question
what do geographers look for?
answer
• Distributions
• Distances
• Directions
• Shapes & Forms
• Patterns
• Cores
• Peripheries
• Distances
• Directions
• Shapes & Forms
• Patterns
• Cores
• Peripheries
question
basic geographic concepts
answer
• Location, direction and distance
• Size and scale
• Physical and cultural attributes
• Attributes of place are always changing - a dynamic reality (new infrastructure)
• Interrelations between places
• Place similarity and regions
• Size and scale
• Physical and cultural attributes
• Attributes of place are always changing - a dynamic reality (new infrastructure)
• Interrelations between places
• Place similarity and regions
question
development of health geography
answer
application of geographical perspectives and methods to the study of health
• To investigate health related topics
• Drawing facts freeing from other social, physical and biological sciences
• To investigate health related topics
• Drawing facts freeing from other social, physical and biological sciences
question
themes concerning the development of health geography
answer
o Health and disease and the geographical variations in them and the cause of the variations
o Health care provision and utilisation
o The different between traditional practices and current practices
o Health care provision and utilisation
o The different between traditional practices and current practices
question
traditional practices
answer
Traditional practices - generally quantitative
1. The spatial patterns of disease
2. Special patterns of health service use/provision
1. The spatial patterns of disease
2. Special patterns of health service use/provision
question
current practices
answer
Current practices - generally qualitative
1. Humanistic - concerned about what people think and believe about health care
2. Structuralism/materialist - role of broader social structure in affecting health
3. (Cultural) Pluralism - meanings of health/health care in different cultural contexts - Humanism tends to be individualistic, where the focus here is broader
1. Humanistic - concerned about what people think and believe about health care
2. Structuralism/materialist - role of broader social structure in affecting health
3. (Cultural) Pluralism - meanings of health/health care in different cultural contexts - Humanism tends to be individualistic, where the focus here is broader
question
the remphasis of place in health geo originated from two sources...
answer
places are different, philosophies of those places are different
inadequacies of the biomedical disease model
inadequacies of the biomedical disease model
question
the concept of place
answer
• Place is not an arena for everyday life, it is a centre of felt value, incarnating the experience and aspirations of people and influencing their health
• Human territoriality results from the interaction between economic, political and social processes which can constitute, constrain and meditate the role of space
• Human territoriality results from the interaction between economic, political and social processes which can constitute, constrain and meditate the role of space
question
renewed interest in place
answer
the capacity of one's immediate environment to influence health
uneasiness with the biomedical model and acceptance of the socioecological model of health
the determinants of ill health depend on the person and depend on their environment
uneasiness with the biomedical model and acceptance of the socioecological model of health
the determinants of ill health depend on the person and depend on their environment
question
three main concepts of space (also who made them)
answer
Eyles made them
concepts:
space as a container
space viewed as an attribute
a relational view of space
concepts:
space as a container
space viewed as an attribute
a relational view of space
question
space as a container
answer
Space merely provides the backdrop for activities
The context of locality and its role in health is neglected
The context of locality and its role in health is neglected
question
space viewed as an attribute
answer
Space gained meaning from human activities - what is happening inside
Space becomes a stage which is moulded by the actors into a particular shape for a particular purpose based on their beliefs and needs
Space becomes a stage which is moulded by the actors into a particular shape for a particular purpose based on their beliefs and needs
question
a relational view of space
answer
The objects including people contained and represented through relations with other objects/people
Dualism of space and place - outside of where you are
One way to see "space in place" is to utilize and develop theoretical constructs that contextualize the spatial, as well as the social
Dualism of space and place - outside of where you are
One way to see "space in place" is to utilize and develop theoretical constructs that contextualize the spatial, as well as the social
question
time geography
answer
• Hägerstrand's time geography is a powerful framework for understanding constraints on human activity participation in space and time
