Routledge Handbook of Health Geography

Valorie A. Crooks, Gavin J. Andrews, Jamie Pearce, Valorie A. Crooks, Gavin J. Andrews, Jamie Pearce

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367659905
• eBook ISBN: 9781351598538
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Geography
• Index: Geography

The places of our daily life affect our health, well-being, and receipt of health care in complex ways. The connection between health and place has been acknowledged for centuries, and the contemporary discipline of health geography sets as its core mission to uncover and explicate all facets of this connection.

The Routledge Handbook of Health Geography features 52 chapters from leading international thinkers that collectively characterize the breadth and depth of current thinking on the health–place connection. It will be of interest to students seeking an introduction to health geography as well as multidisciplinary health scholars looking to explore the intersection between health and place. This book provides a coherent synthesis of scholarship in health geography as well as multidisciplinary insights into cutting-edge research. It explores the key concepts central to appreciating the ways in which place influences our health, from the micro-space of the body to the macro-scale of entire world regions, in order to articulate historical and contemporary aspects of this influence.

1
Introducing the Routledge Handbook of Health Geography

Valorie A. Crooks, Gavin J. Andrews, Jamie Pearce and Marcie Snyder

Health geography is a vibrant, engaged, and methodologically diverse sub-discipline of human geography that explores all aspects of the relationship(s) between health and place. Research by health geographers is not only contributing to wider disciplinary debates in geography, but also proving increasingly influential across other social science and health disciplines and in the development of local, national, and global public-health policy. This edited volume provides the most comprehensive overview to date of contemporary research in the field of health geography. As a collection, it chronicles the diverse ideas, debates, and pressing questions that have driven this sub-discipline forward. The contributed chapters are written by those with recognized expertise in specific domains, which serves as a significant strength of this landmark edited collection. Each chapter offers an overview of the intellectual trajectory of a particular domain, identifies major claims and developments related to this domain in the context of health geography and health research more broadly, discusses the principal contributions of the domain to the sub-discipline, articulates the main criticisms or limitations of this domain of study, and offers ideas regarding future research directions or developments.

Our goal in this chapter is not to provide an exhaustive or detailed overview of health geography and its evolution. There are excellent resources to turn to for such accounts (e.g., Andrews et al., 2012; Elliott, 1999, 2017; Kearns and Gesler, 1998; Kearns and Moon, 2002). Instead, we seek to contextualize this volume by briefly providing insight into the relationship between health and place and the sub-discipline of focus and then introducing the structure and organization of the book. We build on this initial contextualization in our own short chapters that are placed at the start of each of the five sections. These short chapters provide further insight into important facets of health geography and the study of health and place, including syntheses of some of the most significant contemporary debates in the sub-discipline.

The acknowledged relationship between health and place

Space and place affect people’s health, well-being, and access to and experiences of health care. The connections between health and place have been recognized as far back as Hippocrates’ Airs, Waters and Places (written in 400 BC) showing early recognition of the causal influence of place (water, food, climate and seasons) on health and well-being. Similarly, the work of the social reformers of the 19th century in Great Britain, such as Edwin Chadwick, Friedrich Engels and Benjamin Seebohm Rowntree, was significant in making the connections between the rapid industrialization of British cities and the health of people living there (Pearce, 2014). These early reformers not only documented the stark differences in health across urban areas of the country but also identified some of the underlying living conditions that were integral to understanding the observed inequalities. The same can be said about the importance of the earliest works that described traditional medicines, and the later writings of Florence Nightingale (1859) and other public-health pioneers, in terms of articulating the importance of the local environment in understanding people’s opportunities for health and well-being (Barrett, 2000). The interconnection between health and place has thus been acknowledged for centuries, and the sub-discipline of health geography sets at its core the task of uncovering and explicating all of its facets. Indeed, this interconnection is widely recognized, and the relationship between health and place has been researched not only by geographers, but also by those from public health, sociology, epidemiology, biostatistics and other disciplines (see Macintyre, Ellaway and Cummins, 2002).

In 1946, the World Health Organization defined “health” as being composed of our “physical, mental and social well-being, not merely … the absence of disease or infirmity” (World Health Organization, 2014, p. 1). Acceptance of this widened definition of “health” prompted a gradual shift away from an exclusively biomedical model of health toward a framework of health that also emphasized its economic, political, social and cultural antecedents not only in the health professions but also among health researchers. This shift also led to wider interest in understanding and acknowledging social influences on health; in doing so, it helped popularize consideration of the role of place (e.g., where we live, where we work, where we access health services) in shaping health. For example, by the time of the World Health Organization’s Declaration of Alma Ata in 1978, which was a milestone declaration enforcing the necessity of primary health care in achieving health for all globally, the infusion of heavily geographic concepts such as community, (spatial) equity and (socio-spatial) access into public health vocabulary had become reasonably commonplace (Crooks and Andrews, 2009a, 2009b).

