Public Health Geography and Health
by
Sarah Curtis
  • LAST REVIEWED: 04 October 2016
  • LAST MODIFIED: 30 June 2014
  • DOI: 10.1093/obo/9780199756797-0121

Introduction

Health geography considers the significance for physical and mental health of interactions between people and their environment. It investigates why space and place are important for health variation in the population. Approaches in health geography are diverse, drawing on different ways of conceptualizing space, place, and health. Some geographers work with positivist concepts of causal processes that can often be researched in Euclidian space by considering patterns of variability across a large number of areas. Others conceptualize place using interactionist or phenomenological perspectives and consider space and place to be socially constructed and highly contingent on individual experience and perception. The idea of scale is often crucial, and geographers are concerned with processes operating from the global to the micro scale. Some geographical research focuses on a specific place (such as a single building, a natural setting, or a local community). Geographers are interested in concepts of embodiment and the physical and social construction of the human body as a “site” where social processes associated with health are expressed. Geographical research concerns processes operating in time as well as space, linking health over the life course with processes of human migration, environmental change, and duration of exposures to different environmental risk factors. Geography considers “health” broadly defined as physical or mental health, well-being, and health-related practices, and addresses a range of different substantive issues. These include spatial epidemiological questions of how and why human health varies from one area to another at the “ecological” (aggregated population) level. Geography also examines how individual health outcomes and health- related practices relate to one’s varying experience of (and exposure to) physical and social environments. Geographical research uses methods ranging from statistical studies using quantitative indicators of health and health determinants to qualitative techniques, including unstructured interviews or ethnographic observations. Also, “mixed methods” include participative mapping techniques, allowing individual research participants to determine the selection and interpretations of geocoded observations on the ground. Geographical Information Systems (GIS) are one of many methods used in health geography. The various themes in geography of health reviewed below show the field has evolved over time. Future developments in the field seem likely to include work to extend the concern with environmental change, globalization, and the significance of social processes and social theory for our understanding of the relationships between health and the environment.

General Overviews

Overviews of health geography show how the field has evolved over time. The following are rather broad in scope, and there are others in subsequent sections that review work on particular aspects of health and health variation. There was initially a dominant focus on “medical geography,” emphasizing research on geographical factors associated with specific diseases, as presented in Meade and Earickson 2000. Other overviews show how the field has evolved to be viewed as “health geography,” considering health and illness as socially as well as medically constructed phenomena: this is well explained, for example in Jones and Moon 1987. The overviews below also emphasize the different theoretical and methodological perspectives used in health geography discussed in Gatrell and Elliott 2009. Compendia such as Brown, et al. 2009 also represent the breadth of the field and its relevance for public health research embracing fields including disease, health, and well-being, as well as accessibility and use of services and the ways that users interact with services in different settings (all of which are considered in more detail below in this section). In addition to research on geographical factors as determinants of health, health geographers also investigate the ways that our state of health affects our experience of physical and social environments.

  • Brown T., S. McLafferty, and G. Moon. 2009. A companion to health and medical geography. Chichester, UK: Wiley-Blackwell.

    DOI: 10.1002/9781444314762Save Citation »Export Citation » Share Citation »

    NNNA collection of essays by leading researchers in the field, this provides an overview of major debates in geographies of health. It also includes sections on geographical perspectives on disease, health and well-being, public health, and health care, and caring.

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  • Gatrell A., and S. Elliott. 2009. Geographies of health. Chichester, UK: Wiley-Blackwell.

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    NNNThis updates an earlier edition published by Anthony Gatrell and provides a useful introduction to the field, clearly showing how different theoretical and methodological approaches can be brought to bear on questions of health geography.

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  • Gesler, W., and W. Kearns. 2002. Culture place and health. Critical Geographies. London: Routledge.

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    NNNA comprehensive overview, from a health geography perspective, of the ways that theoretical and empirical knowledge of cultural and social processes help us to understand the relationships between place and health.

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  • Jones, K., and G. Moon. 1987. Health disease and society. London: Routledge.

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    NNNThis groundbreaking book contributed to the shift in health geography from a geographical perspective on medically defined disease to a more broadly interpreted idea of health and illness as socially constructed processes. Argues for the ways that places help to constitute health and includes chapters on mental as well as physical health.

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  • Kearns, R., and G. Moon. 2002. From medical to health geography: Novelty, place and theory after a decade of change. Progress in Human Geography 26.5: 605–625.

    DOI: 10.1191/0309132502ph389oaSave Citation »Export Citation » Share Citation »

    NNNDiscusses the development of the focus on geography of health with new emphasis on themes of place and engagement with social and critical theory to complement models aligned with positivist science.

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  • Meade, M., and R. Earickson. 2000. Medical geography. New York: Guildford.

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    NNNThis is the second edition of an important review of the field from a medical geography perspective by leading American specialists. Has a particularly strong emphasis on disease ecology and the links between geography and medicine.

