Geography Reference
In-Depth Information
outcomes. So a continuing challenge for a research field such as epidemiology is to
get to the root causes of ill-health and premature mortality in various locations and
to provide new preventative health policies that relate to all the health determinants.
Unfortunately, as the authors of a text on Unhealthy Cities have argued, the twen-
tieth century approach to public health has until recently ignored or at least under-
estimated many of the spatial variations in these determinants;
…In part because public health has been burdened with a tradition that overemphasizes
individual-risk factors, the consequences of social and environmental conditions for health
promotion and illness have been overlooked. (Fitzpatrick and La Gory 2011, p. 155)
So even though the twentieth century focus on the biomedical model has ensured
major advances in the level of health and continues to do so, hopefully by solving
the problem of ABR and the new diseases, there is also a pressing need to reduce the
negative place-based factors that contribute to ill-health by investigating the impact
of other health determinants.
13.5.1
Human Biology, Medical Knowledge and Medical Care
These are the first three health determinants shown in Fig. 13.1 . The most funda-
mental influence on the health of persons or populations stem from their biological
constitution , their ability to ward-off and recover from disease and disabilities. In
this context features such as age, gender, life-history and the genetic make-up of
people are all important. Age is really a matter of being more prone to certain prob-
lems as the body ages and experiences what amounts to wear and tear, or in the early
years when a baby may not have developed the strength or immunities to fight off
the dangers in the local environment. Gender is also important, as males or females
may be more liable to suffer more from one type of disease or disability than others.
The latter certainly live longer on average than the former, although some of the dif-
ferences are due to greater risk-taking in males and their more unhealthy life-style
choices. Some families may have flaws in their genetic make-up that make them
more prone to certain diseases. In addition, some groups have a greater ability than
others to resist certain diseases, not because of inherent racial features, but through
centuries of developed immunity to problems caused by some pathogens. Others do
not have these resistances. The tragic result of these differences not being understood
was seen in the European Age of Exploration when the indigenous peoples of the
Americas died in their tens of millions from diseases introduced by Europeans.
Table 13.1 separates medical knowledge from health care since high levels of
knowledge does not mean there is 'cure and care' for all individuals in an area,
especially while there are many different forms of care and differential access to it.
Continued research and effective and equitable application in all of these determi-
nants are obviously needed, especially given the need to counteract the severe chal-
lenges identified above that come from emerging medical problems. Nevertheless,
there are still many spatial inequalities in the provision, availability and effective-
ness of medical care, not simply within and between cities, but in urban centres in
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