Medical Geography (GEOG 445)
Fall 2012 Class meets:
T & TR 12:30-1:45 PM
452 Hamilton Hall
Instructor: Mike Emch
Email: emch@unc.edu
Office: 326 Saunders Hall
Office hours: 2-3:30PM Tuesday and 3:30-5 Thursday or by appointment
Course Objectives
This course surveys medical geography, a field that focuses on geographical aspects of health
and disease. Medical geography deals with human-environment interactions and the influence
these interactions have on public health. What distinguishes medical geography from the
discipline of geography as a whole is simply its thematic focus, not its methods or theoretical
grounding. Throughout the semester we will use the concepts and techniques of the discipline of
geography to investigate a variety of health-related topics. This course covers three major
approaches to medical geographic research: ecological approaches, which systematically analyze
relationships between people and their environments; social approaches, including political
economy and socio-behavioral approaches; and spatial approaches, which employ maps and
spatial statistics to identify patterns of single and associated variables. Students are encouraged
to view these three approaches as complimentary. Much research in medical geography
incorporates ecological, social and spatial theories and methodologies. Medical geography is
integrative and multidisciplinary, incorporating contributions from a wide range of
specialties. Specific course objectives include:
1. Facilitate a critical understanding of health, disease, illness, and society;
2. Introduce major contemporary issues in global health;
3. Promote an understanding of how geography as a discipline contributes to understanding
health and health care;
4. Understand the impact of ecological and population change on health;
5. Explain how social and economic context impacts health;
6. Utilize maps to examine the spatial patterns of disease and risk factors that may
contribute to disease
Readings
The course text is “Meade, M.S. and Emch, M.E. 2010. Medical Geography, 3rd ed. New York:
The Guilford Press.”
Grading
The points available for the course are divided among the following activities. All assignments
are due on time, and will be penalized 3% of your grade for each day late.
Midterm 35%
Final 35%
Case Studies 30% (15% per case study)
You will write up two case studies during the term. Directions are on the Blackboard site under
Assignments. Write-ups for these case studies will consist of a 1-2 page paper (plus some other
outputs). We will also have a midterm and final. Attendance to this course is mandatory. You are
expected to take part in the discussions and if you are not in class then you cannot. If there is a
special reason that you need to miss class such as a conference or a religious holiday then let the
instructor know. Email the instructor each time you miss class before you miss class. Also, each
time you miss class you must hand in a one-page typed summary/ critique of the readings for that
day within one week of missing the class. If you don't hand this in then you will be penalized 5%
for each class period that you miss. You need to hand in the one-page summary/ critique even if
you have a good reason for missing class.
Graduate students:
We will meet outside of class to discuss additional activities/readings and you will write a class
paper or another mutually agreed upon deliverable.
Schedule
Week: Dates
Topics and Readings
INTRODUCTION
Introduction to Medical and Health Geography, Concepts of Health and Disease,
Epidemiological Terminology
Week 1:
Aug 21 & 23
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What is medical geography?
How do we define health?
Some epidemiological terminology that will help you throughout the
semester
Readings
Meade & Emch, "Chapter 1: Questions of Medical Geography"
Suggested Resource: CDC's Glossary of Epidemiology Terms:
http://www.cdc.gov/reproductivehealth/epiglossary/glossary.htm
ECOLOGICAL APPROACHES
Disease Ecology
Week 2:

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Aug 28 & 30
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What is disease ecology?
How do we use this theoretical framework to understand the spatial
distribution of disease?
Why/how are specific diseases affected by population, habitat and
behavior to greater or lesser extents?
What is a natural nidus and how does it relate to landscape
epidemiology?
Readings
Meade & Emch, "Chapter 2: The Human Ecology of Disease"
Emerging and Reemerging Diseases: Ecological Change, Evolution of
Pathogens & People
Week 3:
Sep 4 & 6
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What are emerging and reemerging diseases?
What are the drivers that cause diseases to re(emerge)?
How have environmental changes impacted disease distributions?
How has evolution led to the emergence/reemergence of diseases?
Readings
Meade & Emch, "Chapter 4: Landscape Epidemiology"
Demographic and Epidemiological Transitions, Migration, Mobility and
Globalization
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Week 4:
Sep 11 & 13
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How have mortality and fertility levels changed over time? Have these
trends differed in different areas of the world?
How have the major causes of death changed over time? Why have these
changes occurred?
What's the difference between mobility, migration and circulation?
How does mobility contribute to disease transmission?
How has mobility changed over time?
Readings
Meade & Emch, "Chapter 5: Transitions and Development"
Meade & Emch "Chapter 10: Disease Diffusion in Space"
Week 5:
Sep 18 & 20
Food and Nutrition

How has agricultural production changed over time?

