Health Geography Research Articles

Health geography and the 'performative' turn: making space for the audio-visual in ethnographic health research.

The purpose of this paper is to critically reflect on the added value of video in ethnographic research that seeks to understand peoples' lived experiences of health and place. Of particular interest is the potential for video to elicit the embodied, multisensory and relational nature of people's place experiences that are the focus of much recent health geography research. We draw on our experiences of using video in an ethnographic study that sought to explore the experiences of people with intellectual disabilities engaged in nature based (or 'green care') therapeutic interventions for health and wellbeing. We argue that video has the potential to capture aspects of people's wellbeing experiences that may be lost using other methods, such as observational field noting. Consideration is also given to how researchers using video methods should seek to (re)present people's wellbeing experiences, as well as the practical and ethical challenges that this approach has for those working in the field of health geography.

The impact of life course exposures to neighbourhood deprivation on health and well-being: a review of the long-term neighbourhood effects literature.

BackgroundIn this review article, we detail a small but growing literature in the field of health geography that uses longitudinal data to determine a life course component to the neighbourhood effects thesis. For too long, there has been reliance on cross-sectional data to test the hypothesis that where you live has an effect on your health and well-being over and above your individual circumstances.MethodsWe identified 53 articles that demonstrate how neighbourhood deprivation measured at least 15 years prior affects health and well-being later in life using the databases Scopus and Web of Science.ResultsWe find a bias towards US studies, the most common being the Panel Study of Income Dynamics. Definition of neighbourhood and operationalization of neighbourhood deprivation across most of the included articles relied on data availability rather than a priori hypothesis.ConclusionsTo further progress neighbourhood effects research, we suggest that more data linkage to longitudinal datasets is required beyond the narrow list identified in this review. The limited literature published to date suggests an accumulation of exposure to neighbourhood deprivation over the life course is damaging to later life health, which indicates improving neighbourhoods as early in life as possible would have the greatest public health improvement.

Associations between access to green and blue spaces and physical activity attainment – an 18-country study

PDS 70: Green space, Johan Friso Foyer, Floor 1, August 28, 2019, 1:30 PM - 3:00 PM Epidemiological and health geography research has found mixed support for the idea that better availability of natural environments is related to higher physical activity attainment. Often this is because the relationship is limited by the definitions of “physical activity” and “natural environment”, and direct use of natural environments is not considered. We examined associations between different metrics of blue space accessibility (coastal proximity, blue space proximity, surface water coverage in radial buffers) and the amount of leisure-time physical activity or walking undertaken in the last week in 18 countries using mixed models. Using the BlueHealth International Survey (a harmonised 18-country survey primarily focused on the relationship between recreational contact with blue spaces and human health and wellbeing), we were also able to detect whether energy expenditure on recreational visits to blue space mediated the relationship between access to blue spaces and physical activity. We detected mixed relationships between blue space accessibility and physical activity attainment, with strong between-country differences. In addition, different accessibility metrics yielded different results. Results of mediation analyses will be presented at the conference. The findings have implications for urban planning and the protection of blue spaces as a public health resource, but no universal conclusions can be made regarding blue space accessibility and physical activity outcomes. The results additionally suggest choosing accessibility metrics based on theories or models of the exposure-health relationship as it can greatly influence conclusions.

Developing a Locally Adaptive Spatial Multilevel Logistic Model to Analyze Ecological Effects on Health Using Individual Census Records

Geographical variable distributions often exhibit both macroscale geographic smoothness and microscale discontinuities or local step changes. Nonetheless, accounting for both effects in a unified statistical model is challenging, especially when the data under study involve a multiscale structure and non-Gaussian response variables. This study develops a locally adaptive spatial multilevel logistic model to examine binomial response variables that integrates an innovative locally adaptive spatial econometric model with a multilevel model. It takes into account global spatial autocorrelation, local step changes, and vertical dependence effects arising from the multiscale data structure. Another appealing feature is that the spatial correlation structure, implied by a spatial weights matrix, is learned along with other model parameters via an iterative estimation algorithm, rather than being presumed to be invariant. Bayesian Markov chain Monte Carlo (MCMC) samplers are derived to implement this new spatial multilevel logistic model. A data augmentation approach, drawing on recently devised Pólya-gamma distributions, is adopted to reduce computational burdens of calculating binomial likelihoods with a logit link function. The validity of the developed model is evaluated by a set of simulation experiments, before being applied to analyze self-rated health for the elderly in Shijiazhuang, the capital city of Hebei Province, China. Model estimation results highlight a nuanced geography of self-rated health and identify a range of individual- and area-level correlates of health for the elderly. Key Words: geography of health, local spatial modeling, multilevel models, spatial autocorrelation, spatial econometrics.

