Introduction
• The main concerns of Geography may be
summarized by the words ‘place’, ‘space’
and ‘environment’.
• Environment: How people influence and
are influenced by their environment, both
physical and human (i.e. cultural, poltical,
social, economic).
Introduction …
• Space: How things vary over space, and
how spatial variations in one thing influence
spatial variations in other things.
• Place: How the combination of factors
found at a place make that place unique.
People’s subjective attachment to places.
Definitions
1. Medical geography is the application of geographical
perspectives and methods to the study of health,
disease and health care.
• Johnston et al., (1994) Dictionary of Human
Geography, p.374.
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Definitions…
2. Medical geography uses the concepts and techniques
of the discipline of geography to investigate healthrelated topics.
• Subjects are viewed in holistic terms within a variety of
cultural systems and a diverse biosphere.
• Draws freely from the facts, concepts and techniques of
other social, physical, and biological sciences.
• Medical geography is an integrative, multistranded
subdiscipline that has room within its broad scope for a
wide range of specialist contributions.
• Meade and Earickson (2000) Medical Geography, p.1
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Medical Geography …
• Geographic variation in health has long
been studied in interdisciplinary rubrics as:
–
–
–
–
–
–
Geographic pathology
Medical ecology
Medical topography
Geographical epidemiology
Geomedicine
Medical climatology etc.
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Sub-Branches
• A distinction is sometimes made between Medical
Geography and Health Geography.
• Health geographers tend to focus on place as
opposed to space or environment. They also tend
to focus on subjective aspects (e.g. illness, as
opposed to disease) and tend to favour the use of
both qualitative and quantitative methodologies.
• The main division in Medical / Health Geography
is between the geography of health (i.e. the causes
of diseases) and the geography of health care (i.e.
the provision and uptake of medical services).
Medical Geography Criticized
• The new generation of health geographers, in
reaction to the previous medical geographer's view of
the discipline, state:
• Our reply is that this dominant 'biomedical' viewpoint
is both flawed and limited.
• There is an urgent need to 'go outside the body' to
develop an alternative social and environmental
perspective on health in which geography can play an
important part, along with other social sciences
(Jones and Moon, 1989).
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Medical Geography Criticized…
• Local variations in health status and health care
provision are certainly important, but the principal
concerns of medical geography as currently practised
-access to and the location of and utilization of health
facilities, the use of quantitative techniques for spatial
analysis in health care planning or the socio-political
determinants of health and access to health care-are
limiting.
• Medical geography requires radical surgery if it is
truly to come to grips with such issues (Mohan,
1989).
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Medical Geography Criticized…
• In the marriage of humanistic geography and
contemporary models of health suggested by
these writers, we have an incipient "postmedical" geography of health (Kearns, 1993).
• Therefore there are two strands of medical
geography: the traditional and contemporary
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Medical Geography Criticized…
• The 'traditional' strands accept disease as a
naturally occurring, culture-free, and 'real'
entity, where the problems posed by
questions of accurate measurement and
distribution are assumed to be technical and
solvable.
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Medical Geography Criticized …
• In contrast, the other 'contemporary' strands adopt
a stance which argues, in various ways, that
notions of health, disease, and illness are
problematic, and intimately linked to power
relations in society.
• Thus, the assumption of health professionals as
invariably caring, neutral scientists is questioned,
and the different roles they fulfill in maintaining
the current social order become subjects for
scrutiny (Curtis and Taket, 1996).
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Medical Geography Criticized …
• “Medical geography" … too narrow -- "health
geography" preferred now, much more in tune
with debates in social theory and policy
• Special role for “place" - physical space, place
in the world, and sense of place.
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Some Questions?
• What is Health?
• What is Disease?
• What is illness?
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Health
• Everyone knows what health is, and yet a precise
definition of health is difficult to come by
• Health: ‘is a state of complete physical, mental and
social well-being and not merely the absence of disease
or infirmity’ (WHO, 1947)
• However, in practice ‘health’ tends to be regarded as the
absence of disease.
Disease
• May (1961) defined disease as “that alteration of
living cells or tissues, that jeopardizes survival in
their environment”
• Disease refers to an objective ‘malfunction’ (i.e.
adverse physical condition), irrespective of
whether the person feels unwell (e.g. hypertension
– high blood pressure).
Disease …
• Is that which is diagnosed by a physician
• It is usually believed to be located in specific
organs or systems in the body and curable through
specific biomedical treatments.
• Disease is a socially mediated event
Disease …
• Several important points in the
definition of disease:
– The organism has an environment
– The idea that disease jeopardizes survival
implies there may be different levels of health
without there being disease
– E.g., an office worker does not need the
physique or eyesight of a hunter
Metaphoric Meanings of Disease
• Metaphors attached to diseases are often
destructive and harmful.
• They frequently lead to punitive effects on the
patient because they exaggerate, simplify, and
stereotype the patient's experience.
• Metaphors may function as stigma.
• They may serve to isolate the person with the
disease from the community.
Metaphoric Meanings of Disease …
• Metaphors often imply adverse moral and
psychological judgements about the ill person.
