Health Geography Research Articles

Health Geography and Public Health Implementations

Sağlık ve coğrafya içsel olarak bağlandılıdır. Doğulan, yaşanılan, çalışılan yer ve direk çalışılan iş kolu dahi sağlığı direk ya da dolaylı yollarla etkilemektedir. Bulunulan bölge, mekan ya da alanda solunan hava, yenilen yiyecekler, maruz kalınan virüsler ve erişilebilen sağlık hizmetleri sağlığı olumlu ya da olumsuz yönde etkilemektedir. Mekansal konum bahsedilen etkilerinin yanı sıra çevresel risklerin şekillenmesinde de önemli rol oynamaktadır. Bu noktada sağlık hizmetlerinin yerini belirleme, halk sağlığı stratejileriini belirleme ya da salgınları izleme de sağlık coğrafyasının önemli rolü ortaya bulunmaktadır. Sağlık coğrafyası, insanın mekânla etkileşimi sonucu meydana gelen hastalıklarla mücadelede, coğrafyanın ilkelerini kullanarak, hastalığın ortaya çıkışları ve mücadele etme yolları üzerinde metotlar ve modeller geliştiren bir coğrafya alanıdır. Sağlık coğrafyasının amaçları; hastalıkların mekânsal dağılışı ve mekân ile ilişkisi, hastalıkların nedenleri, prognozu, insanlar üzerindeki etkileri ve sonuçlarına yönelik olarak insan sağlığının korunması amacıyla sağlık hizmetlerinin coğrafi olarak planlamasına yol gösterici olmaktır. Bu coğrafya dalı eski çağlardan itibaren çevre ve sağlık etkileşimi üzerine odaklanmakta olup; günümüzde hastalıkların küresel çapta salgınla yaratması önemini daha da arttırmıştır. Sağlık coğrafyası; coğrafik koşullara bağlı olarak gelişen hastalıkları ayırt etmek, hastalığa neden olan faktörleri belirlemek, sağlık sorunlarını en aza indirmek, bireylerin sağlık kurum ve kuruluşlarından yararlanmasını optimal düzeye çıkarmak ve halk sağlığına katkıda bulunmak amacıyla yapılan sağlık planlaması çalışmalarına yol göstermektedir. Sağlık coğrafyası ve halk sağlığı alanları birbirileri ile bağlantılı olarak çalışan ve özellikle çevresel ve coğrafik özelliklerin sağlık üzerindeki etkilerini anlamaya ve açıklamaya çalışan ayrı bilim dallarıdır. Bu derleme çalışmasında sağlık coğrafyası halk sağlığı bakış açısıyla irdelenmeye çalışılmıştır.

A problem-based learning course to teach Brazilian biology students about the viral hepatitis from a health geography perspective

ABSTRACT In this study we designed, implemented, and evaluated a Problem-based Learning (PBL) course to teach undergraduate students about Viral Hepatitis from a Health Geography perspective. The course was attended by undergraduate students with no previous experience with PBL from a college in the Brazilian Amazon state of Acre. The course design was based on a combination of features from different PBL frameworks, allowing the students to gradually switch from a content-centered educational environment to a student-centered one. The PBL unit was based on an ill-structured real-life problem concerning the division of a hypothetical budget among actions to fight Viral Hepatitis in the state’s municipalities. Student problem solutions indicated that they learned basic Viral Hepatitis and Health Geography concepts. Furthermore, perceptions of their own learning demonstrated that students regarded their acquired problem-solving skills and their knowledge of the course subject as their main educational outcomes. We argue that the combination of different PBL frameworks, the gradual transition from lectures to active learning and the social relevance of the course subject to students are among the putative factors that contributed to the course’s success. This study, therefore, provides insights into the design of PBL courses for students inexperienced in active learning.