Linkages between Time to Reach Education Centers, Health Facility Centers, Poverty Status and Geography: A Multivariate Approach

Background: The first, third and fourth goals of SDG are concerned with ending poverty in all its forms everywhere, ensure healthy lives and promote well-being for all at all ages and ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, respectively. Nepal is committed to ensuring all children with access to free, compulsory, and good-quality basic and secondary education in Nepal.
 Objectives: This study aims to compare the average time to reach education centers and health facility centers by poverty status and ecological region.
 Materials and Methods: This study is based on NLSS 2011 data. In this study two major factors of access to facility namely education and health are considered. Four variables on access to education and three variables on access to health are used. Mean vectors, correlation matrices, and covariance matrices have been computed. The Multivariate Analysis of Variance is used to compare the mean vectors and to check the homogeneity of the variance-covariance matrix using Box's M test. Four tests namely Wilk's Lambda, Lawley- Hoteling trace, Pillai trace and Roy's largest root have been used to compare the mean vectors.
 Results: This study has shown that the average time to reach each nearest education center of poor households is higher than non-poor households in each ecological region. The average time to reach the primary school is lowest and highest to reach secondary school in each poverty status and ecological region. The average time to reach the nearest health post is lowest among different health facility centers in each poverty status and ecological region. The p-values of each Box's M and Pillai trace tests are less than 0.0001.
 Conclusion: The mean vectors of time to reach the nearest education center are significantly different between poor and non-poor households in each ecological region. The average time to reach the health facility centers is also significantly different in poor and non-poor households within each ecological region.

The place of courage

I have been rereading my editorial for 57(2) and cannot quite comprehend how quickly the quarter has flown by. Electing to leave off writing this present editorial until the end of the Institute of Australian Geographers 49th annual conference, held last week in Hobart, I recall sitting in Washington DC in April, thinking about the Hobart meeting and about conference culture more generally. Now, suddenly, the Hobart meeting is over and, as I write, people have wound or are winding their ways home. For those of us who reside here, of course, that journey is blissfully short—a rare event for us, and, I confess, welcome. So today, as I gaze at Kunanyi’s snow-covered peaks and valleys, I have time to reflect on the conference in a way more leisurely than might be the case had I been travelling. Scanning the contents for this issue, readers will see we have been fortunate to reproduce a speech given at the conference opening by University of Tasmania’s Vice Chancellor and President, Professor Rufus Black. I will not pre-empt what he writes except to note that he was gracious and authentic in his engagement with us and encouraged us to continue to be courageous in our scholarly considerations of place, in our defence of place, and in the example we set for others in relation to place. Readers will also see that we have included a few reflections on the conference from the lead organisers, Jason Byrne and Aidan Davison. In addition, Carolyn Finney has graciously given her permission to reproduce the moving poem she read during her keynote address at the conference.

Presenting health and medical geography: People, places, and change

Assessments of the development of geography as a discipline, and studies of sub‐disciplinary development within geography, have generally focused on the subject matter under study. Consideration has concentrated on topics, theories, methods, and paradigm shifts identified by analyses of published literature. There has been rather less interest in the spatialisation of the practice and performance of the discipline by people and institutions (though there have been exceptions) and equally little attention to the evidence provided by geographical conferences. We address these lacunae in current knowledge through a quantitative study of changing disciplinary endeavour in health geography as evidenced by participation in the International Medical Geography Symposia. For 35 years this biennial meeting has been the flagship conference for health and medical geographers. We have obtained, reviewed, and coded the proceedings of all 17 symposia, analysing the submitted papers by location of symposia, lead authorship, affiliation, and country of authorship. We investigate the globalisation of the sub‐discipline and changes in key institutional involvement. Novel network analysis methods are used to identify changing linkages between research centres. What emerges is a complex sub‐discipline driven by the changing neoliberal context of higher education and marked by both continuities and discontinuities in its practitioner networks.

Geografía de la salud: aplicaciones en la planificación territorial y urbana

Se realiza un análisis sobre los campos de estudio y las aplicaciones en la planificación territorial y urbana de la Geografía de la Salud, rama de la Geografía que analiza cómo las variables socioeconómicas, ambientales y urbanísticas afectan a la salud de la población a distintas escalas. La Geografía de la Salud puede ayudar a detectar ciertas causas de las desigualdades de salud de la población en el territorio y es útil para planificar entornos saludables y para establecer medidas adecuadas de prevención y atención sanitaria. La relevancia científica global de los estudios de Geografía de la Salud es cada vez mayor y se están dando una serie de condiciones para que destaque como una rama muy relevante de la Geografía aplicada

Top 10 Research Priorities in Spatial Lifecourse Epidemiology.