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Journals

Many journal publish research in this field. Among the most widely cited international sources are Social Science and Medicine and Health and Place as well as journals which are more specifically targeted to a public heath audience such as Journal of Epidemiology and Community Health or Spatial and Spatio-temporal Epidemiology. Research in health geography is also reported in geographical journals such as Annals of the Association of American Geographers, Transactions of the Institute of British Geographers (and Area) and Progress in Human Geography, and those which cover fields of planning such as Environment and Planning.

Historical Perspectives

Geographical factors important for health have been debated for a long time (Barrett 2000 has collated material dating back to ancient Greek sources). Most overviews of the subject reference early applications of geographical ideas and methods related to the study of health and health care. A widely cited 19th-century example is John Snow’s work to map cases of cholera in London as part of his campaign to raise awareness of the link to contaminated water supplies. For health geographers, as for researchers in other disciplines, this continues to attract attention. Geographers have often revisited the historical records of Snow’s work to explore how it might have been enhanced using modern geographical techniques and theories and to assess the historical role of the mapping work in establishing scientific evidence of the cause of cholera (Koch and Denike 2004). Charles Booth’s mapping of social conditions in London is a further example of the use of geographical techniques to support the early public health movement in the UK, which still has resonance in the 21st century (see McLeod 2000 and Orford, et al. 2002). Early work in the United States includes 19th-century research by Jarvis that established the idea of a distance decay effect, whereby the likelihood that a patient will use a health facility (such as psychiatric asylum institutions) declines with increasing distance between the patient’s place of residence and the location of the facility. Again, this has been widely cited, and the original data have been reworked to explore further nuances in the data that were used (e.g., Smith, et al. 2007 and Hunter and Shannon 1985). Faris and Dunham’s 1939 study of the geographical distribution of schizophrenia in Chicago is a further illustration showing how small areas of information on prevalence or incidence of disease can be brought together with information on socioeconomic conditions to explore the links between health and its wider determinants: this study has provoked subsequent debate about the reasons for the associations between poor living conditions and mental illness.

  • Barrett, F. 2000. Disease and Geography: The History of an Idea. Toronto: Geography Department, York Univ.

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    NNNThis provides a compendium of early sources of thinking about how geography relates to health.

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  • Faris R., and H. Dunham. 1939. Mental Disorders in Urban Areas. Chicago: Univ. of Chicago Press.

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    NNNThis work is often cited as one of the earliest examples of research which investigated links between social conditions and mental illnesses.

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  • Hunter, J., and G. Shannon. 1985. Jarvis revisited: Distance decay in service areas of 19th century asylums. Professional Geographer 37.3: 296–303.

    DOI: 10.1111/j.0033-0124.1985.00296.xSave Citation »Export Citation » Share Citation »

    NNNThese authors revisited the analysis by Jarvis to demonstrate that distance decay effects in service use do not apply equally in all settings were complex and contingent on local conditions.

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  • Koch, Tom, and Ken Denike. 2004. Medical mapping: The revolution in teaching—and using—maps for the analysis of medical issues. Journal of Geography 103.2: 76–85.

    DOI: 10.1080/00221340408978578Save Citation »Export Citation » Share Citation »

    NNNThis paper acknowledges John Snow’s work as a “landmark study.” It also explores how modern methods for spatial analysis of disease might have provided a way to improve the power and scientific validity of Snows original work.

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  • McLeod, Kari S. 2000. Our sense of Snow: The myth of John Snow in medical geography. Social Science and Medicine 50.7: 923–935.

    DOI: 10.1016/S0277-9536(99)00345-7Save Citation »Export Citation » Share Citation »

    NNNExplores the historical record of events surrounding John Snow’s work. It addresses the question of how important the mapping of cases of cholera really was for John Snow’s work to identify the source of a cholera outbreak in London.

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  • Orford, S., D. Dorling, R. Mitchell, M. Shaw, and G. Davey-Smith. 2002. Life and death of the people of London: A historical GIS of Charles Booth’s inquiry. Health and Place 8.1: 25–35.

    DOI: 10.1016/S1353-8292(01)00033-8Save Citation »Export Citation » Share Citation »

    NNNThis research examines the local variation of living conditions for the population of London at the end of the 19th century, mapped by Charles Booth. Demonstrates similar patterning of the wider determinants of health at the end of the 20th century.

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  • Smith, C. A., D. Wright, and S. Day. 2007. Distancing the mad: Jarvis’s Law and the spatial distribution of admissions to the Hamilton Lunatic Asylum in Canada, 1876–1902. Social Science and Medicine 64.11: 2362–2377.

    DOI: 10.1016/j.socscimed.2007.01.003Save Citation »Export Citation » Share Citation »

    NNNThis paper uses 19th-century data for an area of Canada to explore the nuances of distance decay effects in patterns of use of psychiatric institutions.

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Disease and Medical Care

Much of the original geographical work on health and health care adopted a view of health informed by a medical interpretation of health and focused on geographies of diseases and their care and treatment. The focus was often on infectious disease, particularly in countries where average income and poor living conditions combine with factors in the natural environment to make these diseases particularly important as causes of illness and death. As reviewed in Learmonth 1988 and Meade and Earickson 2000, much of the earliest work in medical geography was founded on perspectives informed by human ecology as it relates to disease (focused on the interactions between human populations, habitats, and behaviors) and influenced by the conceptual frameworks offered by landscape epidemiology, which considers the physical, biotic, and cultural processes that contribute to communicable disease. Atlases of infectious disease such as Smallman-Raynor, et al. 2004 provides useful international perspectives on public health challenges posed by these diseases.