In 1994, Evans, Barer and Marmor spoke to the importance of using a population-based lens for understanding the social determinants of health, outlining a perspective that has become a guiding framework for health and health-promotion policy internationally. A population-health focus considers health outcomes at the group level, including its distribution, and seeks to identify why some populations have better health than others. From a policy perspective, population-level approaches have been increasingly influential, as they seek to identify the policy levers that will have the most wide-ranging and sustainable benefits. A population-health lens also positions health inequities as a central public-health concern and has resulted in a wide-ranging interdisciplinary and international literature on the ubiquitous social gradient in health that has been observed in most countries (Smith, Bambra and Hill, 2015). In recent years, the social determinants of health have come to provide a widely used framework for examining how societal factors and forces, including socioeconomic and political inequalities (e.g., social exclusion, racism, and housing security) shape health status locally and globally. Most of these determinants have explicitly, such as housing and the built environment, or implicitly, such as gender and income distribution, spatial or geographic components, further reinforced a wide acknowledgment of the connections between health and place.

This volume shows that the sub-discipline of health geography is influenced by many conceptualizations of health, particularly those informed by the social model of health proposed by the World Health Organization, as well as the “social determinants of health” framework (see also Elliott, 1999; White, 1981). The first two sections in particular do an excellent job of showcasing this breadth. Health geographers have played a significant role in articulating the role of spatial and place-based factors and forces in shaping health through a social-determinants lens. Examples from the health-geography literature include examining how geographical processes such as local labor market dynamics, urban segregation, neighborhood resources, social capital and networks, housing quality and security, and colonial legacies shape the relationships between place and health outcomes (e.g., Brown et al., 2018; Curtis, 2004). Increasingly, health geographers are giving attention to the role of these determinants in influencing health and well-being among diverse people who are exposed to different structural and social inequalities (Giesbrecht et al., 2014). In particular, work in the sub-discipline has revealed many of the key barriers to, and facilitators of, positive health experiences among some of the most marginalized groups in society. These contexts are particularly well highlighted in the third section of this book, which explores some of the people and groups that have received significant attention in health-geography research.

Health geographers are interested in understanding and exploring health as it relates to place. As we shall see in this book, place can be a specific location, fixed set of geographic coordinates or politically defined space, or it can be a social and cultural phenomenon, one that is performed, sensed, felt and imbued with meaning and identity (Andrews, 2018; Gatrell and Elliott, 2009). Places are complex in that various elements and facets converge within them to dictate people’s overall experiences. Meanwhile place is susceptible to outside influences from officialdom that can facilitate the health of a population, a group, or an individual and can even contribute to exclusion and marginalization. Health geographers widely acknowledge this complexity. Indeed, we expand on the complexity of place as it relates to health in Chapter 32, our introduction to the fourth section of this book. While in this section of the current chapter we have shown that there is wide interest in and acknowledgment of the connection between health and place, it is health geographers’ intellectual engagement with place in all its facets that sets this sub-discipline apart from other social-science and health disciplines that are informed by social models of health and social-determinants frameworks.

The sub-discipline of health geography

Health geography has evolved considerably since its inception as a sub-discipline of human geography in the mid-20th century. Initially referred to as medical geography, this sub-discipline was heavily positivist, focusing on ecological perspectives of disease (e.g., geographical patterns of disease and environmental determinants) and the spatial distribution of health services (e.g., identifying geographical gaps in health-care provision) (Meade and Earickson, 2000). Although these and related questions were important, this narrow focus resulted in a limited and incomplete understanding of how and why place is implicated in understanding health. What is often referred to as the “cultural turn” in human geography greatly informed the trajectory of the sub-discipline, directing it away from a biomedical understanding of health and disease toward a theoretically informed socio-environmental perspective on health. At the same time, developments in the sub-discipline mirrored shifts in other health-related disciplines by adopting population-level perspectives to examine wider determinants of health (see the previous section in this chapter). An outcome of these changes was a transformation in name, from medical to health geography, but more importantly a diversification in the methods, theories, and approaches that health geographers employed (Kearns, 1995).

It is widely recognized that this important shift in the sub-discipline from medical to health geography was in part inspired by Kearns, who in his landmark 1993 publication called for a postmedical or reformed medical geography. He suggested it was time for a repositioning of the sub-discipline within social geography and for the incorporation of stronger links to social theories that recognize situated experiences and qualitative research as valid ways of knowing (for a review, see Andrews, 2003; Elliott, 2018). This approach suggested that facets of social theory, together with a place-sensitive approach, were critical to the evolution of the former medical geography. Several of the theories and conceptual approaches now used in health geography are showcased in the second section of this book and have heavily influenced the work covered throughout the volume. This reformed health geography has also seen increasing attention given to other significant concerns in the wider human-geography literature, such as scale and difference (Parr, 2004) and life-course perspectives that recognize the importance of time and the durability of place (Pearce et al., in press), which are also concepts that run throughout the chapters contributed to this collection. Recently another paradigm shift has begun; a post-human turn whereby place is conceived as an assemblage – both it and the bodies within it are understood to be networked, material, open, active and performed phenomena. This turn has seen sub-disciplinary attention increasingly paid to such things as the sensory, atmospheric and affective qualities of health and place, all within a broader objective to think about how health emerges and takes place (Andrews, 2018; Duff, 2014).