Summary:The International Initiative on Spatial Lifecourse Epidemiology (ISLE) convened its first International Symposium on Lifecourse Epidemiology and Spatial Science at the Lorentz Center in Leiden, Netherlands, 16–20 July 2018. Its aim was to further an emerging transdisciplinary field: Spatial Lifecourse Epidemiology. This field draws from a broad perspective of scientific disciplines including lifecourse epidemiology, environmental epidemiology, community health, spatial science, health geography, biostatistics, spatial statistics, environmental science, climate change, exposure science, health economics, evidence-based public health, and landscape ecology. The participants, spanning 30 institutions in 10 countries, sought to identify the key issues and research priorities in spatial lifecourse epidemiology. The results published here are a synthesis of the top 10 list that emerged out of the discussion by a panel of leading experts, reflecting a set of grand challenges for spatial lifecourse epidemiology in the coming years. https://doi.org/10.1289/EHP4868

Out of place, out of time: towards a more-than-human rhythmanalysis of smoking

Geography has in the last two decades showed an increasing interest in smoking and while mainly within the purview of health geographies, some have also utilised Foucauldian concepts of ‘governmentality’ and Goffman’s notion of ‘stigma’ to study smoking’s spatial exclusion and purification of public spaces. More recently, cultural geographers have started to investigate the more embodied, sensory as well as affective elements of smoking. Notwithstanding recent developments, the temporalities of smoking have largely remained unaccounted for, while the more-than-human in smoking has received little sustained attention. This article aims to fill this gap and in doing so intervenes in this body of critical work by developing a framework that can account for the pharmacological and habitual affordances of smoking, without descending into the pathologisation of smoking bodies that has characterised a public health focus on the addictive qualities of nicotine. To develop this framework, the article brings theories of the more-than-human into dialogue with rhythmanalysis, in order to examine the messy human–nonhuman ties through which everyday rhythms of smoking are enacted, embodied and performed. By focusing on the spatio-temporal patterns of two nonhuman elements, nicotine and the cigarette, the aim is to dislodge the human body from the centre of analysis. This conceptual more-than-human rethinking of smoking offers a means to account for the agency and affects of nonhumans in relation to smoking, and addiction more broadly, without slipping back into deterministic, public health understandings of the body.

How Do Professions Globalize? Lessons from the Global South in US Medical Education

AbstractThis article explores the professional construction of the space of Global Health. I argue that the growth of Global Health as a field of practice does not merely indicate an intensification of North-South intervention. It is also a professional project of reimporting lessons from the South to countries in the North. I focus on the emerging didactic regime for Global Health in US medical education and the deterritorialized “global” lessons that students are taught in poor countries. By rescaling these lessons to precarious settings at home, the space of Global Health is reterritorialized as a Global Medical South stretching into the United States, reinforcing the perception that health is not a right but a privilege. The analysis is based on a content analysis of university websites and didactic handbooks and a sample of sixty-four articles evaluating the education effects of study abroad experiences. It reveals an emerging canon of Global Health virtues and the construction of domestic scales for Global Health practices, which are based on ethnic and socioeconomic categories. This analysis of professional projects as spatial projects sheds new light on the geography of Global Health and of professional globalization more generally.

Introduction

As an emerging subfield of medical anthropology with roots in histories and geographies of colonial and international health, critical global health studies reflects both changing modes of health practice and the centering of critique as a core anthropological endeavor. This special section seeks to analyze and reflect on the meanings, valences, affects, and entailments of anthropological critique, taking the rise of global health and flourishing of global health ethnography as key sites of investigation. Each of the contributing pieces is oriented around a global health object or technology.

Soap

Anthropology has long grappled with the politics of critique. In critical global health studies, an emerging subfield of medical anthropology with roots in histories and geographies of colonial and international health, ethnographers negotiate relations and transactions in the field that pivot around boundaries at the core of our disciplinary practice: inside/outside, critique/complicity, theoretical/applied. Yet, while critique is a primary endeavor of the anthropologist, few have explicitly analyzed or reflected on its meanings, valences, affects, and entailments, particularly amid the rise of global health and the NGOization of the global South that inflects much of our work. In this essay, I reflect on the state of critique in critical global health studies, sketching its gestures, rhetoric, and intentions. Then, I trace some of the journeys of the bar of soap pictured below, an object that touched me in many senses of the term by intersecting, facilitating, and holding my anthropological interest for over a decade. Finally, drawing on recent feminist science studies scholarship, I suggest that critique, as entangled and entangling practice, is a form of care that might productively reframe anthropologists’ normative aspirations to ‘usefulness’ or ‘relevance’.

