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Summary of the lectures of Population, Health and Place
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Summary of the lectures of Population, Health and Place
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Lecture 1: Introduction and Organization.Getting started: news related to Population, Health and Place → How do places
affect population health?
An example from the news is given → The cholera outbreak in Yemen. The worst
cholera outbreak in the world has claimed more than 1,700 lives.
- According to WHO: 297,438 cholera cases and around 1800 related deaths, still
updates from the Yemeni healthy ministry and non reported case.
- All but one of Yemen’s 23 provinces affected. The four most affected provinces -
Sanaa, Hudaydah, Hajja and Amran - have reported almost half of the cases.
- Outbreak is direct consequence of the civil war, with 14.5 million people cut off from
regular access to clean water and sanitation
- Over 50% of health facilities are no longer functioning, almost 300 facilities have
been damaged or destroyed, and some 30,000 local health workers who are key to
dealing with the outbreak have not been paid for 10 months.
- Rising rates of malnutrition have weakened the health of vulnerable people - above
all children under the age of 15 and the elderly - and made them more vulnerable to
the disease.
Another example is the outbreak and spread of Zika virus in Brazil.
- end of 2014: first reported cases of acute (exanthematic) disease in Northeast Brazil,
March 2015, Zika Virus (ZIKV) determined as causative agent of (exanthematic)
disease.ZIKV also identified in the cerebrospinal fluid of patients with acute
neurological syndromes and previous exanthematic disease.
- end of September 2015, increasing number of infants with small head circumference
or microcephaly in Northeast Brazil. ZIKV identified in blood and tissue samples of a
newborn and in mothers who had given birth to infants with microcephaly and
ophthalmological anomalies.
- In 2015, estimated 440,000 - 1,300,000 Zika cases in Brazil. 4,783 suspected cases
of microcephaly, most of them in the Northeast of Brazil associated with 76 deaths.
- Spread of Zika to other other countries around the globe
Next we look at body mass index around the world. There is a world obesity epidemic.
- in 2016 39% men and 40% woman aged 18+ were overweight and 11% and 15% of
women were obese.
- nearly 2 billion overweight adults worldwide and, of these, 650 millions were obese
- 41 million children under the age of 5 were overweight or obese
- marked increase in overweight and obesity over the past 4 decades
- most of world population lives in countries where obesity and overweight
kill more people than undernutrition → more overnourished than
undernourished people in the world
- in 2010, overweight and obesity were estimated to cause 3-4 million deaths
Another thing we can look at is maternal health and child development in the form of
adolescent pregnancies
- Ca. 16 million girls, aged 15-19 years, and 2.5 million girls <16 years give birth each
year in developing regions.
, - Complications during pregnancy and childbirth are leading cause of death for 15-19
year-old girls globally
- Every year, some 3.9 million girls aged 15-19 years undergo unsafe abortions
- Adolescent mothers (ages 10-19 years) face higher risks of pregnancy complications
than women aged 20 to 24 years
- Children of adolescent mothers exhibit higher risks of school underperformance, late
life health etc.
Micro and Macro level relationships, the dual link between health and geography
We can see the micro and macro levels in the examples of the news that we have
discussed.
- Example cholera: macro level effect, importance of sanitation, health care facilities
and trained medical staff.
- Example Zika: housing situation, income, climate change, migration/mobility.
- Example adolescent pregnancies: education, cultural beliefs, poverty
- Example nutrition: health behaviour, education, income
- Example Alzheimer: care provision, family arrangements, age
The micro level relates to individuals on the individual level.This means that we look at
specific diseases or disabilities by persons (caused by individual characteristics or
behaviour). e.g. health of an individual is affected by an agent that causes a certain
condition/disease.
The macro level relates to populations (cities, regions, countries) on the population levels.
We look at aggregated information of (individual) health (causes of death in population). e.g.
(sub-) population health is affected by physical or social environment.
Coleman’s Bathtub is a stylized scheme to
show the relationship between macro and micro level phenomena. Also used to show the
determinants of social change and applied from various disciplines for different phenomena
(criminology, sociology, economic, epidemiology).
Link 1 and 2 concern micro level processes, e.g. how institutions, social organization,
environment in general affect individual outcomes or how individual behaviour affect
individual outcomes.
Link 3 and 4 concern macro level processes, e.g. change in environment over time, effect of
individual behaviour on macro level outcomes.
,The picture below explains the multiple aspects of environment.
The dual link between geography and health.
- Where you live affects your health
- Where you live affects the health care you get
- Spread of diseases
- Mobility/migration and health
- Role of place on health (therapeutic landscapes)
- Also: influence health on place (selection migration, health behaviour)
Geographical aspects that we look at are: space/location, place (meaning & value),
distance, spatial scale, time and environment.
Healthy geography is inherently interdisciplinary it draw upon sociology, ecology, medicine,
economic, psychology, anthropology and biology. With these different disciplines come
different ways to approach things.
One way to approach health geography is a spatial approach. For example:
- Assessing the distribution of grocery stored by socioeconomic characteristics of
neighbourhoods
- Analyzing the distribution of services for the homeless in Vancouver, Canada
- Analyzing the regional availability of medical resources on preventable mortality
Another way to approach is an ecological approach. For example:
- The impact of the development of irrigation on the spread of schistosomiasis
- The impact of insecticide-treated bed nets in curbing malaria transmission
- The role of occupational exposure to particulate matter in the development of lung
cancer among miners.
Example of social approaches:
- language as barriers to healthcare access for Turkish immigrants in Germany
- The influence of race on incidence of stroke in Auckland, new zealand
, - The influence of disparities in wealth on the global distribution of healthcare providers
- The role of community gardens as places of healing.
- The importance of the internet in creating spaces for interaction between physically
impaired and able-bodied teenagers.
Epidemiology is the study of diseases in population (how often and why?). When we talk
about geographical epidemiology we look at
1. disease ecology: is how disease interacts with organisms and the environment.
Human disease ecology is concerned with the ways human behaviour, in its cultural
and socioeconomic context, interacts with environmental conditions to produce or
prevent disease among susceptible people.
2. disease geography
3. geography pathology.
Geographical epidemiology shows us the relationship between disease and the social and
physical environment. The focus is on:
- Spatial variations, clustering, spread and diffusion of disease → Disease
diffusion studies are interest in the spatial structure and spatial form of
disease patterns, and put emphasis on trying to understand the way in
which a disease diffuses over space during and epidemic, rather than on
the biological causes.
- Relation of the disease between spread and the environment
- Mapping and Modeling of disease
We use quantitative approaches to geographical epidemiology:
- Mapping
- Spatial analysis
- Gis applications
- Statistical or associative analysis
- Modelling techniques
Health care geography is the geography of medical care or the geography of health service
provision. Themes in health care geography are:
- Spatial distribution of services
- patterns of utilization
- inequalities/inequities in access
- Distance-decay (use)
- Policy criterions and performance standards
- Variety in health care systems
- Reforms/changes in medical systems
- integration of traditional and modern medicine.
The methodology of health care geography is diverse.
The ‘new’ geography of health has been debated since the early 1990s. It was seen as
needed because of dissatisfaction with approaches and methods in classic medical
geography.
The subdiscipline focused on the dynamic and recursive relationship between health and
place, and on the impact of both health services and the health of population groups on the
vitality of places.
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