Summary exam literature
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Lecture 1: HEALTH GEOGRAPHY, AN INTRODUCTION
Geographies of Health: an introduction (Chapter 1) - Gatrell & Elliot (2015)
Health and geography are linked → where you live affects available treatments, risk of disease
and well-being → access to basic resources is geographically differentiated.
Health = dynamic state of well-being characterised by a physical, mental and social potential → if
the potential is insufficient to satisfy the demands the state is disease → invest in health through
private health insurance → lose health when becoming ill or breaking something.
→ we experience illness (subjective), doctors diagnose disease (objective) → epidemiology =
incidence, distribution and possible control of diseases and other factors relating to the health of
populations → mortality (death) → morbidity (sickness) → concepts around health:
incidence = number of new chronic = long-lasting (FEX. diabetes), impairment = if someone is restricted in
cases occurring within a given acute = abrupt conditions (FEX. heart its physical or mental functioning (FEX.
time, prevalence = number of attack), infectious = caused by defective or missing body part), disability
people with the disease or organisms that spread directly from
= social or cultural form of exclusion.
illness at any point in time. one person to another (FEX. measles).
→ types of care: (a) primary (general physician), (b) secondary (hospital-based setting), (c) tertiary
(specialised care).
Location = a fixed point or geographic area on the earth’s surface → contains latitude and
longitude coordinates → FEX. “51.17 °N, 30.15 °E” refers to a location approximately 51 degrees
north of the equator and 30 degrees east of the Greenwich meridian.
→ locations become places when charged with a meaning → place = a small area (FEX. a favorite
chair or an important building) → locations remain fixed over time, places don’t (inhabitants may
gain or lose population, FEX. due to a tsunami) → experiences/beliefs about spaces may change
too → some effects of places are immediate (seasonal effects), some are long-term (climate
change effects) → distance = something that relates one place/location to another.
Geography = study of places and relationships between people and their environments → places
may be good or bad for health → bad: Chernobyl explosion affected people to a larger extent in
southeast Europe → good: therapeutic landscape = places that are beneficial for health →
provide physical, mental or spiritual healing.
→ scale = can vary from body surrounding, neighborhood, city, region, country → health data are
often aggregated in different scales → relations in one scale may differ from other scales.
Disease ecology = one cannot understand the distribution of a disease, without knowing about
its relationship to local and regional ecologies (interactions between climate, plants and animals).
Health geography = the interaction between people and the environment → multidisciplinary
and holistic perspective encompassing society and space → looks at social influences.
Examples of the impact of geography on health: obesity is shaped by neighbourhood factors →
legislation related to smoke-free public places influences the prevalence of smoking → contexts
in our daily lives are constrained by societal structures and access to resources.
Health geography: supporting public health policy and planning - Dummer (2008)
Spatial location = the geographic context of places and the connectedness between places.
→ 2 dimensions health geography: (1) patterns, causes and spread of disease, (2) planning and
provision of health services → core geographic research themes:
, - Spatial scale, globalization and urbanization:
global issues directly influence health policy
→ FEX. global patterns in infectious diseases
are linked to migration, population
movement and disease diffusion.
- Social and spatial inequalities in health:
determinants and consequences of health
variations, including poverty and health care
access.
Geographic research in health is divided in: (a)
quantitative studies (aligned with epidemiology) and
(b) qualitative studies (aligned with medical sociology and social sciences).
Geographical information system (GIS) = collecting, storing, representing and manipulating
spatial data → used to analyze health related info to investigate health outcomes and health care
provision → mapping, monitoring and modelling infectious and chronic diseases.
→ challenges: (a) technical (FEX. development of appropriate computer software and hardware),
(b) ethical (FEX. access to appropriate data, privacy and confidentiality of personal info).
Policy derived from geographic research can fall victim to 3 problems:
1. Ecological fallacy = incorrect assumptions about people based on aggregated data about
their communities → associations over a set of geographical areas cannot simply be
applied to individuals → your data, analysis and conclusion must be on the same areal
unit → FEX. more people smoke in the global north and there is a higher life expectancy,
BUT we cannot say smoking results in a higher life expectancy.