  • Learmonth, A. 1988. Disease ecology: An introduction to ecological medical geography. Oxford: Basil Blackwell.

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    NNNThis book is one of the “classic” texts in medical geography and still provides a valuable point of reference for those interested in the ideas underpinning this field of research.

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  • Meade, S., and R. Earickson. 2000. Medical geography. New York: Guildford.

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    NNNThis review of the field of medical geography provides an important introduction to the field.

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  • Smallman-Raynor, M., P. Haggett, and A. Cliff. 2004. World atlas of epidemic diseases. London: Hodder Headline.

    DOI: 10.1201/b13526Save Citation »Export Citation » Share Citation »

    NNNProvides a comprehensive review of the geographical dimensions of infectious diseases worldwide.

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Specific Infectious Diseases and Their Causes

Technical GIS is increasingly being combined with participative methods that draw on the knowledge and expertise of local inhabitants in the areas of interest, exemplified in Dunn 2007 and Dunn, et al. 2011. Studies such as Perez-Heydrich, et al. 2013; Ali, et al. 2003; Smallman-Raynor, et al. 2004 (cited under Disease and Medical Care) have developed streams of work relating to infectious diseases in new ways, drawing on advanced GIS techniques and considering how socio-political as well as physical environmental factors act to influence risk of diseases (see Berrang-Ford, et al. 2011).

  • Ali, M., Y. Wagatsuma, M. Emch, and R. F. Breiman. 2003. Use of a geographic information system for defining spatial risk for dengue transmission in Bangladesh: Role for Aedes albopictus in an urban outbreak. American Journal of Tropical Medicine and Hygiene 69.6: 634–640.

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    NNNThis analysis of risk factors for dengue fever generated additional information that could inform efforts at control of this disease, illustrating how medical geography may contribute to public health planning for control of infectious diseases.

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  • Berrang-Ford, L., J. Lundine, and S. Breau. 2011. Conflict and human African trypanosomiasis. Social Science and Medicine 72.3: 398–407.

    DOI: 10.1016/j.socscimed.2010.06.006Save Citation »Export Citation » Share Citation »

    NNNA study illustrating how social disruption can impact on public health risks of infectious disease.

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  • Dunn, C. E. 2007. Participatory GIS: A people’s GIS? Progress in Human Geography 31.5: 616–637.

    DOI: 10.1177/0309132507081493Save Citation »Export Citation » Share Citation »

    NNNProvides a useful review of the significance of participatory approaches in contemporary applications of Geographical Information Systems, approaches that are increasingly used in health geography to better understand the socio-geographical aspects of public health.

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  • Dunn, C. E., A. Le Mare, and C. Makungu. 2011. Malaria risk behaviours, socio-cultural practices and rural livelihoods in southern Tanzania: Implications for bednet usage. Social Science and Medicine 72.3: 408–417.

    DOI: 10.1016/j.socscimed.2010.11.009Save Citation »Export Citation » Share Citation »

    NNNThis research is a good illustration of advances to medical geography introduced by using participatory mapping and diagramming methods. Shows how these methods can reveal a more nuanced understanding of the risk factors for malaria in the study area and provide new insights for prevention programs.

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  • Perez-Heydrich, Carolina, Jill M. Furgurson, Sophia Giebultowicz, et al. 2013. Social and spatial processes associated with childhood diarrheal disease in Matlab, Bangladesh. Health and Place 19:45–52.

    DOI: 10.1016/j.healthplace.2012.10.002Save Citation »Export Citation » Share Citation »

    NNNThis example of innovative use of social and cartographic data used analysis of road networks and social networks to explore the significance of social connectivity for risk of diarrheal disease.

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Non-Communicable Diseases

Medical geographical research has extended beyond infectious diseases to examine noncommunicable diseases such as cancer (Craft, et al. 1993) and cardio-vascular problems (see Pedigo, et al. 2011). These often aim to search for local clusters of morbidity and mortality due to such diseases, which may be important to help us understand how to address the risk factors. Because such health problems develop over long time periods, and because they have multiple risk factors associated with both the social and behavioral and physical environmental conditions, this is a challenging field of research; readers should consider carefully how well socioeconomic and other factors are taken into account, as well as physical environmental risk factors such as pollution (see Cambra, et al. 2013).

  • Cambra, K., T. Martinez-Rueda, E. Alonso-Fustel, et al. 2013. Association of proximity to polluting industries, deprivation and mortality in small areas of the Basque Country (Spain). European Journal of Public Health 23.1: 171–176.

    DOI: 10.1093/eurpub/ckr213Save Citation »Export Citation » Share Citation »

    NNNThis illustrates research to explore health risks related to pollution sources. The results need to be considered in light of the difficulties of distinguishing impacts on general mortality of pollution sources from other risk factors such as socioeconomic conditions, which are often associated with proximity to pollution sources.