DISTRIBUIÇÃO ESPACIAL DE FATORES DE RISCO E TEORES DE FLÚOR NA ÁGUA DE ABASTECIMENTO PÚBLICO EM ESCALA MUNICIPAL

Fluoridation of public water supplies is an important measure to prevent dental caries and is linked to Sustainable Development Objective 6. This study aimed to evaluate the fluoride content of Ceará's municipalities. The research used secondary data from SISAGUA (municipality; year, date, source and point of collection; form of supply; supply system; chlorine and fluoride concentrations) and the IBGE (HDI, population, FIRJAN Municipal Development Index, and estimated population) for spatial distribution and the analysis of fluoride risk factors. Of the 26,390 samples collected, only 17.8% had ideal fluoride content, with a higher prevalence in samples collected in 2016, in isolated urban areas, in water supply systems, and in chlorine levels above the ideal. Of the 182 municipalities evaluated, 16.7% had most of the samples with ideal fluoride content. In a multivariate analysis, municipalities with a population below 30 thousand inhabitants had a prevalence of inadequate fluoride content (below or above the ideal) 2.12 (95% CI = 1.92-4.88) times higher than municipalities with large populations. It is concluded that less than a fifth of Ceará's population is exposed to adequate public water fluoride levels, and cities with fewer than 30,000 inhabitants are the most affected. Keywords: Fluoride. Water Fluoridation. Environmental Health Surveillance. Health Geography.

Spatial patterns of excess mortality in the first year of the COVID-19 pandemic in Germany

In order to quantify the societal impact of the Corona pandemic, several studies have estimated excess mortality rather than infections or COVID-19-related deaths. The question of whether there was excess mortality associated with COVID-19 in Germany in the first year of the pandemic is controversial, as there are different ways of calculating this. From the perspective of health geography, however, this question must be answered with a spatial approach since epidemics are spatial diffusion processes and mortality varies regionally. This study aims to test whether there is excess mortality at a regional level in Germany in 2020, whether it is spatially dependent and whether all-cause mortality is associated with COVID-19-related deaths. Excess mortality is investigated at a small-scale spatial level (NUTS 3; 400 counties) and under consideration of demographic changes by calculating Standardized Mortality Ratios (SMRs). SMRs and COVID-19-related deaths per 100,000 people are tested for spatial dependence by the Moran’s I index. It is, furthermore, tested whether all-cause mortality is associated with COVID-19-related deaths by correlation coefficients. Excess mortality can be detected in only a minority of counties, regardless of age group, confirming previous results of no excess mortality overall. However, there are large regional disparities of all-cause mortality and COVID-19-related deaths. In older age groups, both indicators show spatial dependence. These results make it possible to identify COVID-19 hotspots. (Excess) mortality in older age groups is impacted by COVID-19, but this association is not found for young and middle age groups.

GEOGRAPHICAL ANALYSIS OF HYPERTENSION IN CANADIAN POPULATION

Objective: A quarter of population is affected by hypertension in Canada. Substantial improvement has been achieved in HTN control in Canada over the past twenty-five years. However, disparities associated with factors like sex, ethnicity, location and health care access remain. Reliable information about trends in hypertension is needed at regional scale for the development of health policies and programs. Health geography and geographic information systems can provide a better understanding of HTN and its risk factors by detecting clusters using spatial analysis and mapping rates of HTN. The objectives of the study were to identify health regions with significantly high or low HTN rate using geostatistics and compare evolution from 2005 to 2019. It also seeks out to identify their populations’ characteristics using conventional statistical analysis. Design and method: Canadian Community Health Survey (2005, 2015, 2019) data were used for the analysis. The 130,000 respondents are located according to health regions and data can be analyzed using a geographic information system. Using age and gender as criteria for subgroups creation, we applied spatial autocorrelation analysis and hot spot/cold analysis to identify geographically contiguous health regions with high or low HBP rates. We then extracted the records in CCHS database for all respondents living in these regions for further statistical analysis. Results: HTN is still a major problem in Canadian population, especially for people aged 65 years and older although 72.9% considered themselves in good, very good or excellent health in 2015. Increase in HTN rate in health regions is spread all over Canada, although some regions showed a decrease in HTN rate. Getis-ord analysis located a cold spot region in western Canada while a hot spot was located in Ontario, central Canada. Cluster of health regions with high HTN rates shows more diabetes and more obese people even though 38.4% declared being in good, very good or excellent health. Conclusions: Increase in hypertension rate in health regions is spread all over Canada, even tough some regions showed a decrease in HBP rate. Canadians 65 years and older with HBP where more prone to obesity & diabetes.

Events Across the Life Course Contribute to Higher Mobility Impairment Rates in Rural U.S.