'When the dog bites': What can we learn about health geography from newspaper coverage in a 'model city' for dog-bite prevention?

Despite calls for the adoption of 'One-Health' approaches, dog-bite injuries remain neglected in healthcare and public health, and our study may help to understand why. Media coverage can influence policy directions, including policies that address dogs. We collected articles (n = 65) published in two local newspapers, 2012-2017, then carried out an ethnographically-informed discourse analysis of the dog-bite reports. The newspapers portrayed dog-bites mainly as matters of public disorder, as opposed to priorities for healthcare and public health. Even as our study took place in a city that has shown dog-bite reductions without recourse to 'breed bans' or restrictions (i.e., breed-specific legislation), journalists still tended to emphasize dog breed as a narrative element in explaining dog-bite incidents. Nonetheless, the news coverage did not reproduce a 'nature versus nurture' dichotomy. Rather, the journalists presented dog breed, and presumably associated aggressive behaviour, as entanglements with social, economic, and cultural contexts. Meanwhile, the news stories reduced contextual complexity to geographic locations, as codes for community reputation, in attributing causality and morality.

Geographies of (Cross)fitness: an ethnographic case study of a CrossFit Box

ABSTRACT As an increasingly popular form of physical culture, CrossFit is an ideal site for the investigation of health geographies of non-elite physical activity. In responding to Andrews, Sudwell, and Sparkes' (2005) call for further research on local spatial geographies of everyday fitness, this paper uses Massey’s (2001) concept of nostalgia, as well as her emphasis on both the spatial and temporal relativity of place, to explore and analyze the CrossFit Box. Through a spatial analysis of a CrossFit Box located in the Mid-Atlantic, coupled with participant observation and individual interviews, this paper looks at the ways in which the CrossFit Box acts as a site for the development of cultural and social health subjectivities. In examining the co-production of place within the CrossFit Box, I find the development of a local community based on a nostalgic imaging of the Box space, a stratifying hierarchy of membership based on a culture of ‘pushing’, and the subsequent emergence of health subjectivities that necessitate significant lifestyle changes.

Genetics and the geography of health, behaviour and attainment.

Young people's life chances can be predicted by characteristics of their neighbourhood1. Children growing up in disadvantaged neighbourhoods exhibit worse physical and mental health and suffer poorer educational and economic outcomes than children growing up in advantaged neighbourhoods. Increasing recognition that aspects of social inequalities tend, in fact, to be geographical inequalities2-5 is stimulating research and focusing policy interest on the role of place in shaping health, behaviour and social outcomes. Where neighbourhood effects are causal, neighbourhood-level interventions can be effective. Where neighbourhood effects reflect selection of families with different characteristics into different neighbourhoods, interventions should instead target families or individuals directly. To test how selection may affect different neighbourhood-linked problems, we linked neighbourhood data with genetic, health and social outcome data for >7,000 European-descent UK and US young people in the E-Risk and Add Health studies. We tested selection/concentration of genetic risks for obesity, schizophrenia, teen pregnancy and poor educational outcomes in high-risk neighbourhoods, including genetic analysis of neighbourhood mobility. Findings argue against genetic selection/concentration as an explanation for neighbourhood gradients in obesity and mental health problems. By contrast, modest genetic selection/concentration was evident for teen pregnancy and poor educational outcomes, suggesting that neighbourhood effects for these outcomes should be interpreted with care.

Toward an Ethically Founded Framework for the Use of Mobile Phone Call Detail Records in Health Research.

Data derived from the plethora of networked digital devices hold great potential for public benefit. Among these, mobile phone call detail records (CDRs) present novel opportunities for research and are being used in a variety of health geography studies. Research suggests that the public is amenable to the use of anonymized CDRs for research; however, further work is needed to show that such data can be used appropriately. This study works toward an ethically founded data governance framework with social acceptability. Using a multifaceted approach, this study draws upon data governance arrangements in published health research using CDRs, with a consideration of public views and the public’s information expectations from mobile network operators, and data use scenarios of CDRs in health research. The findings were considered against a backdrop of legislative and regulatory requirements. CDRs can be used at various levels of data and geographic granularity and may be integrated with additional, publicly available or restricted datasets. As such, there may be a significant risk of identity disclosure, which must be mitigated with proportionate control measures. An indicative relative risk of the disclosure model is proposed to aid this process. Subsequently, a set of recommendations is presented, including the need for greater transparency, accountability, and incorporation of public views for social acceptability. This study addresses the need for greater clarity and consistency in data governance for CDRs in health research. While recognizing the need to protect commercial interests, we propose that these recommendations be used to contribute toward an ethically founded practical framework to promote the safe, socially acceptable use of CDR data for public benefit. This pattern needs to be repeated for the appropriate use of new and emerging data types from other networking devices and the wider internet of things.