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  • Craft, A., W. Parker, S. Openshaw, et al. 1993. Cancer in young people in the north of England, 1968–85: Analysis by census wards. Journal of Epidemiology and Community Health 47.2: 109–115.

    DOI: 10.1136/jech.47.2.109Save Citation »Export Citation » Share Citation »

    NNNThis early example of geographical research on cancer risks examined the risk of cancer associated with proximity to nuclear power installations, reflecting public concern at the time about the public health risks associated with these facilities.

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  • Pedigo, A., T. Aldrich, and A. Odoi. 2011. Neighborhood disparities in stroke and myocardial infarction mortality: A GIS and spatial scan statistics approach. Bmc Public Health 11.

    DOI: 10.1186/1471-2458-11-644Save Citation »Export Citation » Share Citation »

    NNNThis research identified local concentrations of stroke and myocardial infarction in East Tennessee, suggesting these areas needed additional health care and prevention and demonstrating a link to low levels of educational attainment. It illustrates the use of geographical methods to assess geographical variation in risks of non-communicable disease.

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Inequality in Population Health

Much of the research on geography of health in populations demonstrates variability and inequality of health. Geographical research is often focused on the connections between health variation and material and socioeconomic conditions as explored in Curtis 2004. Since much of the inequality in health observed could potentially be prevented (especially through public health measures) there has also been a good deal of attention given to changes in health inequality over time and whether inequalities are narrowing or growing, as reported in Shaw, et al. 1999. It is often observed that while average levels of health in populations are improving over time, the level of inequality remains persistent or gets worse. Inequality can be studied at various different scales, ranging from small area differences in health across quite small distances in major cities, to inequalities between countries and regions of the world. Inequality in wealth as much as absolute wealth is important for health, at least in some higher income nations, as evidenced in North America (see Ross, et al. 2005). Patterns of inequality can often inform public health strategies by indicating where resources for health promotion need to be concentrated.

  • Curtis, S. 2004. Health and inequality: Geographical perspectives. London: SAGE.

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    NNNStrongly focused on issues of health disparities and how to address them, this book adopts a structure based on the idea of different types of “landscapes” that make up health geography. These are associated with different dimensions of the causal pathways that generate inequality, ranging from biophysical and ecological to socio-political and socio-psychological processes.

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  • Ross, N. A., D. Dorling, J. R. Dunn, et al. 2005. Metropolitan-income inequality and working-age mortality: A cross-sectional analysis using comparable data from five countries. Journal of Urban Health-Bulletin of the New York Academy of Medicine 82.1: 101–110.

    DOI: 10.1093/jurban/jti012Save Citation »Export Citation » Share Citation »

    NNNAn interesting example of an international analysis by geographers of the extent to which inequality of income within areas is important for health outcomes, as well as average income of the local population. It connects to a wider debate about the importance of socioeconomic inequality for public health.

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  • Shaw, M., D. Dorling, D. Gordon, and G. Davey Smith. 1999. The widening gap. Bristol, UK: Policy Press.

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    NNNAn analysis of how inequalities of health in Britain had worsened since the 1970s.

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Health Care

Complementing work on health outcomes has been a long-standing strand of research on the geographical dimensions of use of services and access to care (e.g., Joseph and Phillips 1984, which analyzes geographical variation in the rates of use of services). A comprehensive source of recent work focused on primary care, exemplified in Crooks and Andrews 2008, shows how the focus of this research has developed to address contemporary debates about treatment beyond hospital settings and access to preventive care and health promotion, which are important for public health. Methods to assess variation in access to health care are becoming progressively more varied and complex: for example, see Apparicio, et al. 2008. Sometimes research on use of health services is used as a proxy for population health, as well as revealing geographical dimensions of the spatial organization of services and how this affects access, use, and delivery of care (see Curtis, et al. 2006 and Gatrell, et al. 2002). Graves 2008 explores the potential of this type of geographical research to inform policy as well as academic research.

Public Mental Health, Psychiatric Disorders, and their Outcomes

Geographies of mental health explore a range of geographical perspectives and processes relevant for public mental health. Curtis 2010 presents a comprehensive assessment of research in this field. Parr 2008 underlines the social dimensions of geographies of mental health, and Laws 2013 shows how mental health problems relate to social processes involved in different aspects of work and the workplace. Congdon 1996 gave rise to a number of studies exploring the association between social fragmentation at the community level and risks for mental health. A number of studies using ecological and other data have examined geographies of psychiatric diseases and suicide showing their varying impact on ill health and mortality in different geographical areas, illustrated in Giggs and Cooper 1987, Congdon 1996, and Middleton, et al. 2008. Several publications relating to ecological studies of mental health outcomes have drawn attention to the public health significance of work in this field, since it reveals the importance of a range of environmental factors, including socioeconomic stressors and access to means of suicide. This research helps to highlight those areas where mental health-care provision and measures to improve public mental health are most needed (see Miller, et al. 2012 and Cheung, et al. 2012).

