of Health Services 214

Use of Primary Health Care Services 215

Use of Secondary and Tertiary Health Care Services 226

Do Provision and Utilization Affect Outcome? 231

Concluding Remarks 238

Chapter 9 Ageing and Place 244

What is Age? 245

Ageing Populations: Global and Regional Perspectives 246

The Distribution of Ill-Health and Disability Among Older Adults 249

Health Inequalities in Older Adults 254

Healthy Ageing “In Place” 258

There’s No Place Like Home 264

Concluding Remarks 268

Chapter 10 People on the Move: Migration and Health 273

Migration, Disruption, and Health 274

Voluntary migration and mental health 274

Forced displacement 276

The Impact of Migration on the Spread of Disease 280

Migration and the Incidence of Disease and Ill-health 283

Direct effects 283

Longer-term health impacts of migration 285

Migration as a confounding variable 290

Impact of Health Status on Migration 295

The Relationship Between Migration and Access to Health Services 298

Concluding Remarks 301

Part III Health and Human Modification of the Environment 307

Chapter 11 On Airs, Waters, Places 309

Air 311

Area sources 314

Linear sources 320

Point sources 324

Water 329

Cholera 331

Schistosomiasis 334

Gastroenteritis 335

Chemicals in drinking water 337

Concluding Remarks 342

Chapter 12 Health Impacts of Global Environmental Change 349

Stratospheric Ozone Depletion 352

The Science of Climate Change and Its Role in Human Health 356

Health Impacts of Climate Change 358

Air quality 360

Contamination of food and water 360

Temperature extremes 363

Extreme weather events and natural hazards 364

Impacts on infectious vector-borne disease 367

Concluding Remarks 370

Chapter 13 Emerging, Re-emerging, and Neglected Infectious Diseases 375

Disease Transmission: The Role of Vectors 376

The Drivers of Emerging, Re-emerging, and Neglected Diseases 378

Ecosystem change 378

Political upheaval, conflict, and disaster 382

Mobilities of people and goods 385

Antimicrobial resistance 387

Socioeconomic determinants and consequences 388

Concluding Remarks 391

Index 395

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