• Human activities in an integrated system of time and space under the effects of spatiotemporal constraints
• Human activities in an integrated system of time and space under the effects of spatiotemporal constraints
question
activities
answer
everything done by a human in a certain place at a certain time
question
stations
answer
places where desired activities are carried out
humans move between individual stations and communicate with them
humans move between individual stations and communicate with them
question
space time paths
answer
Space-time paths are most often visualized in a 3D orthogonal space - space time map
A two-dimension horizontal plane represents the geographical space and time is represented by the vertical axis
A two-dimension horizontal plane represents the geographical space and time is represented by the vertical axis
question
bundles
answer
If two or more individuals' trajectories meet at a place
You can see on a map that their trajectories come together
You can see on a map that their trajectories come together
question
constraints (types)
answer
capacity
coupling
authority
coupling
authority
question
capacity constraint
answer
derived of the physical/biological construction of a human and his or her needs - satisfaction of these needs require space and time which take up some usable part of an individual's day
question
coupling constraint
answer
a human must carry out their activities in a certain time in a certain place and mostly uses some tools or company of individuals - someone can only be in one place at one time
question
authority constraint
answer
given by the society, or determined by general ethical or moral principals
question
geography in the context of information communication technology
answer
disrupts the conventional view of human's behaviour in time and space
makes us more afraid of getting disease because we can find out earlier
• People under the effects of ICTs are now able to pursue several parallel activities
living space has been enriched (virtual mobility)
• Traditional time geography now has to consider modern trend in space time behaviour
makes us more afraid of getting disease because we can find out earlier
• People under the effects of ICTs are now able to pursue several parallel activities
living space has been enriched (virtual mobility)
• Traditional time geography now has to consider modern trend in space time behaviour
question
hypermobility
answer
- as a result of the combination of:
o Physical: mobility as interaction by car, bus, train etc
o Medial: communication via television, radio and other communication means
o Virtual mobility: the interpersonal contact via PC, internet, mobile phones
o EXAMPLE: surfing the internet while traveling on the bus to work
o Physical: mobility as interaction by car, bus, train etc
o Medial: communication via television, radio and other communication means
o Virtual mobility: the interpersonal contact via PC, internet, mobile phones
o EXAMPLE: surfing the internet while traveling on the bus to work
question
5 geographical perspectives
answer
1. Spatial patterning of disease and death
2. Spatial patterning of service provision
3. Humanism in health geography
4. Structural/materialist/critical theme
5. (Cultural) Pluralism
2. Spatial patterning of service provision
3. Humanism in health geography
4. Structural/materialist/critical theme
5. (Cultural) Pluralism
question
perspective #1: spatial patterning of disease and death
answer
• Relevance of space and place in understanding variation in health, disease, death
biomedical model
some insights with reference between environment and health - termed disease ecology studies
• "a map will make visible to the eye the development and nature of any phenomenon in regard to its geographic distribution"
biomedical model
some insights with reference between environment and health - termed disease ecology studies
• "a map will make visible to the eye the development and nature of any phenomenon in regard to its geographic distribution"
question
John snow's cholera map
answer
o 18040s-1850s study of Cholera in London
o Put on a map all the incidences of cholera - found they were all condensed around one spot, near a well
o Put on a map all the incidences of cholera - found they were all condensed around one spot, near a well
question
perspective #2: spatial patterning of service provision
answer
concerned with provision and access to health care services
• The greatest predictor of health in Canada is location - as you go North, access to health care services decreases
• Emphasis on geography of health service networks and utilization - where do we put a facility? How many people will use it? At what cost?
• Accessibility - travel costs, time distance - variables in analysis
• The greatest predictor of health in Canada is location - as you go North, access to health care services decreases
• Emphasis on geography of health service networks and utilization - where do we put a facility? How many people will use it? At what cost?
