Health/Medical Geography

What is health/medical geography?

Health/medical geography is the study of the spatial distribution and spread of disease, and the various factors that influence human health. Geographical techniques, particularly geographic information systems (GIS) and spatial statistics/modelling, can be used effectively to determine the environmental causes of disease, how those diseases might change and spread over time, and how differences in medical care and facilities might impact the health of populations.

Re-creation of John Snow’s map of cholera cases in London, 1854.

The physician John Snow’s use of spatial analysis to identify the source of cholera in mid-19th century London represents one of the first well-documented applications of health geography. He was able to pin-point a contaminated well as the source of the 1854 cholera outbreak by plotting on a map the locations of cholera cases. Before John Snow’s analysis it was thought that cholera was an airborne disease that floated about as a kind of miasma. The link between contaminated water and disease that Snow discovered using an early form of spatial analysis was a major breakthrough in public health.

Health is obviously a key issue that impacts all human populations around the globe. There exist several broad benchmarks for assessing the health of a population, including:

  • Mortality
  • Morbidity
  • Case mortality rate
  • Crude death rate
  • Infant mortality rate

To assess health issues at a deeper level, we can look at the main factors affecting these benchmarks. The number of citizens per doctor gives a good picture of how long individuals must wait to see a healthcare professional, and the cost of healthcare will undoubtedly affect how many people are able to acquire the quality of care required. Spatial proximity and general accessibility to healthcare facilities and practitioners is of particular interest to health/medical geographers.

Global Health Disparities

More economically developed countries will usually have better quality equipment and technology for treating disease, as well a larger pool of available doctors. Education is important as it aids in awareness of preventable diseases. An aging population will naturally contribute to a higher death rate. Culture and lifestyle also have a significant effect on health, as does the propensity for a society to engage in war or other violent behavior. Extended periods of war can also impede the ability of countries to develop economically, reducing health benchmarks.

The spread of diseases such as HIV/AIDS and malaria are key variables affecting the health of large populations around the world, and are of keen interest to health/medical geographers. The survival rates for individuals with these diseases can tell us about the quality of healthcare in a country, with more economically developed countries (MEDCs) generally able to provide a greater level of care than less economically developed countries (LEDCs).

Health geography overlaps with epidemiology, or the study of the spread of disease. Here the global spread of the Chikungunya Virus (mosquito-borne) is mapped and monitored. Source: Weaver and Lecuit (2015).

Examining the kinds of diseases that have a greater effect on the morbidity rate in a particular region is also informative. In MEDCs, diseases such as Alzheimer’s, cancer, and heart disease are some of the more prevalent diseases, whereas in LEDCs, malaria, TB and HIV more commonly contribute to the morbidity rate. The availability of vaccines is a crucial factor in preventing certain infectious diseases such as malaria.

Access to plentiful, healthy food is also crucial to maintaining health. In LEDCs, undernourishment and malnutrition are the key food issues, whereas in MEDCs, obesity is often the primary challenge. Famine in an LEDCs can cause significant health issues and loss of life, regardless of the cause. Famine may be brought on naturally by a drought, a sudden/rapid population increase, rapid cost inflation of food, or a wide-spread livestock or crop disease.

The Ethiopian famine of 1984 is one of the most infamous occurrences of famine in recent times. The combination of civil war and drought contributed to one of the worst human disasters of the 20th century. It is quoted by the World Health Organization (WHO) that one person died of undernourishment every 20 minutes at the peak of the famine. The government of Ethiopia now keeps 350,000 metric tonnes of food in reserve to distribute during a drought, and an early warning system now can predict when periods of no rainfall will occur in order to help the government plan effectively. Health/medical geographers study the relationships between health and changing environmental/climatic conditions affecting the availability of nutritious food and clean water.

Obesity is linked to affluence, which can support a sedentary lifestyle and over-consumption of high-calorie food. When energy intake exceeds energy output in the human body, energy is stored as fat. This accumulation of fat in the body can have negative impacts on a wide variety of organs and organ systems. Obese individuals are at a greater risk of developing heart disease and cancer, and are generally less able to fight diseases. The environmental factors for obesity are numerous, but almost certainly include the design of the built environment (suburbs encourage automotive use and less walking), and, in some places, limited accessibility to fresh, healthy food (a spatial phenomenon known as food deserts).

Spatial analysis of children's eating habits in Liverpool, UK
Spatial analysis of children’s eating habits in Liverpool, UK. Source: Dummer (2008).

Transnational corporations can also impact global health. Companies like British American Tobacco (BAT) affect the economies of whole countries and the health of millions. In Malawi, BAT employs many local people on tobacco farms and cigarette factories, and tobacco farming is known to contribute up to 2/3 of the Malawai GDP. However, smoking is a leading cause of death worldwide due to lung cancer, bronchitis and emphysema. Furthermore, farmers often choose to grow tobacco rather than vegetables and other edible crops due to the higher value of tobacco. This can increase vulnerability to famine.

Another type of transnational corporation that substantially impacts global health are pharmaceutical companies such as GlaxoSmithKline (GSK). They profit from the development and sale of drugs used to treat a wide variety of diseases linked to obesity and sedentary lifestyles common in MEDCs. One criticism of pharmaceutical companies is the way in which drug development is guided by profitability, meaning that those in LEDCs suffering from diseases such as malaria or other tropical diseases are not a high priority due to lack of profit. Much of the focus tends to fall on wealthy populations. Such inequities in healthcare and medical treatment manifest themselves at both local and global scales, and their spatial patterns are increasingly of interest to geographers.

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