2. Modifiable areal unit problem = different results arise when
modifying the boundaries (picture right) → an identified
geographical pattern is partly a consequence of the size and share
of the areal unit → FEX. depending on how you divide space there
are strong republican/democratic areas.
3. Small number problem = as areal units become larger, the number of cases grows
(estimates of disease risk are unstable).
Spatial relations are dynamic and health variation can be a consequence of individual mobility,
population movement and migration.
Shaping cities for health: complexity and the planning of urban environments in the 21st
century - Rydin et al. (2012)
Cities are complex systems = (a) emergent, (b) unbalanced, (c) requiring much energy to maintain
themselves, (d) displaying patterns of inequality and (e) saturated flow (resilient) systems.
Urban advantage = health benefits of living in urban as opposed to rural areas → BUT, average
levels of health hide effects of socioeconomic inequality within urban areas (rich and poor people
live in different worlds, even within the same city → occurs in high- and low-income countries).
Healthy Cities movement = phase 1; new organisational structures, creating agents of change
and introducing new working practices focused on health. phase 2; healthy public policy and city
health planning. phase 3; meeting fixed criteria and systematically monitoring and assessing.
phase 4; promoting partnerships, intersectoral cooperation and networking between cities.
phase 5; substantial growth in the number of cities involved.
→ based on: community participation, empowerment and institution building.
3 components of a new approach to planning for urban health:
, Learning from projects: trial Social learning: dialogue, deliberation and Creating forums to debate the
and error to increase the discussion between key stakeholders → moral and ethical dimensions of
understanding of how best to use a wide range of sources of knowledge approaches to urban health and
improve urban health outcomes → combine statistical data with the environments: consultation,
in specific contexts → localised insights of tacit and experiential knowledge mediation and deliberation →
projects are sensitive to local of practitioners and lay knowledge and promotion of the urban health
circumstances. experience of local communities. agenda itself.
5 key recommendations: (1) stakeholders in urban
planning and public health should work together →
(2) health inequalities within urban areas should be
a key focus → (3) the urban advantage needs to be
maintained through new urban planning policies →
(4) relations and policies affecting urban health
outcomes must be understood → (5) should be
local experimentation and assessment of projects
to create an active dialogue and mutual learning.
COVID-19 pandemic and health inequalities - Bambra et al. (2020)
Inequalities in pandemics: inequalities in prevalence and mortality rates between (a) high- and
low-income countries, (b) more and less affluent neighbourhoods, (c) higher and lower
socio-economic groups and (d) urban and rural areas.
Inequalities in the social determinants of health: syndemic = closely intertwined and mutually
enhancing health problems that affect the overall health of a population within harmful social
conditions → for the most disadvantaged communities, COVID-19 is a syndemic (pandemic that
exacerbates existing NCDs (non-communicable diseases) and social conditions).
Inequalities in chronic conditions: are the result of inequalities in exposure to the social
determinants of health = the conditions in which people live, work, grow and age.
Economic crisis and health inequality: unequal health impacts; (a) unequal experiences of a
lockdown (due to job and income loss, overcrowding, urbanity, access to green space, key worker
roles), (b) how the lockdown is shaping social determinants of health (reduced access to health
care services), (c) inequalities in the immediate health impacts of the lockdown (mental health).
→ largest consequences through political and economic pathways → lead to increases in
morbidity, mental ill health, suicide and death from alcohol and substance use.
Conclusion: long-term public health policy responses are needed to ensure that the COVID-19
pandemic does not increase health inequalities for future generations.
Lecture 2: THINKING SPATIALLY ABOUT HEALTH AND METHODS
Geographies of Health: an introduction (Chapter 3) - Gatrell & Elliot (2015)
Types of quantitative measures:
Spatial mapping = 3 tasks in quantitative spatial mapping:
(1) Visualisation: draw a map of the data to detect spatial patterning or associations
between disease and social or environmental factors.
(2) Exploratoration: search for spatial patterns and associations with other variables.