• Accessibility - travel costs, time distance - variables in analysis
question
3 main components of perspective #2
answer
o Structure and spatial patterning of health service facilities at a range of scales
o Patterns of inequality in supply and use of services. The state of affairs and how this deviate from some norm/optimum
o Patient utilisation of health services and factors influencing this such as how people decide to use services
o Patterns of inequality in supply and use of services. The state of affairs and how this deviate from some norm/optimum
o Patient utilisation of health services and factors influencing this such as how people decide to use services
question
perspective #3: humanism in health geography
answer
• Asks how people understand and think about their health and behave unhealthfully
• Provides means by which researches understand people's experiences with, perceptions of, health and ill health
• "complete stories about health, health care and sickness in which individuals make sense of their lives"
• Notions of accessibility, satisfaction, health from the point of view of lay the person being studied; defining health themselves
• Provides means by which researches understand people's experiences with, perceptions of, health and ill health
• "complete stories about health, health care and sickness in which individuals make sense of their lives"
• Notions of accessibility, satisfaction, health from the point of view of lay the person being studied; defining health themselves
question
perspective #4: structural/materialist/critical theme
answer
• Focuses on the social causes of differences in health/health care status among individuals and/or groups
• It is not enough to say the ill health/health care access is caused by the particular disease/condition - is it environment, work, housing, malnutrition, education? - have to take into account different factors
• Moves beyond germ theory of disease and idea of special aetiology or causation. Thereby challenging the biomedical model
• It is not enough to say the ill health/health care access is caused by the particular disease/condition - is it environment, work, housing, malnutrition, education? - have to take into account different factors
• Moves beyond germ theory of disease and idea of special aetiology or causation. Thereby challenging the biomedical model
question
perspective #5: (cultural) pluralism
answer
role of culture as a broad system of meanings for making sense of health and health care
cultural production of place/place-based production of culture
• Places achieve positive or negative reputations because people perceive that they do or do not fulfill basic human needs
cultural production of place/place-based production of culture
• Places achieve positive or negative reputations because people perceive that they do or do not fulfill basic human needs
question
descriptive studies
answer
Characterize health status by person, place or time
surveillance
surveillance
question
analytical studies
answer
Exposure and outcome (dose response)
question
two types of observation epidemiological studies
what is are obseravtion study designs?
what is are obseravtion study designs?
answer
descriptive
analytical
• Exposure not under control of the investigator
• Study subjects have other characteristics that help to differentiate them
analytical
• Exposure not under control of the investigator
• Study subjects have other characteristics that help to differentiate them
question
experimental study designs
answer
• researcher has direct control over study subjects
• less common in epidemiological research because of ethics of research on humans - animal studies
• less common in epidemiological research because of ethics of research on humans - animal studies
question
caveat
answer
since we don't know the result, we cannot be sure that applying the subjects with the exposure will not be harmful
question
criterion
answer
only under certain circumstances where it is demonstrable that the effect is likely to be small or negligible, we can justify the promise of the study over potential risks
question
social epidemiology
answer
• epidemiology is the study of the causes and distributions of disease
• epidemiological investigation began in the last century when the prevalent diseases seemed to be contagious and infectious disease
• patterns of human contact were obviously relevant in studying the incidence of these diseases
• epidemiological investigation began in the last century when the prevalent diseases seemed to be contagious and infectious disease
• patterns of human contact were obviously relevant in studying the incidence of these diseases
question
epidemiology - John snow
answer
• First epidemiological research
• Cholera outbreak in 1854
• His research led him to the corner of Broad and Cambridge street at the epicenter of the epidemic - all deaths had taken place within a short distance of a water pump on that corner
• 500 deaths in 10 days - once pump was disconnected, almost immediately showed that cholera was linked with water supply
• Cholera outbreak in 1854
• His research led him to the corner of Broad and Cambridge street at the epicenter of the epidemic - all deaths had taken place within a short distance of a water pump on that corner
• 500 deaths in 10 days - once pump was disconnected, almost immediately showed that cholera was linked with water supply
question
incidence
answer
o refer to the number of new cases of a specific health disorder occurring within a given population during a stated period of time
question
prevalence
answer
o the total number of cases of a health disorder that exist at any time
o Prevalence would include all new cases as well as all previously existing cases
o Prevalence would include all new cases as well as all previously existing cases
question
types of prevalence
answer
point
period
lifetime
period
lifetime
question
point prevalence
answer
the number of cases at a certain point in time, usually a particular day or week
question
period prevalence
answer
the total number of cases during a specified period of time, usually a month or year
question
lifetime prevalence
answer
the number of people who have had the health problem at least once during their lifetime
question
crude rate
answer
which is the number of persons (cases) who have the characteristics being measured during a specific unit of time
question
standardization
answer
• Medical geographers are typically concerned with the effects of specific variables or social characteristics
• Standardizing focuses on these variables so results can be better applied - ex. Death rate by ages
• Why standardize? - crude rate is no use, standardizing makes results better
• Standardizing focuses on these variables so results can be better applied - ex. Death rate by ages
• Why standardize? - crude rate is no use, standardizing makes results better
question
4 types of quantitative data methods for modelling
answer
point
continuous
areal
interaction
continuous
areal
interaction
question
disease mapping
answer
• Visualization - Spatial patterns
o Random, uniform, clustered (clustering = disease hotspots)
o Random, uniform, clustered (clustering = disease hotspots)
question
small numbers problem
answer
not enough data to show relationship on a big map
question
Modifiable Areal Unit Problem
answer
depending on the size you chose, the data may tell different stories
question
k function
answer
visit each observation point, concentric circles, counts and graph counts by distance
question
kernel estimation
answer
visit all point in study space (not just observed points).