Traumatic landscapes: Two geographies of addiction

The confluence of the contemporary opioid crisis and the Great Recession has renewed interest in theories of addiction that can account for the relationship between individual symptoms and large-scale socio-political forces. Gesler's (1992) theory of ‘therapeutic landscapes’ examines the ways that social, political, and cultural forces, embedded in place, contribute to health and wellbeing. This article considers the inverse of the therapeutic landscape: the traumatic landscape that harms its inhabitants, proposing it as one way of understanding how addiction is related to place. I draw on research in health geography, medical anthropology, and critical psychology to develop a novel theorization of the relationship between place, trauma, and addiction. Drawing on eighteen months of ethnographic fieldwork with drug users exiting the prison system in Chicago, Illinois, the article considers the life histories of two men whose addictions to drugs and alcohol are profoundly related to place. Through close readings of these cases, I develop two readings of addiction-in-place, one in which addiction is the result of environmental stresses that produce a need to use drugs as a form of self-medication, and another in which the landscape acts as a container for histories of trauma and produces an addiction resembling a psychoanalytic symptom, expressed in self-destructive acts. Finally, through my use of the case history method, I contribute to methodological debates about how to research experiences of place and health, arguing that close attention to lived experience is necessary to draw links between macro-level arguments about structural violence and the subjective experience of trauma that lies at the heart of addiction.

Health, faith and therapeutic landscapes: Places of worship as Black, Asian and Minority Ethnic (BAME) public health settings in the United Kingdom

Within the United Kingdom, there is evidence that faith-based affiliations, ideas, actors and organisations play a role in public health (PH) that has been neither properly recognised nor integrated into mainstream health systems (November, 2014). Discourses on faith and improving health outcomes have been particularly focused on 'seldom heard' groups, including 'Black, Asian and Minority Ethnic' (BAME) communities (November, 2014; Jain, 2014; Burton et al., 2017; Muhammad, 2018). In this paper we first present findings from a qualitative scoping study carried out in the UK cities of Leeds and Bradford, between 2014 and 2015, which examined Places of Worship (PWs) as BAME PH settings. We carried out 19 semi-structured interviews with purposively selected respondents, and three focus groups. Second, we develop a theory that originates from one in the sub-discipline of 'health geography' concerned with 'therapeutic landscapes', applying it to our research findings on PWs as BAME PH settings. The paper argues for the recentring of religion and faith settings back into the therapeutic landscapes literature, reflecting evidence that faith-based affiliations, ideas, actors and organisations are relevant to the pursuit of health and wellbeing. We also contend that a therapeutic landscapes framework provides a way of making the health relevance of PWs visible to both health practitioners and to members of PWs. We argue that PWs act as therapeutic places (i.e. specific transformative sacred sites) as well as therapeutic spaces (i.e. settings that provide adjuncts to formal PH promotion services), and are often part of therapeutic networks included in 'kinship groups and networks of care provided by family, friends, therapists and other agents of support' (Smyth, 2005: 490). This approach allows us to see how influences on health behaviour are not just confined to biomedical settings, but that the 'healing process works itself out in places (or situations, locales, settings and milieus)' (Gesler, 1992: 743).

Precarious encounters with urban life: The city/psychosis nexus beyond epidemiology and social constructivism

The article analyses the specific sense of precarity experienced in cities by persons living with a diagnosis of schizophrenia. It aims to bring a social science perspective on precarity as embodied affect into conversation with perspectives on psychosis in the life sciences. To do so the article focuses on two moments in an interdisciplinary research process involving psychiatrists, linguists and geographers. The first is an epistemic moment describing the co-design of a research laboratory across the social and the life sciences to study participants' precarious encounters with urban situations. The second is an ontological moment discussing the results of co-experimentation across disciplines in the research team. It shows how collaboration within the team led to a redefinition of our respective analytical categories and discusses empirical findings concerning factors of urban stress and protection for persons living with a diagnosis of schizophrenia. The conclusion situates the socio-natural analysis of urban precarity developed in the paper within broader contemporary discussions on the study of bio-social entanglements. Arguing for epistemological plurality and ontological contamination, the paper is both a methodological contribution to contemporary debates in geographies of health and a contribution to studies of urban precarity.