Health geography is the application of geographical information, perspectives, and methods to the study of

health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

, and

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

. Medical geography, a sub-discipline of or sister field of health geography, Oxford Bibliographies entry of Medical Geography. focuses on understanding spatial patterns of

and

as related to the natural and social environment.Meade MS, Florin JW, Gesler WM. Medical geography. New York, NY: The Guilford Press, 1988.Meade, M.S., 2014. Medical geography. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, pp.1375-1381. Conventionally, there are two primary areas of research within medical geography: the first deals with the

spatial distribution A spatial distribution in statistics is the arrangement of a phenomenon across the Earth's surface and a graphical display of such an arrangement is an important tool in geographical and environmental statistics. A graphical display of a spatial d ...

and determinants of

morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

and

mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

, while the second deals with health planning, help-seeking behavior, and the provision of health services.Mayer, J.D., 1982. Relations between two traditions of medical geography: health systems planning and geographical epidemiology. Progress in Geography, 6(2), pp.216-230.

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. 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.Glass, G. E. 2000. Update: spatial aspects of epidemiology: the interface with medical geography. Epidemiologic Reviews 22 (1): 136-139. 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.

Health geography

The study of health geography has been influenced by repositioning medical geography within the field of

social geography Social geography is the branch of human geography that is interested in the relationships between society and space, and is most closely related to social theory in general and sociology in particular, dealing with the relation of social phenomena ...

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 Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alt ...

and

traditional medicine Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...

) are studied by the

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

researchers, sometimes with the aid of health geographers without

medical education Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship (medical), internship) and additional training thereafter (e.g., Re ...

. 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.Philo, Chris (2009). "Health and Health Care". In Gregory, Derek; Johnston, Ron; Pratt, Geraldine et al. ''The Dictionary of Human Geography (Fifth Edition)''. Oxford:Blackwell. pp.325-326 This alternative methodological approach means that medical geography is broadened to incorporate philosophies such as

Marxian political economy Critique of political economy or critique of economy is a form of Social criticism, social critique that rejects the various social categories and structures that constitute the mainstream discourse concerning the forms and modalities of resourc ...

structuralism In sociology, anthropology, archaeology, history, philosophy, and linguistics, structuralism is a general theory of culture and methodology that implies that elements of human culture must be understood by way of their relationship to a broader ...

, social interactionism,

humanism Humanism is a philosophical stance that emphasizes the individual and social potential and agency of human beings. It considers human beings the starting point for serious moral and philosophical inquiry. The meaning of the term "humani ...

feminism Feminism is a range of socio-political movements and ideologies that aim to define and establish the political, economic, personal, and social equality of the sexes. Feminism incorporates the position that society prioritizes the male po ...

and queer theory.Philo, Chris (2009). "Medical Geography". In Gregory, Derek; Johnston, Ron; Pratt, Geraldine et al. ''The Dictionary of Human Geography (Fifth Edition)''. Oxford:Blackwell. pp.451-453

History

Relationships between

place Place may refer to: Geography * Place (United States Census Bureau), defined as any concentration of population ** Census-designated place, a populated area lacking its own Municipality, municipal government * "Place", a type of street or road ...

and

have long been recognized throughout human history, predating modern health delivery systems and providing insights into the transmission of

infectious agents In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...

, well before the

germ theory The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade ...

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 In simple terms, risk is the possibility of something bad happening. Risk involves uncertainty about the effects/implications of an activity with respect to something that humans value (such as health, well-being, wealth, property or the environme ...

. 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 Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...

in his treatise ’’On Airs, Waters, and Places’’ (ca. 400 BC). The

industrial revolution The Industrial Revolution was the transition to new manufacturing processes in Great Britain, continental Europe, and the United States, that occurred during the period from around 1760 to about 1820–1840. This transition included going f ...

in the 1700s brought with it a plethora of novel

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

issues stemming from rapid

urban development Urban means "related to a city". In that sense, the term may refer to: * Urban area, geographical area distinct from rural areas * Urban culture, the culture of towns and cities Urban may also refer to: General * Urban (name), a list of people ...

and poor

sanitation Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems ...

