SV Geographies of Health
Lecture 1 – Health Geography: an introduction
What is health geography?
➢ Health geography is a subdiscipline of human geography, which deals with the interaction
between people and the environment
➢ Multidisciplinary analyses and understandings of health and places!
Conceptualising health
➢ Can be conceptualised and defined in many ways
➢ Old WHO definition: Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity
o Not measurable to define health and well-being
➢ New complex and comprehensive definition (Bircher): Health is a dynamic state of wellbeing
characterized by a physical, mental, and social potential, which satisfies the demands of a life
commensurate with age, culture, and personal responsibility. If the potential is insufficient to
satisfy these demands the state is disease
o Indicated health and its relevance in wider social and cultural contexts
➢ Health conditions are measured in objective or subjective terms
➢ Can be considered in terms of individual condition or condition of a population (e.g., public
health)
Conceptualising geography
➢ Geography is the study of places and the relationships between people and their
environments.
➢ The Connection: Places may be good or bad for health.
Key concepts in health geography: Health side
➢ Illness is a subjective experience
➢ Diseases are related to specific symptoms
➢ Sickness determines whether a person is entitled to treatment and economic rights, exemption
from social duties, such as work (sick leave)
➢ Epidemiology: The basic science to public health. It deals with the incidence, distribution,
and possible control of diseases and other factors relating to the health of populations.
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, o Key focus: Distribution, determinants (causes, risk factors), specified populations
(neighborhood, school, city, state, country, global)
➢ Incidence rate is the number of new cases occurring within a given time.
➢ Prevalence is the number of people with the disease or illness at any one point in time.
➢ Morbidity: sickness (disease and illness) and its causes
➢ Mortality: death and its causes
➢ Chronic: often long-lasting (hearth disease & diabetes)
o Recurring
➢ Acute: start abruptly, last perhaps only a few days and then settle, but may develop into a
chronic condition (stroke, heart attack, appendicitis)
o intense
Key concepts in health geography – Geography side
➢ A location is a fixed point or geographic area on the earth’s surface. It becomes a place
when it is charged with meaning.
o Coordinates to Utrecht Science Park
o Both locations and places can refer to small to large areas. One building to a city or
nation.
o Places can be good or bad for health!
o Chernobyl explosion → affected people and lives more close by to a larger extent in
the southeast Europe
➢ Therapeutic landscapes: Places that have achieved lasting reputations for providing
physical, mental, and spiritual healing”
o Properties can be physical conditions (e.g., water, topography), also be socially or
culturally constructed.
o Example of Japanese Onsen (hot springs).
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, ▪ Physically: the water contains sodium bicarbonate and calcium (increase
oxygen flow), intense heat (dulled perception of pain)
▪ Socially: the stories of samurai that would come to bathe in the waters to heal
their wounds after a battle
➢ Distance: Perhaps the fundamental concept in Geography!
o How far are people from facilities delivering health care?
o How far are people from a possible source of pollution or infection centre? (Distance
from Chernobyl or Wuhan)
o Places are located in relation to other places (“relative location”), hence relate one
place to another, allow comparisons among places
o Can be straight line or road network distance (physical), can be perceived distance
(cognitive)
➢ Scale: Another fundamental concept in Geography! Has many meanings!
o Can be interpreted in several ways (e.g., spatial, temporal)
o Spatial scales can vary from: body surrounding > neighbourhood > city > region >
country
o Health data are often aggregated in different scales, and relations observed in one
scale may not be observed in other scales!
o As kinds of events that impact upon our health may operate at different scales. Local
contamination to global climate change
➢ Time:
o Locations remain fixed over time, but places change. Example of Chernobyl, was a
vibrant place to live before explosion, now inhabitable for the next few hundreds
years!
o People move into different places everyday or over the life course, so changes their
surrounding environment
o Some effects of places are more immediate (seasonality effects), some can observed
in long term (climate change effects)
Case Study on the relations between health and places
Neighbourhoods and obesity in NYC:
➢ Dependent on many factors: Food intake & levels of exercise; Social class, income, age,
ethnicity, gender
➢ Obesity is not only about individuals and their behavior
➢ Need to understand the influence of places on obesity, in particular shaping the behaviour of
the individuals
➢ Does the presence of neighborhood amenities (including fast-food outlets) play any part in
shaping obesity levels?
➢ To what extent is obesity also affected by the availability of facilities to improve fitness?
➢ Why certain neighborhood has more or less obesity rate than others?
➢ Determinants of obesity operate at two levels: (1) Individual (income, education, etc.) (2)
Geographic (access to healthy food and fitness- prominent in red dots)
➢ Health-related behaviors depend on what is provided in the local environment
Inequalities and COVID-19:
➢ Area-level socio-spatial gradients in confirmed cases in Illinois and positive test results in
New York City, with dramatically increased risk of death observed among residents of the
most disadvantaged counties
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, ➢ “A syndemic is a set of closely intertwined and mutual enhancing
health problems that significantly affect the overall health status of a
population within the context of a perpetuating configuration of
noxious social conditions”.
➢ Caution: correlations is not causation!
Complex intertwined relations among health and place in urban contexts:
➢ Majority of earth’s population now live in cities. And cities are
vulnerable to many crisis situation such as COVID-19.
➢ Cities are complex systems, so urban health outcomes are
dependent on many interactions
➢ Does the urban advantage concept (urban population more advantaged than the rural
population in terms of health outcomes) currently hold true or need to be promoted?
5 key recommendations for healthy cities:
1. Stakeholders working in urban planning and public health should work together
2. Health inequalities should be a key focus area
3. The urban advantage needs to be maintained
4. The relations and policies affecting urban health outcomes must be understood
5. Experimentation and assessments of a large range of projects
Exam literature
Health geography: supporting public health policy and planning:
➢ When using geographic methods, it is important to be aware of the potential risks. Policy
derived from geographic research can fall victim to ecological fallacy, in which incorrect
assumptions are made about people based on aggregated data about their communities. This
may result in the misapplication of policy targeting specific groups of people or places. The
modifiable areal unit problem, which is a potential source of error, arises when an identified
geographic pattern is partly a consequence of the size and shape of the areal units used in the
study. Although maps are important tools for visualizing health information and supporting
policy decisions, the choice of areal units and the aggregation and categorization of data must
be considered when interpreting the results.
➢ Limitations aside, place and geographic context are recognized as important influences on
health. Although ecologic fallacy has been used to dismiss ecologic (aggregate) studies as
unreliable and blunt instruments useful only for showing broad patterns, it is now recognized
that many risk factors do operate at the population or community level.25 These risks may
modify effects, such as interaction between genes and chemical pollutants, or directly
influence health. Dismissing ecologic studies neglects the geographic context within which
health outcomes occur. Advances in multilevel modelling, geographic information systems
and spatial analysis further supports research investigating the relative influence of
individual-and community-level health risks within a unified framework.
➢ Current developments in health geography include a stronger focus on health inequalities and
the impact of spatial and social marginalization on health, and more explicit exploration of the
nature of health change. The latter acknowledges that spatial relations are dynamic and that
health variation can be a consequence of individual mobility, and population movement and
migration. Geographic information systems, which support the analysis of dynamic spatial
data, are being more closely aligned with global positioning systems to monitor the
movement of people in real time to contextualize the interrelations between the physical and
built environments, people's daily routines and their health. However, there are both technical
(e.g., the development of appropriate computer software and hardware to capture and analyse
these data) and ethical (e.g., access to appropriate data, the privacy and confidentiality of
personal information) challenges in improving these systems.
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