  • Cheung, Y. T. D., M. J. Spittal, J. Pirkis, and P. S. F. Yip. 2012. Spatial analysis of suicide mortality in Australia: Investigation of metropolitan-rural-remote differentials of suicide risk across states/territories. Social Science and Medicine 75.8: 1460–1468.

    DOI: 10.1016/j.socscimed.2012.04.008Save Citation »Export Citation » Share Citation »

    NNNDraws attention to the significance of urban rural differences in risk of suicide in the Australian context.

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  • Congdon, P. 1996. Suicide and parasuicide in London: A small-area study. Urban Studies 33:137–158.

    DOI: 10.1080/00420989650012194Save Citation »Export Citation » Share Citation »

    NNNWidely cited as one of the earliest studies in which Peter Congdon demonstrated that an indicator of social fragmentation, based on census data, was relevant for variation in mental health outcomes, as well as for measures of poverty. Congdon’s social fragmentation index and its derivatives have been widely used to study social risks for a range of illnesses at the population level.

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  • Curtis, S. 2010. Space, place and mental health. Aldershot, UK: Ashgate.

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    NNNThis presents a comprehensive discussion of research on mental health and psychiatric disorders from an international and interdisciplinary (though predominantly geographical) perspective for those interested in how mental health is associated with human experiences of space and place. It examines research on geographies of well-being (see Health and Well-being and their Wider Determinants), showing how geographical conditions and processes may be beneficial for mental health or detrimental. The first chapter also provides an overview of the development of health geography more broadly.

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  • Giggs, J. A., and J. E. Cooper. 1987. Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham. British Journal of Psychiatry 151:627–633.

    DOI: 10.1192/bjp.151.5.627Save Citation »Export Citation » Share Citation »

    NNNThis is often cited as a seminal piece of research in geographies of mental health, showing how cases of schizophrenia in a British city were clustered in areas with specific socioeconomic attributes.

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  • Laws, J. 2013. “Recovery work” and “magic” among long-term mental health service-users. Sociological Review 61.2: 344–362.

    DOI: 10.1111/1467-954X.12020Save Citation »Export Citation » Share Citation »

    NNNThis draws attention to the relationships between mental health, mental illness, and work. It provides an original and thought provoking perspective on the associations between work and health.

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  • Middleton, N., J. A. C. Sterne, and D. J. Gunnell. 2008. An atlas of suicide mortality: England and Wales, 1988–1994. Health and Place 14.3: 492–506.

    DOI: 10.1016/j.healthplace.2007.09.007Save Citation »Export Citation » Share Citation »

    NNNUpdates earlier research on the geographical pattern of suicide in England and Wales.

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  • Miller, M., D. Azrael, and C. Barber. 2012. Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health 33:393–408.

    DOI: 10.1146/annurev-publhealth-031811-124636Save Citation »Export Citation » Share Citation »

    NNNReviews suicide mortality in the United States and underlines the importance of availability of means of committing suicide: notably, access to firearms, which draws attention to one aspect of the public health importance of firearms.

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  • Parr, H. 2008. Mental health and social space. Oxford: Blackwell.

    DOI: 10.1002/9780470712924Save Citation »Export Citation » Share Citation »

    NNNThis explores the significance of social spaces for mental health and illustrates how a social geographical interpretation can help us to better understand the experience of mental health and health care.

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Health and Well-being and their Wider Determinants

Health geography extends beyond a focus on medically defined disease to consider aspects of health that correspond to World Health Organization 1946, which defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Geographies of well-being and good health are expanding (see Atkinson, et al. 2012), as is work on geographies of emotion exemplified in Davidson, et al. 2005. Health geography also includes work on interpretations of health that may be socially constructed in variable ways by different social groups. Research in health geography is based on the understanding that attributes of places and spaces may be among the factors that constitute health and influence variation in health among populations and individuals. It is therefore consonant with perspectives on public health that consider social determinants such as employment, housing, and social conditions in communities and that have been promoted internationally by World Health Organization 2008.

  • Atkinson, S., S. Fuller, and J. Painter, eds. 2012. Wellbeing and Place. Farnham, UK: Ashgate.

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    NNNBrings together papers from an international conference on geographies of well-being and shows the range and diversity of different ways that geographers explore the relationships between place and well-being.

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  • Davidson, J., L. Bondi, and M. Smith, eds. 2005. Emotional geographies. Aldershot, UK: Ashgate.

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    NNNThis collection of papers provides a rich source of ideas and examples of emotional geographies. Work in this field is related to perspectives described in the section Public Mental Health, Psychiatric Disorders, and their Outcomes, though emotional geographies should not be considered as identical in approach to geographies of mental health, since the theoretical and substantive perspectives of these streams of work are distinct.

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  • Kearns, R. A. 1993. Place and health: Towards a reformed medical geography. Professional Geographer 45:139–147.

    DOI: 10.1111/j.0033-0124.1993.00139.xSave Citation »Export Citation » Share Citation »

    NNNThis paper is frequently referenced in health geography as a statement underlining the shift beyond medical geography to embrace a wider view on health and the importance of geography for health and well-being.

