Health geography

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Hepatitis A prevalence worldwide, 2005. HAV prevalence 2005.png
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. Medical geography, a sub-discipline of, or sister field of health geography, [1] focuses on understanding spatial patterns of health and disease in relation to the natural and social environment. [2] [3] Conventionally, there are two primary areas of research within medical geography: the first deals with the spatial distribution and determinants of morbidity and mortality, while the second deals with health planning, help-seeking behavior, and the provision of health services. [4]

Contents

Overview

Medical geography

The first area of study within medical geography has been described as geographical epidemiology or disease geography and is focused on the spatial patterns and processes of health and disease outcomes. [4] This area of inquiry can be differentiated from the closely related discipline of epidemiology in that it uses concepts and methods from geography, allowing an ecologic perspective on health that considers how interactions between humans and the environment result in observed health outcomes. [5] The second area of study focused on the planning and provision of health services, often with a focus on the spatial organization of health systems and exploration of how this arrangement affects accessibility of care. [6]

Health geography

The study of health geography has been influenced by repositioning medical geography within the field of social geography due to a shift towards a social model in health care, rather than a medical model. This advocates for the redefinition of health and health care away from prevention and treatment of illness only to one of promoting well-being in general. Under this model, some previous illnesses (e.g., mental ill health) are recognized as behavior disturbances only, and other types of medicine (e.g., complementary or alternative medicine and traditional medicine) are studied by the medicine researchers, sometimes with the aid of health geographers without medical education. This shift changes the definition of care, no longer limiting it to spaces such as hospitals or doctor's offices. Also, the social model gives priority to the intimate encounters performed at non-traditional spaces of medicine and healthcare as well as to the individuals as health consumers. [7]

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. [8]

History

John Snow's cholera map of the 1854 Broad Street cholera outbreak. Snow-cholera-map-1.jpg
John Snow's cholera map of the 1854 Broad Street cholera outbreak.

Relationships between place and health have long been recognized throughout human history, predating modern health delivery systems and providing insights into the transmission of infectious agents, well before the germ theory paradigm shift in the late 1800s. Throughout history, there have been many examples of place and location playing major roles in shaping perceptions of health and risk. The associations between geographical characteristics and health outcomes, which essentially form the foundation of modern medical geography, were recognized more than 2,000 years ago by Hippocrates in his treatise ’’On Airs, Waters, and Places’’ (ca. 400 BC). The Industrial Revolution in the 1700s brought with it a plethora of novel public health issues stemming from rapid urban development and poor sanitation, conditions which fueled the development of disease mapping, or medical cartography. A precursor to medical geography, medical cartography arose from the need to communicate spatial discrepancies in risk for diseases of unknown cause, particularly urban outbreaks of cholera and yellow fever. [9] One of the most prominent figures in both epidemiology and medical geography is John Snow, the physician who correctly identified the source of exposure during the 1854 Broad Street cholera outbreak. Snow's famous 1854 map of the cholera outbreak graphically demonstrates that cases were clustered around the Broad Street pump, the source of contaminated water that fueled the epidemic. This map led Snow to identify the contaminated pump and conclude that cholera was a waterborne illness, a remarkable feat given that bacteria were unknown to science at the time. While Snow's contributions to medical geography and epidemiology are irrefutable, the role of the map in this particular investigation is somewhat overstated. [10] Dot maps of cases produced during the industrial period were powerful tools in communicating the findings of traditional epidemiological measures of association, but their role as analytic tools were restricted due to technological limitations. [11]

Modern medical geography arose in the United States in the 1950s with the pioneering work of Jacques May, [12] who worked as a surgeon in Thailand and Vietnam and noticed differences between the health experiences of his patients in these locations and in Europe. [6] Although the notion that the environment could influence human health has been understood since Hippocrates, medical geography as envisioned by May built on this idea, describing medical geography as working to understand the nature of the relationships between pathogen transmission and geographical factors. [13] May soon began mapping global distributions of disease and exploring the cultural and environmental factors that influenced these distributions. [12] [6]

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. [14] The second component 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. [15]

Geographies of disease and ill health

Health geographers are concerned with the prevalence of different diseases along a range of spatial scales from a local to global view, 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 dispersion of health, [16] including various diseases, as individuals spread them amongst themselves, and across wider spaces as they migrate. [8] Health geographers also consider all types of spaces as presenting health risks, from natural disasters, to interpersonal violence, stress, and other potential dangers. [7]

Health insurance coverage Coverage by Type of Health Insurance- 2008 and 2009p25.pdf
Health insurance coverage

Geography of health care provision

Although healthcare is a public good, it is not equally available to all individuals. Demand for public services is continuously increasing. People need advance knowledge and the latest prediction technology, that health geography offers. The latest example of such technology is Telemedicine. Many people in the United States are not able to access proper healthcare because of inequality in health insurance and the means to afford medical care. [17]