, 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 Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...

and

yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. In ...

.Welhausen CA. Power and Authority in Disease Maps: Visualizing Medical Cartography Through Yellow Fever Mapping. J Bus Tech Commun. 2015;29: 257–283. doi:10.1177/1050651915573942 One of the most prominent figures in both

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

and medical geography is

John Snow John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...

, the physician who correctly identified the source of exposure during the

1854 Broad Street cholera outbreak Events January–March * January 4 – The McDonald Islands are discovered by Captain William McDonald aboard the ''Samarang''. * January 6 – The fictional detective Sherlock Holmes is perhaps born. * January 9 – The ...

. 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 Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...

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.McLeod KS. Our Sense of Snow: The Myth of John Snow in Medical Geography. Soc Sci Med. 2000;50: 923–935. 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.Nelson KE, Williams CM, editors. Infectious disease epidemiology: theory and practice. 3rd ed. Burlington, Mass: Jones & Bartlett Learning; 2014. Modern medical geography arose in the United States in the 1950s with the pioneering work of Jacques May,Mark S. Monmonier (1976) Jacques M. May, The Professional Geographer, 28:1, 93, DOI: 10.1111/j.0033-0124.1976.00093.

/ref> 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.Meade, M. S. and M. Emch. 2010. Medical Geography. Guilford Press, New York. Although the notion that the Biophysical environment, environment could influence

human health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

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.May, J. M. 1950. Medical geography: Its methods and objectives. Geographical Review 40 (1): 9-41. May soon began mapping global distributions of disease and exploring the cultural and environmental factors that influenced these distributions.

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 Descriptive research is used to describe characteristics of a population or phenomenon being studied. It does not answer questions about how/when/why the characteristics occurred. Rather it addresses the "what" question (what are the characterist ...

quantifying disease frequencies and distributions, and analytic research concerned with finding what characteristics make an individual or

population Population typically refers to the number of people in a single area, whether it be a city or town, region, country, continent, or the world. Governments typically quantify the size of the resident population within their jurisdiction using a ...

susceptible to disease. This requires an understanding of

. 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 Spatial analysis or spatial statistics includes any of the formal techniques which studies entities using their topological, geometric, or geographic properties. Spatial analysis includes a variety of techniques, many still in their early deve ...

and often borrows from

behavioral economics Behavioral economics studies the effects of psychological, cognitive, emotional, cultural and social factors on the decisions of individuals or institutions, such as how those decisions vary from those implied by classical economic theory. ...

Geographies of disease and ill health

Health geographers are concerned with the prevalence of different diseases along a range of

spatial scale Spatial scale is a specific application of the term scale for describing or categorizing (e.g. into orders of magnitude) the size of a space (hence ''spatial''), or the extent of it at which a phenomenon or process occurs. For instance, in phy ...

s from a local to global view, and inspects the natural world, in all of its complexity, for

correlations In statistics, correlation or dependence is any statistical relationship, whether causal or not, between two random variables or bivariate data. Although in the broadest sense, "correlation" may indicate any type of association, in statistics ...

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, including various diseases, as individuals spread them amongst themselves, and across wider spaces as they migrate. Health geographers also consider all types of spaces as presenting health risks, from

natural disaster A natural disaster is "the negative impact following an actual occurrence of natural hazard in the event that it significantly harms a community". A natural disaster can cause loss of life or damage property, and typically leaves some econ ...

s, to interpersonal

violence Violence is the use of physical force so as to injure, abuse, damage, or destroy. Other definitions are also used, such as the World Health Organization's definition of violence as "the intentional use of physical force or Power (social and p ...

stress Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...

, and other potential dangers.