PurposeThis paper investigates how life events such as injuries, health insurance coverage, geography, and occupation contribute to mobility disability rates over time. Findings can inform policies and practices to address factors that may contribute to disability in rural and urban areas.MethodsWe utilized 27 waves of the National Longitudinal Survey of Youth (NLSY) data from 1979 to 2016 to explore how past injury, occupation, health insurance coverage, and rurality predicted mobility impairment at ages 40 and 50 using regression analysis.FindingsRural respondents reported significantly higher rates of mobility impairment at age 40 and age 50 relative to people living in urban areas, and were more likely to report injury, work in high exertion occupations, and experience several pain-related health conditions. Using logistic regression and controlling for race and education, we found that people had higher odds of experiencing mobility impairment at age 40 if they reported a broken bone in the last 10 years, reported ever being knocked unconscious, had any workplace injury from 1988 to 2000, or lived in a rural area. People reported lower odds of mobility impairment if they had more consistent health insurance coverage over time. Further analysis showed that people consistently uninsured over time were 91% more likely to report mobility impairment at age 40 than those consistently insured.ConclusionA better understanding of environmental factors associated with disability such as access to insurance, risk exposures, resources, and other place-based behaviors can inform additional strategies for reducing the severity and duration of mobility disability.

Ecosystem Health and Environmental Geography in the Belt and Road Regions.

The “Belt and Road” Initiative (BRI), i.e., the official Chinese term for the “Silk Road Economic Belt” and the “21st Century Maritime Silk Road”, was proposed to share China’s development opportunities with BRI-related countries and achieve common prosperity. Though the BRI itself conveys rich social and economic connotations, ecosystem health and the environmental problems in the Belt and Road regions are scientific issues. In this study, papers relating to the ecological issues of the BRI between January 2013 and December 2021 were collected and analyzed via CiteSpace. We found that some ecological issues were involved with the environmental challenges posed by the BRI, whereas others were, to a certain extent, subjective assumptions. Accordingly, we identified and classified the limitations and constraints of those environmental views about the BRI. By emphasizing that scientific data is key to explaining the ecological problems, we advanced four prospects for ecosystem health and environmental geography studies in the Belt and Road regions: (1) Spatial analysis and monitoring technology for the environment; (2) Clarification of the characteristics and mechanisms of the ecosystem and environments; (3) A focus on the interaction between the economy and the environment; (4) Specific and targeted strategies and solutions to different environmental problems.

Spatial lifecourse epidemiology in chronic non-communicable disease research

In recent years, the research focus on determinants of chronic non-communicable diseases has shifted from non-spatial factors (e.g., lifestyle behaviors) to spatial factors (e.g., natural and built environments). As the intersection of lifecourse epidemiology and spatial epidemiology, spatial lifecourse epidemiology is a research area in the field of health geography. It combines advanced spatial technologies, including geographic information systems, surveying, remote sensing, location-based services and artificial intelligence, to accurately retrace, measure, and simulate individuals' exposures across the life course (i.e., exposome); and adopts lifecourse models, including the accumulation of risk model and critical/sensitive period models, to investigate the impact of individuals' exposures in the past on their health status at different stages of life. This paper introduces the theories, main analysis approaches and focus of spatial lifecourse epidemiology in the research of chronic non-communicable diseases for the purpose of better understanding and applications of spatial lifecourse epidemiology in the research of determinants of chronic non-communicable diseases, providing important reference for future research, facilitating the development of health geography to eventually achieve precise health management over the lifecourse.

(Applied) geography, policy, & time: whither health and medical geography?

ABSTRACT In this provocation, we discuss the potential for health/medical geography to contribute to a policy-relevant geographical research agenda that remains attentive to social theory debates. We illustrate the importance of time as a social determinant of health, through the case study of racial/ethnic inequities in spatial access to acute hospitals in the U.S. South region amid rural hospital closures, conversions, and mergers, which have decreased the supply of hospitals since 1990. In sum, racial disparities in spatial access were most pronounced for travel distances/times to the nearest alternative hospital, underscoring the importance of both temporal and spatial equity.