Mobility and Disease Tracking:
With the advent of mobile technology and its spread, it is now possible to track individual mobility. By correlating the movement of individuals through tracking the devices using access towers or other tracking systems, it is now possible to determine and even control disease spread. While privacy laws question the legality of tracking individuals, the commercial mobile service providers are using covert techniques or obtaining government waivers to allow permission to track people.[ citation needed ]

Methods

Geographic Information Systems (GIS) are used extensively in medical geography to visualize and analyze georeferenced health-related data. These spatial data can be vector (point, line, or polygon) or raster (continuous grid) format and are often presented in quantitative thematic maps. Disease outcomes and sociodemographic characteristics collected through surveillance systems and population censuses are frequently used as data sources in medical geography studies. In disease ecology studies, interpolated climate data, gridded land surveys, and remote sensing imagery are examples of data used to quantify the environmental characteristics of disease systems. Spatial statistics or analysis are applied to test hypotheses regarding patterns or relationships within these data, such as the property of spatial dependency (spatially closer entities are more similar or related than spatially distant entities) [18] or spatial heterogeneity (locations are unique relative to other locations). [19] Some examples of the spatial analyses used in medical geography include point pattern analysis, tests for spatial autocorrelation, geographically weighted regression (GWR), ecological niche modeling, spatial scan statistics, and network analysis.

Health geographers

Notable health geographers include:

See also

Related Research Articles

<span class="mw-page-title-main">Geographic information system</span> System to capture, manage, and present geographic data

A geographic information system (GIS) consists of integrated computer hardware and software that store, manage, analyze, edit, output, and visualize geographic data. Much of this often happens within a spatial database; however, this is not essential to meet the definition of a GIS. In a broader sense, one may consider such a system also to include human users and support staff, procedures and workflows, the body of knowledge of relevant concepts and methods, and institutional organizations.

<span class="mw-page-title-main">Human geography</span> Study of cultures, communities, and activities of peoples of the world

Human geography or anthropogeography is the branch of geography which studies spatial relationships between human communities, cultures, economies, and their interactions with the environment, examples of which include urban sprawl and urban redevelopment. It analyzes spatial interdependencies between social interactions and the environment through qualitative and quantitative methods.This multidisciplinary approach draws from sociology, anthropology, economics, and environmental science, contributing to a comprehensive understanding of the intricate connections that shape lived spaces.

<span class="mw-page-title-main">Epidemiology</span> Study of health and disease within a population

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in a defined population.

<span class="mw-page-title-main">Spatial analysis</span> Formal techniques which study entities using their topological, geometric, or geographic properties

Spatial analysis is any of the formal techniques which studies entities using their topological, geometric, or geographic properties. Spatial analysis includes a variety of techniques using different analytic approaches, especially spatial statistics. It may be applied in fields as diverse as astronomy, with its studies of the placement of galaxies in the cosmos, or to chip fabrication engineering, with its use of "place and route" algorithms to build complex wiring structures. In a more restricted sense, spatial analysis is geospatial analysis, the technique applied to structures at the human scale, most notably in the analysis of geographic data. It may also be applied to genomics, as in transcriptomics data.

Spatial epidemiology is a subfield of epidemiology focused on the study of the spatial distribution of health outcomes; it is closely related to health geography.

<span class="mw-page-title-main">Thematic map</span> Type of map that visualizes data

A thematic map is a type of map that portrays the geographic pattern of a particular subject matter (theme) in a geographic area. This usually involves the use of map symbols to visualize selected properties of geographic features that are not naturally visible, such as temperature, language, or population. In this, they contrast with general reference maps, which focus on the location of a diverse set of physical features, such as rivers, roads, and buildings. Alternative names have been suggested for this class, such as special-subject or special-purpose maps, statistical maps, or distribution maps, but these have generally fallen out of common usage. Thematic mapping is closely allied with the field of Geovisualization.

<span class="mw-page-title-main">Field (geography)</span> Property that varies over space

In the context of spatial analysis, geographic information systems, and geographic information science, a field is a property that fills space, and varies over space, such as temperature or density. This use of the term has been adopted from physics and mathematics, due to their similarity to physical fields (vector or scalar) such as the electromagnetic field or gravitational field. Synonymous terms include spatially dependent variable (geostatistics), statistical surface ( thematic mapping), and intensive property (physics and chemistry) and crossbreeding between these disciplines is common. The simplest formal model for a field is the function, which yields a single value given a point in space (i.e., t = f(x, y, z) )

Participatory GIS (PGIS) or public participation geographic information system (PPGIS) is a participatory approach to spatial planning and spatial information and communications management.

A spatial decision support system (SDSS) is an interactive, computer-based system designed to assist in decision making while solving a semi-structured spatial problem. It is designed to assist the spatial planner with guidance in making land use decisions. A system which models decisions could be used to help identify the most effective decision path.