Geography of health care provision

Although healthcare is a public good, it is not equally available to all

individuals An individual is that which exists as a distinct entity. Individuality (or self-hood) is the state or quality of being an individual; particularly (in the case of humans) of being a person unique from other people and possessing one's own need ...

. 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. 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 law Privacy law is the body of law that deals with the regulating, storing, and using of personally identifiable information, personal healthcare information, and financial information of individuals, which can be Personally identifiable information ...

s 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.

Methods

Geographic Information System A geographic information system (GIS) is a type of database containing Geographic data and information, geographic data (that is, descriptions of phenomena for which location is relevant), combined with Geographic information system software, sof ...

s (GIS) are used extensively in medical geography to visualize and analyze georeferenced health-related data. These spatial data can be

vector Vector most often refers to: *Euclidean vector, a quantity with a magnitude and a direction *Vector (epidemiology), an agent that carries and transmits an infectious pathogen into another living organism Vector may also refer to: Mathematic ...

(point, line, or polygon) or

raster Raster may refer to: * Raster graphics, graphical techniques using arrays of pixel values * Raster graphics editor, a computer program * Raster scan, the pattern of image readout, transmission, storage, and reconstruction in television and compu ...

(continuous grid) format and are often presented in quantitative thematic maps. Disease outcomes and sociodemographic characteristics collected through

surveillance Surveillance is the monitoring of behavior, many activities, or information for the purpose of information gathering, influencing, managing or directing. This can include observation from a distance by means of electronic equipment, such as c ...

systems and population

census A census is the procedure of systematically acquiring, recording and calculating information about the members of a given population. This term is used mostly in connection with national population and housing censuses; other common censuses incl ...

es are frequently used as data sources in medical geography studies. In

disease ecology Disease ecology is a sub-discipline of ecology concerned with the mechanisms, patterns, and effects of Host–pathogen interaction, host-pathogen interactions, particularly those of infectious diseases. For example, it examines how Parasitism, para ...

studies, interpolated

climate Climate is the long-term weather pattern in an area, typically averaged over 30 years. More rigorously, it is the mean and variability of meteorological variables over a time spanning from months to millions of years. Some of the meteorologic ...

data, gridded land surveys, and

remote sensing Remote sensing is the acquisition of information about an object or phenomenon without making physical contact with the object, in contrast to in situ or on-site observation. The term is applied especially to acquiring information about Earth ...

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) or

spatial heterogeneity Spatial heterogeneity is a property generally ascribed to a landscape or to a population. It refers to the uneven distribution of various concentrations of each species within an area. A landscape with spatial heterogeneity has a mix of concentra ...

(locations are unique relative to other locations).Sui, D.Z., 2007. Geographic information systems and medical geography: Toward a new synergy. Geography Compass, 1(3), pp.556-582. Some examples of the spatial analyses used in medical geography include point pattern analysis, tests for spatial autocorrelation, geographically weighted regression (GWR),

ecological niche In ecology, a niche is the match of a species to a specific environmental condition. Three variants of ecological niche are described by It describes how an organism or population responds to the distribution of resources and competitors (for ...

modeling, spatial scan statistics, and network analysis.

Health geographers

Notable health geographers include: * Sarah Curtis *

William C. Gorgas William Crawford Gorgas KCMG (October 3, 1854 – July 3, 1920) was a United States Army physician and 22nd Surgeon General of the U.S. Army (1914–1918). He is best known for his work in Florida, Havana and at the Panama Canal in abating the ...

Kelvyn Jones {{Infobox scientist , honorific_prefix = , name = Kelvyn Jones , honorific_suffix = FBA, FLSW, FAcSS , native_name = , native_name_lang = , image = Kelvyn Jones photographed in 2016.jpg , image_size ...

References

External links

Social and Spatial Inequalities

''GeoHealth Laboratory''
{{Authority control Human geography Global health Spatial epidemiology Disease ecology