Uncertain space: Data illusions and the landscape of illness in the 21st century

Abstract

Disease mapping offers certainty in the face of disease outbreaks. Spatially locating illness lets the average person assess their proximity to risk and appears to tie it to specific environmental conditions. During the cholera and yellow fever epidemics of the mid- to late 1800’s, disease mapping was a major factor in decision-making that shaped our environment. In the early 1900’s when hay fever and pulmonary illness continued to wrack urban environments, narrative medical geographies provided written depictions of healthy rural regions to contrast against congested urban cities with experimental maps linking climate, topography and airflow with emerging medical knowledge of respiratory systems and circulation. However, as germ theory and vaccines decoupled environment and illness, the relationship between the physical qualities of the immediate landscape and outbreaks became less important than its simple locus. In this exploratory essay, I discuss how this decoupling has allowed for the wholesale stigmatization of both places and marginalized populations, particularly in the cases of urban blight and the AIDS epidemic. Although we are currently in an era of abundant personal and spatial data, it has proven difficult to tie contemporary public health issues back to the environment, even in cases like obesity where there are tangible connections to the physical and social characteristics of neighborhoods, due to the way this data is collected and structured. Nuanced shifts in the built environment, social determinants of health, and invisible histories of policy and environmental change have on-the-ground impacts as well, and to better understand the nature of today’s landscape of disease, we must find a way to represent them spatially.