Geographies of Health

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 ixList of Tables xiiPreface xivPart I Describing and Explaining Health in Geographical Settings 1Chapter 1 Introducing Geographies of Health 3Health and Geography: Some Fundamental Concepts 6Concepts of health 7Geographical concepts 10Geographies of Health: Five Case Studies 15Neighborhoods and obesity in New York City 16Public places after the introduction of “smoke free” legislation 18The health of Aboriginal populations in Canada 19Habitus and heart health: The collision of place, body, and health 21Mental health in Australian immigration detention centers 23Concluding Remarks 25Chapter 2 Explaining Geographies of Health 29Positivist Approaches to the Geography of Health 30Positivist explanation 30Further examples of positivist approaches 31Social Interactionist Approaches to the Geography of Health 37Social interactionist explanation 38Further examples of social interactionist approaches 39Structuralist Approaches to the Geography of Health 41Structuralist explanation 42Further examples of structuralist or conflict-based approaches 43Structurationist Approaches to the Geography of Health 50Structurationist explanation 50Further examples of structurationist approaches 52Post-structuralist Approaches to the Geography of Health 53Post-structuralist explanation 54Further examples of post-structuralist approaches 54Concluding Remarks 59Chapter 3 Quantitative Methods and Geographical InformationSystems (GIS) 65Visualizing and Exploring Health Data in a Spatial Context 66Modeling Health Data in a Spatial Setting 78Geographical Information Systems and Health 86Concluding Remarks 96Chapter 4 Qualitative Approaches to Interpreting the Geography of Health 101Interviews 102Focus Groups 110Other Qualitative Methods 112Qualitative Data Analysis 113Rigor in Qualitative Research 116Concluding Remarks 117Part II Health and the Social Environment 123Chapter 5 Health Inequalities I: Global Patterns and Regional Contrasts 125Health Inequalities in the Global South 126Health inequalities: Africa 130Health inequalities: The BRIC countries 132Health Inequalities in the Global North 139Regional divides in the global north 139Explaining inequalities in health outcomes in the global north 145Concluding Remarks 152Chapter 6 Health Inequalities II: Neighborhoods and Health 157A Chicago Story 159Neighborhood Context or Social Composition? 161The Obesogenic Neighborhood 163Psychosocial Health and Well-being 167Housing and Health 169Infectious Disease 170Neighborhoods and Access to Care 174Concluding Remarks 178Chapter 7 Systems of Health Care 184Principles of Health Service Delivery 185Levels and types of health care provision 185Promoting health, preventing illness 186Health Care Systems 190Geographies of rationing 192Efficiency and equity 193The need for health care 195Inequalities in the Provision of Health Services 196Health care provision in the global south 196Health care provision in the global north 202Geographies of Care 205Concluding Remarks 208Chapter 8 Inequalities in the Utilization of Health Services 214Use of Primary Health Care Services 215Use of Secondary and Tertiary Health Care Services 226Do Provision and Utilization Affect Outcome? 231Concluding Remarks 238Chapter 9 Ageing and Place 244What is Age? 245Ageing Populations: Global and Regional Perspectives 246The Distribution of Ill-Health and Disability Among Older Adults 249Health Inequalities in Older Adults 254Healthy Ageing “In Place” 258There’s No Place Like Home 264Concluding Remarks 268Chapter 10 People on the Move: Migration and Health 273Migration, Disruption, and Health 274Voluntary migration and mental health 274Forced displacement 276The Impact of Migration on the Spread of Disease 280Migration and the Incidence of Disease and Ill-health 283Direct effects 283Longer-term health impacts of migration 285Migration as a confounding variable 290Impact of Health Status on Migration 295The Relationship Between Migration and Access to Health Services 298Concluding Remarks 301Part III Health and Human Modification of the Environment 307Chapter 11 On Airs, Waters, Places 309Air 311Area sources 314Linear sources 320Point sources 324Water 329Cholera 331Schistosomiasis 334Gastroenteritis 335Chemicals in drinking water 337Concluding Remarks 342Chapter 12 Health Impacts of Global Environmental Change 349Stratospheric Ozone Depletion 352The Science of Climate Change and Its Role in Human Health 356Health Impacts of Climate Change 358Air quality 360Contamination of food and water 360Temperature extremes 363Extreme weather events and natural hazards 364Impacts on infectious vector-borne disease 367Concluding Remarks 370Chapter 13 Emerging, Re-emerging, and Neglected Infectious Diseases 375Disease Transmission: The Role of Vectors 376The Drivers of Emerging, Re-emerging, and Neglected Diseases 378Ecosystem change 378Political upheaval, conflict, and disaster 382Mobilities of people and goods 385Antimicrobial resistance 387Socioeconomic determinants and consequences 388Concluding Remarks 391Index 395