(3) Modeling: specify a formal statistical model of data → testing a hypothesis and involving
a spatial variable.
https://ebookcentral.proquest.com/lib/uunl/reader.action?docID=1819688
Lecture 1: HEALTH GEOGRAPHY, AN INTRODUCTION
Geographies of Health: an introduction (Chapter 1) - Gatrell & Elliot (2015)
Health and geography are linked → where you live affects available treatments, risk of disease
and well-being → access to basic resources is geographically differentiated.
Health = dynamic state of well-being characterised by a physical, mental and social potential → if
the potential is insufficient to satisfy the demands the state is disease → invest in health through
private health insurance → lose health when becoming ill or breaking something.
→ we experience illness (subjective), doctors diagnose disease (objective) → epidemiology =
incidence, distribution and possible control of diseases and other factors relating to the health of
populations → mortality (death) → morbidity (sickness) → concepts around health:
incidence = number of new chronic = long-lasting (FEX. diabetes), impairment = if someone is restricted in
cases occurring within a given acute = abrupt conditions (FEX. heart its physical or mental functioning (FEX.
time, prevalence = number of attack), infectious = caused by defective or missing body part), disability
people with the disease or organisms that spread directly from
= social or cultural form of exclusion.
illness at any point in time. one person to another (FEX. measles).
→ types of care: (a) primary (general physician), (b) secondary (hospital-based setting), (c) tertiary
(specialised care).
Location = a fixed point or geographic area on the earth’s surface → contains latitude and
longitude coordinates → FEX. “51.17 °N, 30.15 °E” refers to a location approximately 51 degrees
north of the equator and 30 degrees east of the Greenwich meridian.
→ locations become places when charged with a meaning → place = a small area (FEX. a favorite
chair or an important building) → locations remain fixed over time, places don’t (inhabitants may
gain or lose population, FEX. due to a tsunami) → experiences/beliefs about spaces may change
too → some effects of places are immediate (seasonal effects), some are long-term (climate
change effects) → distance = something that relates one place/location to another.
Geography = study of places and relationships between people and their environments → places
may be good or bad for health → bad: Chernobyl explosion affected people to a larger extent in
southeast Europe → good: therapeutic landscape = places that are beneficial for health →
provide physical, mental or spiritual healing.
→ scale = can vary from body surrounding, neighborhood, city, region, country → health data are
often aggregated in different scales → relations in one scale may differ from other scales.
Disease ecology = one cannot understand the distribution of a disease, without knowing about
its relationship to local and regional ecologies (interactions between climate, plants and animals).
Health geography = the interaction between people and the environment → multidisciplinary
and holistic perspective encompassing society and space → looks at social influences.
Examples of the impact of geography on health: obesity is shaped by neighbourhood factors →
legislation related to smoke-free public places influences the prevalence of smoking → contexts
in our daily lives are constrained by societal structures and access to resources.
Health geography: supporting public health policy and planning - Dummer (2008)
Spatial location = the geographic context of places and the connectedness between places.
→ 2 dimensions health geography: (1) patterns, causes and spread of disease, (2) planning and
provision of health services → core geographic research themes:
, - Spatial scale, globalization and urbanization:
global issues directly influence health policy
→ FEX. global patterns in infectious diseases
are linked to migration, population
movement and disease diffusion.
- Social and spatial inequalities in health:
determinants and consequences of health
variations, including poverty and health care
access.
Geographic research in health is divided in: (a)
quantitative studies (aligned with epidemiology) and
(b) qualitative studies (aligned with medical sociology and social sciences).
Geographical information system (GIS) = collecting, storing, representing and manipulating
spatial data → used to analyze health related info to investigate health outcomes and health care
provision → mapping, monitoring and modelling infectious and chronic diseases.
→ challenges: (a) technical (FEX. development of appropriate computer software and hardware),
(b) ethical (FEX. access to appropriate data, privacy and confidentiality of personal info).
Policy derived from geographic research can fall victim to 3 problems:
1. Ecological fallacy = incorrect assumptions about people based on aggregated data about
their communities → associations over a set of geographical areas cannot simply be
applied to individuals → your data, analysis and conclusion must be on the same areal
unit → FEX. more people smoke in the global north and there is a higher life expectancy,
BUT we cannot say smoking results in a higher life expectancy.