Experimental Analysis of Geo-spatial Data to Evaluate Urban Greenspace: A Case Study in Dortmund, Germany

Urban greenspace is of high importance for the general public from different points of view. Among others, it is beneficial for recreational activities as well as for cooling effects during summer in urban climate. Many studies investigate urban greenspace from perspectives related to environmental justice or health geography that are usually based on environmental and sociodemographic data of diverse scales or spatial levels of detail and often suffer from high degrees of generalization. To demonstrate the benefit of a higher degree of spatial detail, a representative part of the city of Dortmund (Germany) is selected as study area. A time series of freely available Sentinel-2 images and a freely available digital object height model (DOHM) are used to analyze and describe the spatio-temporal distribution of urban vegetation and its potential effects on the population. Doing so, the Sentinel-2 images are used for the calculation of vegetation indices to identify the active green period of different vegetation land covers. In addition to that, the three-dimensional appearance of vegetation is correlated with the green period to assume the relevance of green land covers for the general public. The results show that an appropriate selection of cloud-free satellite images is of importance for a greenspace analysis. The combination of high resolution 2D and 3D data sets, namely NDVI and plant height information, reveals the spatial distribution of well-equipped greenspace areas with high recreational and health potential as well as poorly-equipped areas in urban neighborhoods, that could be improved.

Detecting Suicide Ideation in the Era of Social Media: The Population Neuroscience Perspective.

Social media platforms are increasingly used across many population groups not only to communicate and consume information, but also to express symptoms of psychological distress and suicidal thoughts. The detection of suicidal ideation (SI) can contribute to suicide prevention. Twitter data suggesting SI have been associated with negative emotions (e.g., shame, sadness) and a number of geographical and ecological variables (e.g., geographic location, environmental stress). Other important research contributions on SI come from studies in neuroscience. To date, very few research studies have been conducted that combine different disciplines (epidemiology, health geography, neurosciences, psychology, and social media big data science), to build innovative research directions on this topic. This article aims to offer a new interdisciplinary perspective, that is, a Population Neuroscience perspective on SI in order to highlight new ways in which multiple scientific fields interact to successfully investigate emotions and stress in social media to detect SI in the population. We argue that a Population Neuroscience perspective may help to better understand the mechanisms underpinning SI and to promote more effective strategies to prevent suicide timely and at scale.

Walking the health geographers' talk: Aging and health inequalities in sub‐Saharan Africa

Although inequalities in the production, distribution, and determinants of health are central to health geographers, the discipline of health geography suffers from a “know‐do” gap. These health inequalities are personified in aging populations; older adults in sub‐Saharan Africa experience shorter life expectancies than in high‐income countries and endure higher disability and disease rates in old age. Concomitantly, the region experiences resource shortages and competing population priorities. Evidence‐informed knowledge and practice is imperative. Informed by the Canadian Coalition for Global Health Research Principles, an integrated knowledge translation (iKT) case study with knowledge holders and users in the inception, implementation, and dissemination of research in Uganda was undertaken. This paper presents the capstone iKT event that shared research results with knowledge owners and users, addressed research implications and applications, and identified future research and policy agendas. Although vast contextual inequalities impede aging health disparity solutions, findings indicate that employing an iKT approach generates possibilities that not only support older adults, but also population health across the life course. Research incorporating iKT overcomes many contextual realities deemed to impede old age health equity. Incorporating iTK into health geography can reveal where inequality exists, expose how inequality is (re)produced, and suggest solutions that generates more equitable futures.

Strengthening Management, Community Engagement, and Sustainability of the Subnational Response to Accelerate Malaria Elimination in Namibia.

ABSTRACT.Leadership and management skills are critical for health programs to deliver high-quality interventions in complex systems. In malaria-eliminating countries, national and subnational health teams are reorienting strategies to address focal transmission while preventing new cases and adapting to decentralization and declines in external financing. A capacity-strengthening program in two regions in Namibia helped malaria program implementers identify and address key operational, political, and financial challenges. The program focused on developing skills and techniques in problem-solving and teamwork, engaging decision-makers, and using financial evidence to prioritize domestic resources for malaria through participatory approaches. Results of the program included an observed 40% increase in malaria case reporting, 32% increase in reporting and tracing of imported malaria cases, 10% increase in malaria case management, integration of malaria activities into local operational plans, and an increase in subnational resources for malaria teams. To promote program sustainability beyond the implementation period, key program aspects were institutionalized into existing health system structures, program staff were trained in change leadership, and participants integrated the skills and approaches into their professional roles. A capacity-strengthening program with joint focus on leadership, management, and advocacy has potential for application to other health issues and geographies.