Number of ways of doing bandwidth, but not number of concentric rings
Number of ways of doing bandwidth, but not number of concentric rings
question
spatial analysis key questions
answer
are the differences in an area significant or by chance?
what is the cause
can we do anything to prevent it?
what is the cause
can we do anything to prevent it?
question
indication of spatial significance`
answer
o Extreme variations between areas
o Clustering (spatial autocorrelations)
o Temporal consistency
o Clustering (spatial autocorrelations)
o Temporal consistency
question
two types of distance`
answer
geographical - distance between 2 places
Euclidean distance - distance between two places measured on a surface (map)
Euclidean distance - distance between two places measured on a surface (map)
question
large scale =
answer
=large detail = small area
question
small scale =
answer
=small detail = large area
question
nearest neighbour analysis
answer
o The mean of the distance between each point and its nearest neighbour is compared with the expected mean distance that would occur if the distribution is random
question
nearest neighbour index
answer
o NNI is the average distance from the closest neighbour to each point with a distance that would be expected on the basis of chance (randomly)
question
ways proximity can be represented
answer
o Share common boundary
o Inter-centroid distance
o K-nearest neighbour
o Boundary-boundary distance
o Inter-centroid distance
o K-nearest neighbour
o Boundary-boundary distance
question
spatial autocorrelation
answer
• Measures the extent to which similar features are found adjacent to one another
CLUSTERING
• Observations are not independent of one another
CLUSTERING
• Observations are not independent of one another
question
qualitative methods
answer
interviews
participant observation
focus groups
evidence
participant observation
focus groups
evidence
question
the health transitions
answer
• The shifts that have taken place in the patterns and causes of death in many countries
• Transition has been covered by two terms: demographic transition, and epidemiological transition
• Transition has been covered by two terms: demographic transition, and epidemiological transition
question
the demographic transition theory
answer
• Describing the change from high fertility and mortality rates in less developed societies to low fertility and mortality rates in modem societies
• Birth rate decline is lagging behind death rate decline - middle phase there is a population explosion
• When societies get more modern, people don't die as often because of better health practices and then they will have less kids because they probably won't die now
• Birth rate decline is lagging behind death rate decline - middle phase there is a population explosion
• When societies get more modern, people don't die as often because of better health practices and then they will have less kids because they probably won't die now
question
DT theory: stage 1
answer
o Birth and death rates are equally high
o Population growth is slow, potential for rapid growth exists
o Death rate fluctuates in response to war and disease
o Involves low income agricultural economy
o Population growth is slow, potential for rapid growth exists
o Death rate fluctuates in response to war and disease
o Involves low income agricultural economy
question
DT theory: stage 2
answer
o Dramatic reduction in death rate as a result of industrialization and related medical and health advances
o Reduction in death rate is not accompanied by a reduction in birth rate
o Rate of natural increase (r) is high - rapid population growth
o Assurance hypothesis: if you have babies who are going to die, you have more babies
o Reduction in death rate is not accompanied by a reduction in birth rate
o Rate of natural increase (r) is high - rapid population growth
o Assurance hypothesis: if you have babies who are going to die, you have more babies
question
DT Theory: stage 3
answer
o Declining birth rates- voluntary decisions to reduce family size
o Related to increased standards of living
o Population growth is slow again - r falls
o You have to have 2 children to replace yourself (2 parents have 2 kids)
o Related to increased standards of living
o Population growth is slow again - r falls