2. Modifiable areal unit problem = different results arise when
modifying the boundaries (picture right) → an identified
geographical pattern is partly a consequence of the size and share
of the areal unit → FEX. depending on how you divide space there
are strong republican/democratic areas.
3. Small number problem = as areal units become larger, the number of cases grows
(estimates of disease risk are unstable).
Spatial relations are dynamic and health variation can be a consequence of individual mobility,
population movement and migration.
Shaping cities for health: complexity and the planning of urban environments in the 21st
century - Rydin et al. (2012)
Cities are complex systems = (a) emergent, (b) unbalanced, (c) requiring much energy to maintain
themselves, (d) displaying patterns of inequality and (e) saturated flow (resilient) systems.
Urban advantage = health benefits of living in urban as opposed to rural areas → BUT, average
levels of health hide effects of socioeconomic inequality within urban areas (rich and poor people
live in different worlds, even within the same city → occurs in high- and low-income countries).
Healthy Cities movement = phase 1; new organisational structures, creating agents of change
and introducing new working practices focused on health. phase 2; healthy public policy and city
health planning. phase 3; meeting fixed criteria and systematically monitoring and assessing.
phase 4; promoting partnerships, intersectoral cooperation and networking between cities.
phase 5; substantial growth in the number of cities involved.
→ based on: community participation, empowerment and institution building.
3 components of a new approach to planning for urban health:
, Learning from projects: trial Social learning: dialogue, deliberation and Creating forums to debate the
and error to increase the discussion between key stakeholders → moral and ethical dimensions of
understanding of how best to use a wide range of sources of knowledge approaches to urban health and
improve urban health outcomes → combine statistical data with the environments: consultation,
in specific contexts → localised insights of tacit and experiential knowledge mediation and deliberation →
projects are sensitive to local of practitioners and lay knowledge and promotion of the urban health
circumstances. experience of local communities. agenda itself.
5 key recommendations: (1) stakeholders in urban
planning and public health should work together →
(2) health inequalities within urban areas should be
a key focus → (3) the urban advantage needs to be
maintained through new urban planning policies →
(4) relations and policies affecting urban health
outcomes must be understood → (5) should be
local experimentation and assessment of projects
to create an active dialogue and mutual learning.
COVID-19 pandemic and health inequalities - Bambra et al. (2020)
Inequalities in pandemics: inequalities in prevalence and mortality rates between (a) high- and
low-income countries, (b) more and less affluent neighbourhoods, (c) higher and lower
socio-economic groups and (d) urban and rural areas.
Inequalities in the social determinants of health: syndemic = closely intertwined and mutually
enhancing health problems that affect the overall health of a population within harmful social
conditions → for the most disadvantaged communities, COVID-19 is a syndemic (pandemic that
exacerbates existing NCDs (non-communicable diseases) and social conditions).
Inequalities in chronic conditions: are the result of inequalities in exposure to the social
determinants of health = the conditions in which people live, work, grow and age.
Economic crisis and health inequality: unequal health impacts; (a) unequal experiences of a
lockdown (due to job and income loss, overcrowding, urbanity, access to green space, key worker
roles), (b) how the lockdown is shaping social determinants of health (reduced access to health
care services), (c) inequalities in the immediate health impacts of the lockdown (mental health).
→ largest consequences through political and economic pathways → lead to increases in
morbidity, mental ill health, suicide and death from alcohol and substance use.
Conclusion: long-term public health policy responses are needed to ensure that the COVID-19
pandemic does not increase health inequalities for future generations.
Lecture 2: THINKING SPATIALLY ABOUT HEALTH AND METHODS
Geographies of Health: an introduction (Chapter 3) - Gatrell & Elliot (2015)
Types of quantitative measures:
Spatial mapping = 3 tasks in quantitative spatial mapping:
(1) Visualisation: draw a map of the data to detect spatial patterning or associations
between disease and social or environmental factors.
(2) Exploratoration: search for spatial patterns and associations with other variables.
(3) Modeling: specify a formal statistical model of data → testing a hypothesis and involving
a spatial variable.