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  • Pearce, J., and K. Witten, eds. 2010. Geographies of obesity: Environmental understandings of the obesity epidemic. Farnham, UK: Ashgate.

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    NNNThis international collection of papers includes discussion from a geographical perspective of the wider determinants of obesity and of the behavioral factors, especially diet and physical activity, which contribute to obesity.

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  • World Health Organization. 1946. Preamble to the constitution of the World Health Organization as adopted by the International Health Conference. New York, 19–22 June 1946. Geneva, Switzerland: World Health Organization.

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    NNNAn essential source of international initiatives to consider public health in terms of well-being, as well as absence of illness.

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  • World Health Organization. 2008. Commission on social determinants of health, final report: Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization.

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    NNNInfluential source of information on how public health depends on risk factors in the wider environment, as well as on individual risk factors and health care. Geographies of health provide a valuable framework to research the wider determinants of health in the social, economic, political, and physical environment.

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Care, Healing, and Health Promotion

The idea of therapeutic landscapes has been widely explored in health geography, especially in Gesler 1992 and Gesler 2003, which are seminal works on the topic. The conceptual framework of therapeutic landscapes encourages us to consider the physical, social, and symbolic dimension of places and why they are important for health and well-being. Therapeutic landscapes may include “healing places,” such as sites of pilgrimage or spa settings that have a reputation for physical, psychological, and spiritual healing. Also natural landscapes have been interpreted by geographers in terms of their healing properties, as illustrated in Williams 2007. Other work focuses on the design of health- care settings such as hospitals and other health-care facilities studied extensively in Gesler, et al. 2004; Curtis, et al. 2007; and Milligan 2009. Research in this field also underlines the diversity of socially and culturally constructed perceptions of what are healthy or healing places, explored in Laws 2009 and Conradson 2005. The idea of therapeutic landscapes can inform our understanding of the wider determinants of public health. These depend not only on the material environment but also on the social interactions that we experience in different settings, our emotional or spiritual attachment to places, and the ways that sense of identity is bound up in particular places. The work can be important in informing strategies to make green spaces, urban settings, and individual buildings more sensitive to public health and well-being concerns as illustrated in Grant and Barton 2006 and Thompson 2011.

  • Conradson, D. 2005. Landscape, care and the relational self: Therapeutic encounters in rural England. Health and Place 11.4: 337–348.

    DOI: 10.1016/j.healthplace.2005.02.004Save Citation »Export Citation » Share Citation »

    NNNThis discusses how one’s sense of a therapeutic landscape is the outcome of interaction between one’s individual perception and attitudes and the attributes of places. It underlines that there is no single set of principles determining what is a therapeutic landscape but that this is contingent on individuals and social construction of places.

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  • Curtis, S., W. Gesler, K. Fabian, S. Francis, and S. Priebe. 2007. Therapeutic landscapes in hospital design: A qualitative assessment by staff and service users of the design of a new mental health inpatient unit. Environment and Planning C 25.4: 591–610.

    DOI: 10.1068/c1312rSave Citation »Export Citation » Share Citation »

    NNNThis exemplifies research aiming to apply ideas of therapeutic landscapes to assessment of health-care settings.

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  • Gesler, W. M. 1992. Therapeutic landscapes: Medical issues in light of the new cultural geography. Social Science and Medicine 34.7: 735–746.

    DOI: 10.1016/0277-9536(92)90360-3Save Citation »Export Citation » Share Citation »

    NNNThis is an early statement by Gesler on his ideas about therapeutic landscapes, which have framed a significant body of subsequent work in geographies of health.

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  • Gesler, W. M. 2003. Healing places. Lanham, MD: Rowman & Littlefield.

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    NNNA rich source of ideas about the concept of therapeutic landscapes and salutogenic environments that have beneficial effects on health.

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  • Gesler, W., M. Bell, S. Curtis, P. Hubbard, and S. Francis. 2004. Therapy by design: Evaluating the UK hospital building program. Health and Place 10.2: 117–128.

    DOI: 10.1016/S1353-8292(03)00052-2Save Citation »Export Citation » Share Citation »

    NNNThis reviews research on how design of hospitals may benefit health in ways beyond clinical treatment. There are lessons for architectural design more generally as a factor that can contribute to a healthy environment.

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  • Grant, M., and H. Barton. 2006. A health map for the local human habitat. Journal for the Royal Society for the Promotion of Public Health 126.6: 252–253.

    DOI: 10.1177/1466424006070466Save Citation »Export Citation » Share Citation »

    NNNThis considers the wider environmental conditions that are important for health and extends earlier discussions of the social determinants of public health.

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  • Laws, J. 2009. Reworking therapeutic landscapes: The spatiality of an “alternative” self-help group. Social Science and Medicine 69.12: 1827–1833.

    DOI: 10.1016/j.socscimed.2009.09.034Save Citation »Export Citation » Share Citation »

    NNNLaws shows how alternative ideas of therapeutic landscapes in unconventional settings appropriated by marginalized groups can afford them a sense of a therapeutic setting.