o You have to have 2 children to replace yourself (2 parents have 2 kids)
question
DT theory: stage 4
answer
o Birth and death rates are equal again
o Low r
o Low r
question
DT Theory: developing vs developed nations
answer
o All industrialized nations have gone through these stages
o Developing nations have completed stage 1 and are now in 2
o Uncertain of how long this process will take
o Countries in western Europe took 200 years - developing nations cannot wait that long in this world (environmental disaster and social upheaval)
o Developing nations have completed stage 1 and are now in 2
o Uncertain of how long this process will take
o Countries in western Europe took 200 years - developing nations cannot wait that long in this world (environmental disaster and social upheaval)
question
the epidemiological transition
answer
• Introduced to describe the changes in mortality and morbidity patterns (from infectious to chronic diseases) as societies' demographic, economic and social structures change
question
3 stages of the epidemiological transition
answer
the age of pestilence and famine
the age of receding pandemics
the age of chronic diseases
the age of receding pandemics
the age of chronic diseases
question
#1: Age of Pestilence and Famine
answer
• Mortality that have prevailed through human history - epidemics, famine and wars cause huge numbers of deaths
• The provision of ecological resources
• Lack of sufficient infrastructure for most services - high levels of mortality and fertility
• Women at childbearing age face considerable risks with pregnancy and childbirth
• Life expectancy between 20-40 years
• Population growth, improvements in health and advances in socio-economic development are limited by local carry capacity
• The provision of ecological resources
• Lack of sufficient infrastructure for most services - high levels of mortality and fertility
• Women at childbearing age face considerable risks with pregnancy and childbirth
• Life expectancy between 20-40 years
• Population growth, improvements in health and advances in socio-economic development are limited by local carry capacity
question
#2: the age of receding pandemics
answer
Involved a reduction in the prevalence of infectious disease and a fall in mortality rates - Life expectancy 35 -50 years
Increased economic growth led to a fall in infectious diseases and from malnutrition
The introduction of modern healthcare and health technologies
• As fertility rates are high, population grows rapidly at this stage - without moving to the next stage, the carrying capacity of the local ecosystem may be exceeded
• If there is a surplus or resources, transition may be accelerated - if lacking then it may slow down
Increased economic growth led to a fall in infectious diseases and from malnutrition
The introduction of modern healthcare and health technologies
• As fertility rates are high, population grows rapidly at this stage - without moving to the next stage, the carrying capacity of the local ecosystem may be exceeded
• If there is a surplus or resources, transition may be accelerated - if lacking then it may slow down
question
#3: the age of chronic diseases
answer
• The elimination of infectious disease led to the development of chronic disease among the elderly
• Improved health care causes less lethal infectious diseases, relativity high morbidity is caused
• Low levels of mortality and fertility so low population growth - Life expectancy may exceed 80 years
• This stage occurs at different rates in developing countries - mortality rates are driven by socially determined factors
• Improved health care causes less lethal infectious diseases, relativity high morbidity is caused
• Low levels of mortality and fertility so low population growth - Life expectancy may exceed 80 years
• This stage occurs at different rates in developing countries - mortality rates are driven by socially determined factors
question
certain problems associated with the epidemiological transition
answer
o Nuclearization of family
o Destruction of group cohesion
o Rise in mental illness
o Crime, delinquency
o Drug dependency
o Alarming rise in medical costs
o Destruction of group cohesion
o Rise in mental illness
o Crime, delinquency
o Drug dependency
o Alarming rise in medical costs
question
future stages of health transition
what are they?
what are they?