Immigrants, migrants, and Paulistanos: Racialized geographies of labor and health in São Paulo, Brazil

Immigrants, migrants, and Paulistanos: Racialized geographies of labor and health in São Paulo, Brazil

Communication Mechanism and Optimization Strategies of Short Fitness-Based Videos on TikTok During COVID-19 Epidemic Period in China

Scientific and moderate exercise is an effective remedy to boost the immune system and minimize the risk of infection in coronavirus disease 2019 (COVID-19) epidemic period. In this context, social media platforms play an essential role in communicating scientific fitness at home. Based on the integrated analysis of communication, physical geography, and health geography, this article takes short fitness-based videos on TikTok as the research object and comprehensively uses text analysis, mathematical statistics, and spatial analysis to reveal the characteristics of communication elements, fitness preferences, and the spatiotemporal evolution of these short videos, and to explore the communication mechanism and optimization path of short videos. The results show that: (1) the communication information focusing on “fighting against the epidemic and keeping fit at home” is made into short videos by female youth. Through the communication channels mainly composed of texts, pictures, and audio, the communication subjects carry out multilevel interactive communication with the communication objects; (2) fitness preferences are mainly composed of dances, unarmed fitness, and fitness with equipment; (3) from the perspective of time, taking February 20 as the node, the daily number of released short videos shows a trend of “increase before decrease”; from the perspective of space, the distribution is significantly unbalanced across provinces, and the direction is not apparent; and (4) this article explores the communication mechanism and targeted optimization countermeasures of short fitness-based videos on TikTok in China's COVID-19 epidemic period.

REFLECTIONS ON PUBLIC HEALTH IN MARANHÃO AND THE SEASONALITY OF COVID-19 CASES

The Geography of Health is a field of study that is gaining more and more space among geographers. Given the emergence of epidemic outbreaks, and more recently pandemics (COVID-19 in 2019 and still in effect), the relevance of health studies from a geographic perspective is verified. The main objective of this research was to reflect on public health in the state of Maranhão in the face of the health crisis caused by the Covid-19 pandemic, a disease caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identifying the rates of lethality in the state, noting that the capital São Luís and the municipalities of Imperatriz, Açailândia, Balsas, Caxias, Santa Inês and Timon concentrate the largest numbers of confirmed cases.

The HealthStreet Cancer Survivor Cohort: a Community Registry for Cancer Research.

This report describes a cancer survivor cohort from a community engagement program and compares characteristics and willingness to participate in health research between the cancer survivors and non-cancer community members. Among 11,857 members enrolled in HealthStreet at the University of Florida (10/2011-03/2020), 991 cancer survivors were identified and 1:1 matched to control members without cancer on sex, age, and zip code. Demographics, body weight, height, social determinants of health, history of cancer, and willingness to participate in research were recorded by Community Health Workers as a part of the baseline Health Needs Assessment. Among the cancer survivors, 71.6% were female and 19.2% lived in rural areas with a mean age of 56.7years in females and 60.8years in males. At baseline, 44.7% received a cancer diagnosis within 5years, while 15.8%, more than 20years. Cancer survivors (vs. matched non-cancer controls) were less likely to be Black (31.1% vs. 63.6%) but more likely to be divorced, separated, or widowed (49.5% vs. 41.2%), be normal/underweight (34.0% vs. 25.6%) and have health insurance (80.0% vs. 68.6%; all p < 0.05). Cancer survivors versus matched controls reported higher rates of ever being in a health research study (32.4% vs. 24.9%) and interest in participating in studies ranging from minimal risk to greater-than-minimal risk. Cancer survivors from this community engagement program agnostic to cancer types and treatment are diverse in geography, race, and social determinants of health and can be a valuable resource for observational, interventional, and biospecimen research in cancer survivorship.

Navigating the LGB Data Landscape: A Review of Appropriate Secondary Data Sources for Sexuality and Substance Use Research in the UK.