Although we provide here only a snapshot of its evolution, it is evident that the sub-discipline of health geography has grown from its positivist roots to become a more broadly defined, interdisciplinary field of study informed by diverse and dynamic perspectives. Indeed, health geography is known for its pluralism, and its study has come to be informed by diverse methodological and theoretical approaches. Health geographers often draw upon methods, ideas, concepts, and even research questions from other social-science and health-science disciplines to inform understandings of the complex relationship between health and place. This interdisciplinary and collaborative approach is seen throughout this volume, though perhaps most especially in the final section, which examines the practice of health geography. From a theoretical perspective, health geographers draw upon an array of lenses to better understand the connection between health and place, including humanism, social constructionism, post-structuralism, political economy, complexity theory, relational approaches, non-representational theory, idealist theory and political ecology. The methodological diversity and innovation of health geographers is also extensive, having employed creative methods such as autoethnography, storytelling, photovoice, participatory arts-based approaches, and innovative geospatial approaches using GIScience, GPS-informed and smart technologies and spatio-temporal statistical modeling. Although this growing theoretical and methodological pluralism may have created a methodological divide between quantitative and qualitative approaches and the research questions they inform (Rosenberg, 2016), many health geographers view the methodological and theoretical diversity and innovation to be one of the greatest strengths of the sub-discipline. This view of sub-disciplinary diversity as strength is echoed throughout a number of the contributed chapters.

The practice of health geography is ever changing, and in recent years health geographers have increasingly addressed applied health problems in order to provide evidence for policy debates, stimulate media dialogue, or create interventions (Crooks and Winters, 2016). This engagement reflects a greater expectation of academics to demonstrate the broader societal value of their research through affecting public discourse and engaging with important policy needs. Health geographers are particularly well-placed to respond to this challenge and are well attuned to working alongside policy-makers in the production of research and ensuring research findings are disseminated in ways that are tailored for their intended target audience(s) (Shortt et al., 2016). Although this shift toward placing greater value on academic impact through engagement has not been unproblematic, the increased visibility of health-geography research has resulted in a growing recognition among policy-makers, practitioners and the public of the complex relationship between health and place. This can be seen, for example, in the greater attention to place in public-health strategies such as improving community network, reducing inequities and addressing the obesity epidemic. It can also be seen in the growth of nursing geographies as a dedicated area of study by some nurse researchers (e.g., Andrews, 2003; Kyle et al., 2016).

Once critiqued for their overwhelming research focus on the Global North, over the past decade health geographers have increasingly taken up development and global health frameworks that have pushed research into ever-expanding geographic territories. This has also widened the net of policy and practice relevance for research in the sub-discipline and is beginning to bring perspectives from health geography to some of the major challenges in global health, such as global governance, global inequalities, transnational movements, the control of infectious disease, and the rise of non-communicable diseases. As several contributors to this volume point out, particularly in the first section, health geography has much evolving to do to truly engage the world – in terms of both where health geographers are based and the topics and places they study – and to produce evidence that is relevant to global debates and issues concerning health for all.

Overview of the book

We have organized the Routledge Handbook of Health Geography into five sections, each of which has nine or ten contributed chapters. These sections are an organizational structure rather than reflecting any dominant classifications of health-geography research, and there is inevitably a certain amount of conceptual overlap between them. As noted above, each section beings with a short introductory chapter by us that provides important context about the sub-discipline of health geography and offers cross-cutting themes. The lead author of each of these chapters is the editor who took overall responsibility for the tone and content in that particular section of the book.

Section 1 provides an overview of key perspectives and debates in the sub-discipline. Taken together, the chapters in this section outline many of the most significant and enduring issues and questions that health geographers and those involved in geographical research on health focus on. Further, the chapters provide insights into the ways in which health geographers are making vital contributions to many of the most pressing public-health challenges across the globe, including immensely complex issues such as transmission of infectious diseases, global food insecurity and the obesity epidemic, and the continued burden of tobacco-related disease. Several chapters identify the latest thinking on very well-established areas of the sub-discipline, such as environmental health and justice and infectious disease. Other chapters highlight emerging perspectives and debates and emphasize where health geographers should be bringing perspectives that contribute to understanding the importance of place in these rapidly evolving concerns. As we ob...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of figures
• List of tables
• Contributors
• Acknowledgments
• 1 Introducing the Routledge Handbook of Health Geography
• Section 1 Perspectives and debates
• Section 2 Theories and concepts
• Section 3 Groups and peoples
• Section 4 Places and spaces
• Section 5 Practicing health geographies
• Index