An Introduction to the Geography of Health
Chapter 7: Power and Politics of Health
Source: CDC (1980)
Structural Approaches to Power and Health
Power is often conceptualized by drawing attention to
the ways in which structures of society, and who
controls them, can influence individuals and groups.
Social scientists often consider how human agency, or
the power an individual has to control a situation, is
constrained by these structures of society.
2
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Political economy approaches to health recognize
the importance of political and economic structures
in constraining and enabling human activities that
influence health.
A political economy approach might focus on
colonial power structures as a means of
understanding AIDS, for example.
Can you think of how a history of
colonialism could have an effect on
contemporary patterns in disease?
3
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Related to political economy, are political ecology
approaches, which consider the ways in which structures
of power and the environment are interrelated.
Political factors such as capitalist economic structures,
colonial histories, and social relations of production can
influence ecological access and environmental change.
How is political ecology relevant
to the geography of health?
4
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Examples of health geography studies in political ecology include:
• How has Africa’s refugee crisis affected emerging infectious disease?
(Kalipeni and Oppong 1998)
• How have historical, social, political, and economic processes
contributed to high levels of lead poisoning in parts of the US and North
Carolina? (Hanchette 2008)
• How have women been disadvantaged by Bangladesh’s arseniccontaminated water? (Sultana 2006)
• What are the impacts of AIDS in Africa on social and environmental
systems? (Barnett and Blaikie 1992)
5
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Politics and Health
Another way in which power can be conceptualized
structurally is by considering the impact of politics—
the ways that groups of people make decisions to
formulate policy—at different scales.
6
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Politics can have an impact on spatial and social
aspects of health, both by driving how healthcare is
funded and administered, and through regulating
health-related behaviors.
Can you think of examples of
how health behavior is regulated
in your country or community?
Photo by Muslimgalerie Bouh
7
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
New Geographies of Power
While the role of government provides a clear
example of how power can influence health, critical
geographers and other scholars have emphasized
that power differentials also characterize everyday
interactions related to health.
For instance, power dynamics characterize the
relationship between patient and doctor, and people
can be “othered”—or systematically marginalized by
society—on the basis of their health.
8
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Key fields of research in these new critical geographies include:
• Segregation and health: How certain groups of people, such as the
infectious, the mentally ill, or the homeless, are systematically
marginalized from society.
• Power and the body: How struggles for power occur at the scale of
the body.
• Surveillance and public health: How biomedicine is increasingly
intervening in the lives of not only the ill, but also the well, in
surveying and regulating behavior.
9
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Fertility Policy
Fertility policy is a common way in which
governments intervene in individual health decisions.
Governments may have social or economic reasons
to implement anti-natalist (discouraging fertility) or
pro-natalist (encouraging fertility) policies.
Why might a government wish to adopt
either a pro-natalist or anti-natalist policy?
10
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Fertility policy can be
examined from a power
perspective.
A key distinction is often made
between policies that promote
contraceptive technologies in
order to empower people to
control their own fertility, and
others that seek to control the
fertility of certain groups
within a society.
Data Source: UN (2009), UNDEP (2009)
11
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Critics of international population campaigns have
argued that Western interests, often with the support of
elite policymakers, have aggressively promoted family
planning in the low-income world as a way to reduce
population growth in these regions rather than to
promote reproductive choice.
Slowing population growth is often a geo-political,
ecological, and/or resource-related goal.
Is it appropriate for the Western world to
try to influence fertility policy in the lowincome world? Why or why not?
12
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Family Planning in China
China has experimented with some of the most aggressive
family planning policies, lending its story particular
relevance to the study of geographies of power.
China’s fertility policies may have prevented 250 million
births over the last 25 years (Zhengming 2000).
13
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
China’s policies have focused on:
1) delaying marriage and childbearing,
2) birth spacing,
3) fertility limitation.
Preferential treatment in education and health has been
provided for only children, while penalties for noncompliance have included large fines.