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  • Milligan, C. 2009. There’s no place like home: Place and care in an ageing society. Farnham, UK: Ashgate.

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    NNNThis explores the experience of health and illness in older age from a geographical perspective, including the idea of a complex “landscape of care.”

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  • Thompson, C. W. 2011. Linking landscape and health: The recurring theme. Landscape and Urban Planning 99.3: 187–195.

    DOI: 10.1016/j.landurbplan.2010.10.006Save Citation »Export Citation » Share Citation »

    NNNThis illustrates how ideas from geographies of health can be applied to landscape architecture and urban planning to create conditions that benefit public health.

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  • Williams, A., ed. 2007. Therapeutic landscapes. Aldershot, UK: Ashgate.

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    NNNThis collection of essays by leading writers in the field provides a good overview of various aspects of work on therapeutic landscapes.

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Context, Composition, and Interactions between Contextual and Individual Health Determinants

Since the 1990s much research has focused on the question of whether we can determine from statistical analyses the degree to which health inequalities among individual people may be due to the attributes of places and communities in which they live, as well as to their individual characteristics as explained in Duncan, et al. 1998. It has been argued that the variation in health between different geographically defined populations is associated partly with the “composition” of individuals with different individual characteristics who make up the local population, and partly with “contextual” attributes of places or collective community conditions that affect the whole of the local population (see Subramanian, et al. 2001). However, theoretically, the notion of complete independence of contextual and compositional factors associated with health is not tenable, so that early-21st-century work has moved on to the question of how individual and area attributes may interact in ways that are linked to public health outcomes. Such work calls for a relational approach, receptive to the idea of place and space as complex, socially constructed dimensions of the worlds we live in (see Cummins, et al. 2007). Research and policy questions for public health arising from this work include whether certain individuals are relatively susceptible or resilient to prevailing environmental risks and whether certain environmental conditions may help to influence individual behaviors and risks that are important for health. Some public health measures may need to be made at the collective population scale, often across a whole area while others are targeted to individuals.

  • Cummins, S., S. Curtis, A. V. Diez-Roux, and S. Macintyre. 2007. Understanding and representing “place” in health research: A relational approach. Social Science and Medicine 65.9: 1825–1838.

    DOI: 10.1016/j.socscimed.2007.05.036Save Citation »Export Citation » Share Citation »

    NNNThis review and discussion has been widely cited. It encourages readers to consider how individual factors and attributes of places interact to influence health, as well as the interest of relational interpretations of space.

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  • Duncan, C., K. Jones, and G. Moon. 1998. Context, composition and heterogeneity: Using multilevel models in health research. Social Science and Medicine 46.1: 97–117.

    DOI: 10.1016/S0277-9536(97)00148-2Save Citation »Export Citation » Share Citation »

    NNNThis influential paper was one of the earliest studies demonstrating how multi-level modeling could help to identify variation in health associated with area conditions as well as differences linked to individual people’s characteristics.

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  • Subramanian, S., V. I. Kawachi, and B. P. Kennedy. 2001. Does the state you live in make a difference? Multilevel analysis of self-rated health in the US. Social Science and Medicine 53.1: 9–19.

    DOI: 10.1016/S0277-9536(00)00309-9Save Citation »Export Citation » Share Citation »

    NNNThis example from the United States illustrates the use of multi-level analyses to test the importance of area of residence for health.

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Dynamic Perspectives

Another growing field of research in geographies of heath considers the combined significance of variation in time as well as space. This research moves beyond “cross-sectional studies” of conditions at one point in time to consider changing environmental conditions experienced by people over their life course. Population Movement and Migration and Environmental Change and the Impacts on Health are processes that can be important for public health.

Population Movement and Migration

This type of work in geography explores, for example, the significance of different aspects of mobility for health examined in Gatrell 2011. A number of research studies have explored the connection between health of geographically defined populations and migration between areas that is “health selective.” Such selective migration may contribute to health inequalities between areas within countries such as Britain, the United States, and Canada as illustrated for example in Exeter, et al. 2011; Connolly, et al. 2007; and Curtis, et al. 2009. New statistical techniques are improving the capacity to examine variation over time as discussed in Goovaerts 2013. And epidemiological studies that examine how population mobility affects lengths of exposure to environmental risks for health are improving our understanding of health determinants, as illustrated in Hystad, et al. 2012. Omariba and Boyle 2010 shows how migration patterns contribute to health inequalities across countries.

  • Connolly, S., D. O’Reilly, and M. Rosato. 2007. Increasing inequalities in health: Is it an artefact caused by the selective movement of people? Social Science and Medicine 64.10: 2008–2015.

    DOI: 10.1016/j.socscimed.2007.02.021Save Citation »Export Citation » Share Citation »

    NNNThis exemplifies research on “health selective” migration and its implications for understanding variation in population health.

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  • Curtis, S., M. S. Setia, and A. Quesnel-Vallee. 2009. Socio-geographic mobility and health status: A longitudinal analysis using the National Population Health Survey of Canada. Social Science and Medicine 69.12: 1845–1853.