Disease diffusion occurs when a disease is transmitted to a new location. It implies that a disease spreads, or pours out, from a central source. The idea of showing the spread of disease using a diffusion pattern is relatively modern, compared to earlier methods of mapping disease, which are still used today. According to Rytokonen, the goals of disease mapping are: 1) to describe the spatial variation in disease incidence to formulate an etiological hypothesis; 2) to identify areas of high risk in order to increase prevention; and 3) to provide a map of disease risk for a region for better risk preparedness.

Tele-epidemiology is the application of telecommunications to epidemiological research and application, including space-based and internet-based systems.

<span class="mw-page-title-main">1854 Broad Street cholera outbreak</span> Severe outbreak of cholera that occurred in London in 1854

The Broad Street cholera outbreak was a severe outbreak of cholera that occurred in 1854 near Broad Street in Soho, London, England, and occurred during the 1846–1860 cholera pandemic happening worldwide. This outbreak, which killed 616 people, is best known for the physician John Snow's study of its causes and his hypothesis that germ-contaminated water was the source of cholera, rather than particles in the air. This discovery came to influence public health and the construction of improved sanitation facilities beginning in the mid-19th century. Later, the term "focus of infection" started to be used to describe sites, such as the Broad Street pump, in which conditions are favourable for transmission of an infection. Snow's endeavour to find the cause of the transmission of cholera caused him to unknowingly create a double-blind experiment.

<span class="mw-page-title-main">Geography</span> Study of lands and inhabitants of Earth

Geography is the study of the lands, features, inhabitants, and phenomena of Earth. Geography is an all-encompassing discipline that seeks an understanding of Earth and its human and natural complexities—not merely where objects are, but also how they have changed and come to be. While geography is specific to Earth, many concepts can be applied more broadly to other celestial bodies in the field of planetary science. Geography has been called "a bridge between natural science and social science disciplines."

Geographic information systems (GISs) and geographic information science (GIScience) combine computer-mapping capabilities with additional database management and data analysis tools. Commercial GIS systems are very powerful and have touched many applications and industries, including environmental science, urban planning, agricultural applications, and others.

<span class="mw-page-title-main">Outline of geography</span> Hierarchical outline list of articles related to geography

The following outline is provided as an overview of and topical guide to geography:

<span class="mw-page-title-main">Dot distribution map</span> Thematic map using dots to visualize distribution

A dot distribution map is a type of thematic map that uses a point symbol to visualize the geographic distribution of a large number of related phenomena. Dot maps are a type of unit visualizations that rely on a visual scatter to show spatial patterns, especially variances in density. The dots may represent the actual locations of individual phenomena, or be randomly placed in aggregation districts to represent a number of individuals. Although these two procedures, and their underlying models, are very different, the general effect is the same.

<span class="mw-page-title-main">Mei-Po Kwan</span> Geographer

Mei-Po Kwan is a geographer known for her research contributions in Geographic Information Science, and human geography, particularly as they apply to time geography and human mobility. She is the Choh-Ming Li Professor of Geography and Resource Management at The Chinese University of Hong Kong (CUHK), Director of the Institute of Space and Earth Information Science (ISEIS) of CUHK, Director of the Institute of Future Cities of CUHK, and Head of Chung Chi College of CUHK.

<span class="mw-page-title-main">Technical geography</span> Study of using and creating tools to manage spatial information

Technical geography is the branch of geography that involves using, studying, and creating tools to obtain, analyze, interpret, understand, and communicate spatial information.

<span class="mw-page-title-main">Uncertain geographic context problem</span> Source of statistical bias

The uncertain geographic context problem or UGCoP is a source of statistical bias that can significantly impact the results of spatial analysis when dealing with aggregate data. The UGCoP is very closely related to the Modifiable areal unit problem (MAUP), and like the MAUP, arises from how we divide the land into areal units. It is caused by the difficulty, or impossibility, of understanding how phenomena under investigation in different enumeration units interact between enumeration units, and outside of a study area over time. It is particularly important to consider the UGCoP within the discipline of time geography, where phenomena under investigation can move between spatial enumeration units during the study period. Examples of research that needs to consider the UGCoP include food access and human mobility.

<span class="mw-page-title-main">Qualitative geography</span> Subfield of geographic methods

Qualitative geography is a subfield and methodological approach to geography focusing on nominal data, descriptive information, and the subjective and interpretive aspects of how humans experience and perceive the world. Often, it is concerned with understanding the lived experiences of individuals and groups and the social, cultural, and political contexts in which those experiences occur. Thus, qualitative geography is traditionally placed under the branch of human geography; however, technical geographers are increasingly directing their methods toward interpreting, visualizing, and understanding qualitative datasets, and physical geographers employ nominal qualitative data as well as quanitative. Furthermore, there is increased interest in applying approaches and methods that are generally viewed as more qualitative in nature to physical geography, such as in critical physical geography. While qualitative geography is often viewed as the opposite of quantitative geography, the two sets of techniques are increasingly used to complement each other. Qualitative research can be employed in the scientific process to start the observation process, determine variables to include in research, validate results, and contextualize the results of quantitative research through mixed-methods approaches.

References

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