Health geography

Health geography is the application of geographical information, perspectives, and methods to the study of health, disease, and health care.

Overview
Initially referred to as medical geography, health geography is based on the biomedical model of health and grounded in the logical positivism philosophy. The social or socio-ecological model adopts a more holistic approach to disease and illness.

It emphasizes treatment of the whole person and not just components of the system. Under this model, new illnesses are recognized, and other types of medicine (such as complementary or alternative medicine) are combined with traditional medicine.

This alternative methodology means medical geography was broadened to incorporate philosophies such as structuration, structuralism, social interactionism and feminism. Thus, the field of health geography was born.

History
A classic piece of research in health (or medical) geography was done in 1854 as cholera gripped London. Death tolls rang around the clock from church towers, and the people feared that they were being infected by vapors coming from the ground. Dr. John Snow thought that, if he could find the source of the disease, it could be contained. He drew maps showing the homes of people who had died of cholera and the locations of water pumps. He found that one pump, the public pump on Broad Street, was central to most of the victims. He figured that infected water from the pump was the culprit. He instructed the authorities to remove the handle to the pump, making it unusable. After that, the number of new cholera cases decreased.

Areas of study
Health geography can provide a spatial understanding of a population's health, the distribution of disease in an area, and the environment's effect on health and disease. It also deals with accessibility to health care and spatial distribution of health care providers. The study is considered a subdiscipline of human geography. But it requires an understanding of other fields such as epidemiology and climatology.

Geography of medical care provision
Although health care is a public good, it is not 'pure'. In other words, it is not equally available to all individuals. The geography of health care provision has much to do with this. Demand for public services is continuously distributed across space, broadly in accordance with the distribution of population, but these services are only provided at discrete locations. Inevitably therefore, there will be inequalities of access in terms of the practicality of using services, transportation costs, travel times and so on.

Geographical factors such as physical proximity and travel time are not the only aspects which influence access to health care. Other types (or dimensions) of accessibility to health care except for geographical (or spatial) are social, financial and functional. Social accessibility to health care depends on race (like separate hospitals for white and black people), age, sex and other social characteristics of individuals. Important here are also relationships between the patient and the doctor. Financial aspects depend upon the price of care, and functional factors reflect the amount and structure of provided services. These can vary among different countries or regions of the world. Access to health care is influenced also by factors such as opening times and waiting lists that play an important part in determining whether individuals or population sub-groups have access to health care. This type of accessibility is termed 'effective accessibility'.

The location of health care facilities depends largely on the nature of the health care system in operation, and will be heavily influenced by historical factors due to the heavy investment costs in facilities such as hospitals and surgeries. Simple distance will be mediated by organizational factors such as the existence of a referral system by which patients are directed towards particular parts of the hospital sector by their general practicioner. Access to primary care is therefore a very significant component of access to the whole system. In a 'planned' health care system, the distribution of facilities is expected to fairly closely match the distribution of demand. By contrast, a market-oriented system might mirror the locational patterns found in other business sectors, such as retail location. Either potential accessibility or revealed accessibility might be measured. But there is a well-established pattern of use increasing with access, i.e., people who have easier access to health care use it more often.

Health Geographers

 * Jonathan Mayer
 * Nancy Breen
 * Ellen Cromley
 * Anthony C. Gatrell
 * Jim Dunn
 * Robin Kearns
 * Sara McLafferty
 * Graham Moon
 * Gerard Rushton
 * W.F. (Ric) Skinner

See also, North American Health Geographers Profiles and International Health Geographers Profiles on the Association of American Geographers, Health & Medical Geography Specialty Group web site (http://userpages.umbc.edu/~earickso/Index.html). There were over 200 profiles in this archive as of January 2009.