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How have changes to agriculture impacted human nutrition and,
ultimately, human health?
What is the nutritional transition? How is it related to changes in
agriculture? How has it influenced the emergence of chronic disease?
Readings
Review Meade & Emch, "Chapter 5: Transitions and Development" section on
"Nutrition in Transition"
Environmental Exposure

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Week 6:
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What do we mean by environmental exposure?
What are the different types of environmental exposures? How are they
connected?
What is an "exposure pathway"?
How might climate change affect the distribution of disease?
Sep 25 & 27
Readings
Meade & Emch, "Chapter 6: Climate and Weather: Influences on Health"
First case study write-up due Thursday of this week in class!
Week 7:
Oct 2 & 4
Catch-up and Review
Midterm Exam Oct 4
Environmental Exposure
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Week 8:
Oct 9 & 11


What do we mean by environmental exposure?
What are the different types of environmental exposures? How are they
connected?
What is an "exposure pathway"?
How might climate change affect the distribution of disease?
Readings
Meade & Emch, "Chapter 7: The Pollution Syndrome"
SPATIAL APPROACHES
Week 9:
Oct 16 (18th is
Fall break)
Spatial Analysis and Health

What spatial techniques, in addition to mapping, are useful for studying
health?
Readings:
Meade & Emch, "Chapter 12: Scale, Spatial Analysis and Geographic
Visualization".
GIS and Public Health
Week 10:
Oct 23 & 25



What goes into the mapping and visualization of health information?
How can I tell a good map from a bad map?
What can I learn from maps?
Readings:
Meade & Emch, "Chapter 3: Maps and Geographic Information Systems in
Medical Geography"
SOCIAL APPROACHES
Week 12 - The Social Context of Disease

Week 11:
Oct 30 & Nov 1

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What health inequalities exist today? How does health vary around the
world?
What are the origins of these inequalities?
How is socioeconomic status related to health outcomes?
What can be done to alleviate these inequalities?
Readings:
Meade & Emch, "Chapter 8: Political Ecology of Noncommunicable Diseases"
The Political Ecology of Health & Healthcare
Week 12:
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Nov 6 & 8
What is political ecology? How is it related to political economy?
How do political interests lead to ecological change?
How do politics influence the spatial distribution of both communicable
and noncommunicable diseases?
Readings:
Meade & Emch, "Chapter 8: Political Ecology of Noncommunicable Diseases"
Poverty, Neighborhoods & Health
Week 13:
Nov 13 & 15
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How do we define poverty?
How does poverty influence health and/or lead to health disparities?
How do we define "neighborhood"?
How do neighborhood environments act to influence health behaviors
and outcomes?
Readings:
Meade & Emch, "Chapter 9: Neighborhoods and Health"
Second case study write-up due Tuesday of this week in class!
Poverty, Neighborhoods & Health
Week 14:
Nov 20
(22th is
Thanksgiving)
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How do we define poverty?
How does poverty influence health and/or lead to health disparities?
How do we define "neighborhood"?
How do neighborhood environments act to influence health behaviors
and outcomes?
Readings:
Meade & Emch, "Chapter 9: Neighborhoods and Health"
Health Services Planning
Week 15:
Nov 27 & 29
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How are health resources distributed? What inequalities exist?
What does "access" mean?
What can be done to promote equitable access to health care?
Why are hospitals located where they are?
Readings:
Meade & Emch, "Chapter 11: Health Care and Promotion"
Take Home Final Exam Essay Questions Handed out today
Week 16:
Catch up and study session for objective part of final exam
Dec 4
Take Home Final Exam Essay Questions Due today
Exam Time:
December 11 noon-3PM (for objective part of exam)
Special Needs: If you feel that you may need an accommodation for a disability or have any
other special need, please discuss this with me. I will best be able to address special
circumstances if I know about them. My office hours and contact information are listed at the
beginning of this syllabus.