Medical Geography And Health Geography

Medical Geography does not have particularly strong links with 'medicine', as normally understood (i.e. the treatment of people who are ill), so many medical geographers now prefer to refer to their subject as the 'Geography of Health and Health Care' and to themselves as 'health geographers'. However, I am not convinced that such formulations represent an improvement. Although correctly recognising that health is more than the absence of illness, most health geographers do not actually examine health in practice - they examine illness and/or disease. They should therefore call themselves 'illness geographers' or possibly 'disease geographers' (or even 'dis-ease geographers'). At a purely semantic level, the change in name to 'health geographer' does not appear to be any more accurate than 'medical geographer'. I suspect that the search for a label to accurately describe what all medical geographers do is probably futile.

As far as I aware, the term 'health geography' originated in a series of articles written by Robin Kearns in the 1990s arguing that 'medical geography should be (re)situated within social geography'. In his initial paper he wrote: 'Rather than advocating a renaming of medical geography, I suggest that two interrelated streams be identified within the medicine/health/geography nexus: medical geography and the geography of health. The concerns of the former are well known and involve spatial and ecological perspectives on disease and health care delivery. The concerns of the latter would consider the dynamic relationship between health and place and the impacts of both health services and the health of population groups on the vitality of places'. (Professional Geographer 45(2), 144-5)

I am personally much more interested in how geographical analysis can provide us with insights about health and ill-health, than in how health issues can inform us about the nature of places. Also, whilst recognising the central importance of social factors as determinants of health (especially in developed countires), I recognise that they are by no means the only factors. For both reasons, I would therefore regard myself as a 'medical geographer' rather than a 'health geographer' (as defined above).

The debate over the name also reflects a debate over deeper issues related to epistemology and methodology. The new 'post-medical' health geography tends to differ from more traditional medical geography by placing the emphasis differently along along a number of axes:

Some health geographers argue that the 'new' health geography is more concerned than more traditional medical geography with the prevention of illness rather than curing people who are already sick. However, in my opinion this argument is fallacious, as medical geographers have always strongly motivated by a preventive ethos, and have always been critical of the orthodoxy imposed by mainstream curative medicine, especially on the epidemiological side of the subject (see below).

Irrespective of whether one prefers to use the term Medical Geography or Health Geography, the discipline has traditionally been divided into two fairly distinct subjects: one examines the geographical factors which contribute to ill-health and disease (geographical epidemiology); whereas the other deals with geographical factors influencing the provision of and access to health services (geography of health care). The two branches of Medical/Health Geography influence one another much less than one might imagine, and most medical/health geographers tend to be very strongly focused in one area or the other, but rarely both. This, I would suggest, is because the major findings in each branch of Medical/Health Geography are largely irrelevant to the major concerns of the other. For example, when examining the factors influencing spatial inequalities in health, inequalities in access to health care are a relatively minor factor - or, to put it more cynically, the evidence suggests that the capacity of the medical profession to bring about improvements in the health of populations is much less marked than most people probably assume. Social inequalities and environmental factors tend to be much more important determinants of inequalities in health than access to health care (and should therefore receive greater attention from policy makers entrusted with the health of the nation). By the same token, spatial inequalities in health (as measured, for example, by differences in life expectancy) are a relatively minor factor when trying to predict which areas will have the greatest need for health services. Population numbers and simple demographic factors, such as the age and sex distribution of the population, are much more important determinants. Geographical epidemiology therefore has relatively few insights to offer those whose main concern is in maximising accessibility to health care. Thus the two branches manage to maintain an almost separate existence. (N.B. These views are my own, and would not necessarily be shared by other medical/health geographers.)

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