    DOI: 10.1016/j.socscimed.2009.08.004Save Citation »Export Citation » Share Citation »

    NNNExplores how residential mobility relates to other health determinants and the relative importance of these aspects of “health selective” migration for variations of different types of health problems.

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  • Exeter, D. J., P. J. Boyle, and P. Norman. 2011. Deprivation (im)mobility and cause-specific premature mortality in Scotland. Social Science and Medicine 72.3: 389–397.

    DOI: 10.1016/j.socscimed.2010.10.009Save Citation »Export Citation » Share Citation »

    NNNThis illustrates research that examines how residential mobility over time may affect area differences in health, especially if an individual’s propensity to move is associated with health.

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  • Gatrell, A. 2011. Mobilities and health. Farnham, UK: Ashgate.

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    NNNThis provides a comprehensive discussion of the importance of mobility for public health, viewed from various different geographical perspectives.

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  • Goovaerts, P. 2013. Analysis of geographical disparities in temporal trends of health outcomes using space-time joinpoint regression. International Journal of Applied Earth Observation and Geoinformation 22:75–85.

    DOI: 10.1016/j.jag.2012.03.002Save Citation »Export Citation » Share Citation »

    NNNThis paper illustrates advanced methods for examining variation in health in time as well as space.

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  • Hystad, P., P. A. Demers, K. C. Johnson, et al. 2012. Spatiotemporal air pollution exposure assessment for a Canadian population-based lung cancer case-control study. Environmental Health 11:22.

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    NNNThis is an illustration of research that explores how exposure to risk factors accumulates over time, depending on the residential history of individuals and how this relates to health variation.

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  • Omariba, D. W. R., and M. H. Boyle. 2010. Rural-Urban Migration and Cross-National Variation in Infant Mortality in Less Developed Countries. Population Research and Policy Review 29.3: 275–296.

    DOI: 10.1007/s11113-009-9140-ySave Citation »Export Citation » Share Citation »

    NNNExplores the hazards for child mortality of rural urban migration processes in developing countries.

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Environmental Change and the Impacts on Health

Geographical research explores how changing area conditions over time may be important for health, as well as for conditions prevailing at particular points in the life course. Even if populations do not move as discussed in Population Movement and Migration, conditions in the environment may change around them. Changes in social and natural health determinants are associated, for example, with local geographical variation in long-term economic trends demonstrated in Riva and Curtis 2012 and local impacts of processes linked to climate change examined in Berrang-Ford, et al. 2012; Poutiainen, et al. 2013; Carrel, et al. 2009; and Curtis and Oven 2011. These environmental changes may be significant for public health outcomes, and geographical research makes an important contribution to work in understanding these relationships.

  • Berrang-Ford, L., K. Dingle, J. D. Ford, et al. 2012. Vulnerability of indigenous health to climate change: A case study of Uganda’s Batwa Pygmies. Social Science and Medicine 75.6: 1067–1077.

    DOI: 10.1016/j.socscimed.2012.04.016Save Citation »Export Citation » Share Citation »

    NNNThis illustrates the importance of climate change for public health for indigenous communities.

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  • Carrel, M., M. Emch, P. K. Streatfield, and M. Yunus. 2009. Spatio-temporal clustering of cholera: The impact of flood control in Matlab, Bangladesh, 1983–2003. Health and Place 15.3: 741–752.

    DOI: 10.1016/j.healthplace.2008.12.008Save Citation »Export Citation » Share Citation »

    NNNFloods, are a growing hazard in areas such as Bangladesh, and this paper discusses the potential importance of flood control measures for infectious disease risk, illustrating the public health significance of such interventions for environmental hazard management.

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  • Curtis, S. E., and K. J. Oven. 2011. Geographies of health and climate change. Progress in Human Geography 36.5: 654–666.

    DOI: 10.1177/0309132511423350Save Citation »Export Citation » Share Citation »

    NNNThis reviews the associations between climate change and geography.

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  • Poutiainen, C., L. Berrang-Ford, J. Ford, and V. Heymann. 2013. Civil society organizations and adaptation to the health effects of climate change in Canada. Public Health 127.5: 403–409.

    DOI: 10.1016/j.puhe.2013.02.004Save Citation »Export Citation » Share Citation »

    NNNThis critically evaluates adaptation to climate change in the Canadian perspective, from a public heath perspective.

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  • Riva, M., and S. Curtis. 2012. Long-term local area employment rates as predictors of individual mortality and morbidity: A prospective study in England, spanning more than two decades. Journal of Epidemiology and Community Health 66.10: 919–926.

    DOI: 10.1136/jech-2011-200306Save Citation »Export Citation » Share Citation »

    NNNExamines the relationship between population health in localities in England and change in the local economic environment, measured in this study by the local long- term employment trend. It shows that health is associated not only with employment levels at the time when population health is measured but also with the longer-run patterns of stability or change in employment. Groups of areas with persistently low employment over the long term (or with falling employment levels) had worse population health, while populations in areas with continuously high levels of employment, or in areas showing rising employment levels, had better health outcomes.

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