Stringent social and administrative control in China has
enabled the implementation of these policies.
14
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Source: Attané (2002) Reproduced by kind permission of Wiley-Blackwell.
15
Anthamatten and Hazen
Compliance with and acceptance
of family planning policies varies
considerably across China.
An Introduction to the Geography of Health
Chapter 7
A population pyramid can shed insight into population
policies. The large base of the pyramid, indicating a high
birth rate, clearly shows why China was interested in
maintaining its anti-natalist policies in 1990.
Data source: US Census (2009)
16
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
The impacts of China’s fertility policies are
clearly visible in the narrowing base of this
population pyramid from 2009.
Data source: US Census (2009)
17
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
China’s fertility policies may pose problems in the future as China’s
working population shrinks. This pyramid, showing China’s projected
population structure for 2050, illustrates how a large elderly
population must be supported by a shrinking working population.
Data source: US Census (2009)
18
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Conclusion
Health and healthcare decisions are infused with power.
Whether at the scale of international debates regarding
fertility, national decisions over smoking policy, or an
individual’s discussions with her doctor, investigating the
impact of power relations is critical.
19
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
Discussion Questions
1.
2.
3.
4.
20
Which is more important: public health or the rights of the
individual? Do governments have a responsibility to regulate
dangerous behaviors such as smoking? To what degree does the
state have the responsibility or the right to regulate behaviors that
may lead to the transmission of disease?
In what way do spatial patterns and processes illustrate or reflect
issues of power? How is the notion of “territory” significant to
health?
Are coercive family planning measures ever warranted?
Is family planning in low-income countries an effort to curtail nonWhite fertility, or do policies reflect a genuine concern for the wellbeing and health of people throughout the world?
Anthamatten and Hazen
An Introduction to the Geography of Health
Chapter 7
References
Attané, I. (2002) ‘China's family planning policy: an overview of its past and future’, Studies in Family Planning, 33: 103–13.
Barnett, T. and Blaikie, P. M. (1992) AIDS in Africa: Its Present and Future Impact, New York: Guilford Press.
[CDC] Centers for Disease Control (1980) “Image ID# 8195” Public Health Image Library [Online]. Available: <
http://phil.cdc.gov/phil/download.asp> (Accessed 10 Jan 2011).
CDC / Barbara Jenkins, NIOSH. Photograph by Roy Perry. (1946) “Image ID# 8956” Public Health Image Library [Online].
Available: < http://phil.cdc.gov/phil/details.asp > (Accessed 02 Jan 2011).
Hanchette, C. L. (2008) ‘The political ecology of lead poisoning in eastern North Carolina’, Health & Place, 14: 209–16.
Kalipeni, E. (2000) ‘Health and disease in southern Africa: a comparative and vulnerability perspective’, Social Science &
Medicine, 50: 965–83.
Sultana, F. (2006) ‘Gendered waters, poisoned wells in Bangladesh’ in: Lahiri-Dutt, K., National Institute for Environment, and
Australian National University (eds.) Fluid Bonds: Views on Gender and Water. Kolkata: Stree.
United Nations. (2009) World Population Prospects: The 2008 Revision, Executive Summary [Online]. New York: United
Nations. Available: <http://esa.un.org/unpd/wpp2008/pdf/WPP2008_Executive-Summary_Edited_6-Oct-2009.pdf>
(Accessed 27 December 2009).
[UNDEP] United Nations and Department of Social and Economic Affairs. (2009) World Population Prospectus: The 2008
Revision Population Database [Online]. Available: <http://esa.un.org/unpp/index.asp> (Accessed 3 January 2010).
US Census Bureau (2009b) International Database: China population data, 1990, 2009, 2050.
Zhenming, X. (2000) ‘Population policy and the family-planning programme’ in: P. Xizhe & G. Zhigang (eds.) The Changing
Population of China. Oxford, UK: Blackwell.
21
Anthamatten and Hazen
An An Introduction to the Geography of Health
Chapter 7