answer
• Marten developed future global health transitions scenarios to paint pictures of possible futures and explore outcomes
• They are imaginary but are already seen in some countries
• There are no clear lines to when stages begin and finish
age of emerging infectious diseases
age of medical technology
age of sustained health
• They are imaginary but are already seen in some countries
• There are no clear lines to when stages begin and finish
age of emerging infectious diseases
age of medical technology
age of sustained health
question
#4: the age of emerging infectious disease
answer
Emergence of new infectious disease or the re-emergence of old ones will have a significant impact on health
Environmental changes as a result of human activity will all contribute to the further spread of disease
• Infectious disease will rise, and life expectancy will fall
• Ill health will lead to lower levels of economic activity
Environmental changes as a result of human activity will all contribute to the further spread of disease
• Infectious disease will rise, and life expectancy will fall
• Ill health will lead to lower levels of economic activity
question
#5: the age of medical technology
answer
• Increased health risks caused by changes in lifestyle and environmental changes will be offset by increased economic growth and technology improvements
question
#6: the age of sustained health
answer
• If environmental and social resources are balanced with economic growth, sustained health may be achieved
• Investments in social services will lead to a sharp reduction in lifestyle related diseases
• Although there is a chance that infections will emerge, worldwide surveillance will be good enough to deal with it properly
• Disparities between rich and poor countries in health will disappear
• Investments in social services will lead to a sharp reduction in lifestyle related diseases
• Although there is a chance that infections will emerge, worldwide surveillance will be good enough to deal with it properly
• Disparities between rich and poor countries in health will disappear
question
health transition in developed countries
answer
• Currently, most developed countries are in the third stage now(ET)
low fertility rates and causes of disease and deaths have shifted from infectious to chronic
• Declining fertility rates and increased life expectancy have led to the ageing or "greying" of the population
low fertility rates and causes of disease and deaths have shifted from infectious to chronic
• Declining fertility rates and increased life expectancy have led to the ageing or "greying" of the population
question
health transition in developing countries
answer
• Varies greatly from one country to another
• Still very low life expectancy due to malnutrition and lack of safe drinking water which are compounded by poor health care facilities
• There also could be large differences in a country due to differences in social or economic nature
• It is believed they will become like North America and Europe one day with economic growth
• Many countries (the poorest) will not trade infectious for chronic diseases, they could have double burden of both
• Still very low life expectancy due to malnutrition and lack of safe drinking water which are compounded by poor health care facilities
• There also could be large differences in a country due to differences in social or economic nature
• It is believed they will become like North America and Europe one day with economic growth
• Many countries (the poorest) will not trade infectious for chronic diseases, they could have double burden of both
question
demographic dividend
answer
• Recognizes that accelerated economic growth could stem from declines in mortality and fertility within countries - resulting in a change in age structure
fewer births = fewer people to support =window of opportunity for economic growth
• Leads to increased production and incomes which results from having more effective workers
• Epidemics have a big impact on a counties DD
fewer births = fewer people to support =window of opportunity for economic growth
• Leads to increased production and incomes which results from having more effective workers
• Epidemics have a big impact on a counties DD
question
when does DD occur?
answer
stage 4 of the DT
question
DD in SSA
answer
• With children making up a significant part of the population, there is a lot of pressure for financial resources among working age adults - also limited by governments to provide
• Declines in fertility have been slow and a demographic transition has not happened yet in most part of SSA
• Conditions for DD were not present anywhere on the continent until 2000 in South Africa
• Labour supply outweighs labour demands - young people without jobs and money causes violence and crime - large working age population but no work for them
• Africa remains the world most youthful continent
• Informal economy in SSA: non-structured sector that has emerged in the urban centers as a result of the modern sectors inability to absorb new entrants
• Declines in fertility have been slow and a demographic transition has not happened yet in most part of SSA
• Conditions for DD were not present anywhere on the continent until 2000 in South Africa
• Labour supply outweighs labour demands - young people without jobs and money causes violence and crime - large working age population but no work for them
• Africa remains the world most youthful continent
• Informal economy in SSA: non-structured sector that has emerged in the urban centers as a result of the modern sectors inability to absorb new entrants
question
first dividend
answer
o Can we get the reduction in mouths to feed?
o Occurs during demographic transition and involves working age population increasing as a share of total population
o The percentage of young and old dependants decreases
o Occurs during demographic transition and involves working age population increasing as a share of total population
o The percentage of young and old dependants decreases
question
second dividend
answer
o Accumulation of wealth - investments
o Occurs as a result of adult longevity, causing people to accumulate more savings (assets) in preparation for old age
o Transitory bonuses from 1st dividend into greater assets for sustainable development
o Second dividend is bigger than first
o Occurs as a result of adult longevity, causing people to accumulate more savings (assets) in preparation for old age
o Transitory bonuses from 1st dividend into greater assets for sustainable development
o Second dividend is bigger than first
question
policies needed to take advantage of DD
answer
• Better health
• Insuring infants receive good medical care
• Protecting women's reproductive health
• Stressing health of children and teens to improve educational performance
• Focusing on low income populations
• Insuring infants receive good medical care
• Protecting women's reproductive health
• Stressing health of children and teens to improve educational performance
• Focusing on low income populations
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