Geography Reference
In-Depth Information
31
Socio-spatial variations in health
Matthew Smallman-Raynor
and
David Phillips
districts and sub-districts of a single city. Seminal
studies by G.Melvyn Howe (1986) on the global
and world regional incidence of cancers, Gerald F.
Pyle (1971) on national and local patterns of heart
disease and stroke in the United States, and John
A.Giggs (1973; 1988; 1990) on schizophrenia,
affective psychoses and substance abuse in the city
districts of Nottingham, England, are illustrative
of the breadth and geographical range of the
problem.
Today, efforts to improve health status and to
erase (or at least to substantially reduce)
variations in the well-being of people and places
lie at the heart of much global health policy.
Spurred by the WHO's
Global Strategy for Health
for All by the Year 2000,
national governments and
international agencies have launched a plethora
of research initiatives to identify and monitor
health inequalities (WHO 1994). The socio-
spatial dimensions of the research issue have
secured an important and growing role for
medical and health geographers. In particular,
geographers have brought an increasing
methodological sophistication in spatial analysis
and statistical modelling (Cliff and Haggett 1988;
Cliff,
et al
. 1998; Thomas 1992), geographical
information systems (Openshaw 1990; de Leper
et al
. 1995; Bailey and Gatrel 1995; Gatrell and
Bailey 1996) and, most recently, qualitative
techniques (Litva and Eyles 1995; Eyles 1997) to
bear on the problem. At the same time, a
traditional concern of medical geography with
the spatial and environmental parameters of
infectious and parasitic diseases (classic diseases
such as cholera, malaria, measles and tuberculosis,
INTRODUCTION
The term 'health' (stemming from the Old
English word
hael,
or 'whole') means different
things to different people (Kiple 1993: pp. 45-
110). In modern Western medicine, for example,
a 'healthy' person or place is often judged
according to the absence (or otherwise) of a
medically defined disease or disorder. The charter
of the World Health Organization (WHO)
favours a broader definition of health as a 'state
of complete physical, mental and social well-
being and not merely the absence of disease or
infirmity' (WHO: 1988: p. 1). At a more abstract
level, health can be defined according to the
unidirectional nature of time; as Hudson (1993)
notes, unless other factors intervene, our genetic
programmes are inexorably geared towards
disease and death. Other medical systems have
placed yet further interpretations on health. In
ancient Greek medicine, for example, health was
viewed in terms of a balance in the bodily
humours (blood, phlegm, and yellow and black
bile), while notions of balance and harmony also
underpinned conceptions of health in ancient
Chinese and other Asian medical systems
(Shigehisa 1993).
There are numerous and varied examples of the
ways in which health—however defined—can
vary between individuals, groups of people and,
equally importantly, between places (Vågerö 1991;
1995; Vågerö and Illsley 1993; West 1991;
Wilkinson 1987). Moreover, health variations are
apparent at every geographical scale, from the
continents and macro-regions of the planet to the