Research has found that sexual minority individuals are more likely to experience health inequalities and have higher rates of substance use compared with their heterosexual counterparts. This association between sexuality and health outcomes is increasingly being explored using quantitative methodologies within the context of public health, psychology and health geography. Much of this research, however, has relied on primary data, despite the wide availability of secondary sources, mainly survey data, collecting information on sexuality and different types of health outcomes and health risk behaviours, such as substance use. This study reviewed recent surveys in the UK that are appropriate for exploring topics related to LGB populations and substance use behaviours. We carried out a narrative review of secondary data sources in the UK to assess the accessibility and suitability of secondary sources for sexuality and substance use research. We identified eight cross-sectional and two longitudinal surveys that contained both sexuality and substance use data. We summarised the possible applications of each survey and the scope of questions within sexuality and substance use research that could be addressed by each survey. The identification of appropriate surveys in this review can allow researchers to extend the use of secondary data sources in the UK to examine substance use inequalities between sexuality groups, further advancing this key topic.

Career aspirations and trajectories of geographies of health and health care graduates: A cross‐sectional study

Despite the diverse academic training of health geographers and their capacity to think spatially and temporally when focusing on complexities of people's health in changing environments, career-related concerns have been raised due to the dearth of academic jobs in the sub-discipline. Given these concerns, an understanding of the career aspirations and trajectories of health geography graduates, as well as their experiences within and outside academia, has the potential to inform the progression and evolution of the sub-discipline. This cross-sectional study of members of the Geography of Health and Health Care Specialty Group of the Canadian Association of Geographers (n = 56) found that acquiring academic work remains the desired career goal for many geography graduates. While a majority of participants aspired to work in academia, some participants reported insecurity in obtaining academic jobs, and precarity in this trajectory. Although belonging to the specialty group has contributed positively to the experiences of graduates in providing network opportunities and job positions, there were calls for critical engagement of the group in mentorship, networking, and increasing exposure to careers outside of academia to help inform the future direction and the inter-relationship of academics within the sub-discipline of health geography. Malgré la formation universitaire diversifiée des géographes de la santé et leur capacité à réfléchir spatialement et temporellement lorsqu'ils se concentrent sur la complexité de la santé des populations dans des environnements changeants, on remarque des inquiétudes chez ceux-ci en raison de la pénurie d'emplois dans ce domaine en milieu universitaire. Dans ce contexte, une meilleure compréhension de leurs aspirations professionnelles et des trajectoires des diplômés, de même que de leurs expériences tant à l'intérieur qu'à l'extérieur du milieu universitaire, nous permet de documenter la progression et l'évolution de la sous-discipline. Cette étude transversale réalisée par certains membres du Groupe spécialisé en géographie de la santé et des soins de santé de l'Association canadienne des géographes (n = 56) fait ressortir que l'obtention d'un emploi en enseignement et recherche universitaires demeure l'objectif professionnel favorisé de nombreux diplômés. Bien qu'une majorité de participants aspirent à travailler en milieu universitaire, certains participants ont exprimé de l'insécurité face à la précarité de cette trajectoire. Par ailleurs, si l'appartenance au groupe spécialisé a contribué positivement aux expériences des diplômés, il y a eu de fortes demandes de participation du groupe au mentorat, au réseautage et à la promotion des carrières possibles à l'extérieur de l'université, afin de mieux informer et encadrer les futurs étudiants.

Biosocial wellbeing: Conceptualizing relational and expansive well-bodies

Cross-epistemological, transdisciplinary team research on health and wellbeing is critical to improving how we understand the human body and, ultimately, how we care for it. The authors have recently been involved in a different kind of “translational medicine”-translating across disciplines and epistemologies in order to come up with a template for thinking about the human body that captures all of an individual body's relational complexity. This paper explores how a simple desire to think differently about the body can set off a series of subsequent theoretical shifts and political imperatives with respect to health and wellbeing. After describing our recent trials with cross-epistemological theorizing/research on the biosocial body, we use concrete examples to link this work to theoretical and practical priorities in geographies of health and wellbeing. We characterize an approach to wellness that attends to the nuance of individual experience while asking what a liberatory practice of wellness, grounded in a relational and expansive conception of the body, would mean.