• They have perpetrated the view, for example, that
cancer is a form of self-judgement or self-betrayal.
Media Images of Cancer, Heart Disease,
and AIDS
• A study of the way cancer, heart disease, and
AIDS have been portrayed in the mass media
illustrates how diseases come to have unique
meanings and metaphors associated with them.
• Disease is seen as much more than a mechanical
failure and a physiological pathology
• Table 1
Images of Cancer, Heart Disease and AIDS
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Table 1 - Source: Clarke, 2004
Media Images of Cancer
• The moral worth of the person with cancer is
attacked by the invasion of an evil predator
so fearsome it is not even to be named, but
fought as a powerful alien intruder that
spreads secretly through the body.
• The person with cancer is not offered much
hope of recovery.
Media Images of Cancer…
• By and large, the media portray cancer as
associated with horrid symptoms,
mutilations, excruciating suffering, and
finally death.
• To some extent the person with cancer is held
to be blameworthy because the cancer could
have been detected through medical
checkups etc.
Media Images of Cancer…
• There is a great deal of uncertainty about the cause
of cancer.
• There are numerous putative causes.
• They are usually described as the result of
individual lifestyle decisions.
• The individual who is ultimately culpable.
Media Images of Heart Disease
• The media description is radically different when the
disease is a heart attack.
• The heart attack is presented as an objective,
morally neutral event that happens at a specific
time and place and causes a great deal of pain.
• Heart disease is portrayed in optimistic terms.
Media Images of Heart Disease …
• Not only are there very clear and precise steps to be
taken to prevent it, but when it occurs it can be
treated in a variety of mechanical ways, including
using technology to replace a malfunctioning
heart.
• Heart disease does not affect the whole person or
the moral being of the person.
• It 'attacks' one part only.
Media Images of Heart Disease …
• Heart disease is an outsider that can be repelled
through quick, 'decisive’ action and the use of
medical marvels.
• The person with heart disease may experience acute
fear and pain, but the period of recovery is likely
to be dominated by optimism about a cure and a
resolve to change the lifestyle habits that led to the
disease in the first place.
Media Images of AIDS
• The person with AIDS is portrayed as a diseased
person and as somewhat morally repugnant.
• S/he is described as hopelessly doomed and isolated
from potentially significant sources of emotional
support such as lovers and family members.
• The disease itself is described in mechanical and
biomedical terms.
Media Images of AIDS …
• The media do not dwell on the painful or
debilitating symptoms of the disease.
• They do not focus on the inevitable terminal
stages of the disease, on death itself, or on
the mortality rate.
Media Images of AIDS …
• Rather, they focus on the fear of contagion and the
uncertainty about the causes of contagion.
• The person afflicted with AIDS is stigmatized
because of the connection with a deviant lifestyle
• Isolation
Illness
• Illness: subjective feeling of feeling unwell
(‘disease’), even if there are no apparent
symptoms.
• The experience of being ill draws from the
symbolic interactionist tradition:
– it draws attention to:
– the meanings
– interpretations
– world views of human beings in relation to
illness, sickness, disease, and death.
Illness …
• Meanings are constructed out of social interactions
in specific social, political, economic, and
historical contexts.
• Meanings reflect a person's position in the social
structure and that person’s personal relationships
and experiences.
Culture and Illness
• Cultural attitudes to illness vary
• The meaning of illness to people also vary
• Physicians have been mostly concerned with the
biomedical aspects of this complex
• But patients have developed their own lay theories
of illness causation - and have given certain
illnesses a metaphoric meaning which creates a
totally different universe in which doctors usually
feel completely lost.
Illness …
• Variations in the experience of being ill
• In all societies people experience illness, pain,
disability, and disfigurement.
• Possible causes of disease.
– sorcery,
– the breaking of a taboo
– the intrusion of a disease causing spirit into the
body
– the intrusion of a disease-causing object into
the body
– the loss of the soul
Illness …
• All the above explanations, except for the
intrusion into the body of a disease-causing
object, involve the supernatural or magic
in an attempt to understand illness.
Illness …
Westners
• Westerners tend to see illness as empirically
caused and mechanically or chemically treatable.
• To a large extent, Westerners have separated the
mind, the body, and the spirit.
Illness …
Non-Westerners
• However, in most of the non-western world,
non-empirical explanations and cures for
disease seem to dominate:
• illness is seen as a combination of
– spiritual
– mental
– physical phenomena.
Sickness
• Refers to the social actions taken by person as a
result of illness or disease, such taking
medication, visiting the doctor, resting in bed, or
staying away from work.
• Patients feel illness and sickness
• Sickness is a socially mediated event
• Social-cultural factors influence whether a
person visits a doctor, chiropractor etc.
Sickness …
• Refers to the social actions taken by person as a
result of illness or disease, such taking
medication, visiting the doctor, resting in bed, or
staying away from work.
• Patients feel illness and sickness
• Sickness is a socially mediated event
• Social-cultural factors influence whether a
person visits a doctor, chiropractor etc.