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political ecology on water, energy, food and waste explodes traditional understand-
ings of city and country as discrete places. Water, for instance, both incubates
disease and disease transmitting insects and cleanses wounds that might otherwise
lead to ill-health and even death. Too much water in the wrong places and times
erodes vulnerable soil, compromising food security, but without water, food pro-
duction is impossible. Vital to human survival, water fl ows are increasingly con-
strained by human technologies, and yet still escape human control in both
predictable and unpredictable ways.
Yet, even while geographers working in urban political ecology consider the
sustainability of urban ecological systems, there is little attention to the human
health implications of unsustainability. For instance, in an otherwise sophisticated
and insightful analysis of New York City's 'metropolitan natures' - ideologies and
incumbent transformations of nature within and beyond the city to effect the city -
Gandy (2003) pays relatively little attention to the (human) body. As Braun notes,
Gandy is thus
continuing a tradition in geography to imagine nature to be 'outside' the body. Yet, if
bodies are truly 'composites' and urban natures - water, air, food - crucial to their
capacity for life, this is an odd elision. It points also to the vast gulf that remains
between the new urban environmental geography and medical [i.e., health] geography,
despite common knowledge of the historical links between public health, the state and
urban form. (Braun, 2005, p. 647, brackets added).
Despite the general absence of human health in urban political ecology research,
pioneering health geographers have begun to address health outcomes in wider
political ecological contexts. This approach derives directly from a long tradition
of disease ecology within health geography, which examines 'the ways human
behavior, in its cultural and socioeconomic context, interacts with environmental
conditions to produce or prevent disease' (Meadeet al., 1988, p. 29). In this view,
the intersection of habitat (physical and built), population, and behaviour is seen
to underlie human health. The task for disease ecologists, then, is to understand
how social, cultural, political and behavioural factors, on the one hand, and envi-
ronmental characteristics, on the other, shape human exposure to disease vectors
(May, 1954). The main limitation of this approach is its tendency to focus on a
local scale, with limited attention to structural forces operating at regional, national
and global scales to generate those mediating social, cultural and political factors
in the fi rst place. Mayer (1996; 2000) expanded the concept of disease ecology and
reframed it as the
political ecology of disease
that takes into account the political
economy as well as the cultural ecology within which humans interact with the
environment. Mayer (1996) argued that political ecological analyses of disease
situate disease in its local socio-economic and biophysical context to processes and
circumstances stretching across broader geographic scales. In ecological terms, the
political ecology of disease perspective views population, society and environment
in dynamic equilibrium, which can be thrown off balance by events and actions
occurring at diverse scales.
The political ecology of disease perspective has been used to link health outcomes
with social, political and environmental factors at multiple scales, in both developed
and developing world contexts. Salehi and Ali (2006), for example, use a political
ecology framework to examine in detail the human-environment interactions that
enabled the transmission of SARS in Toronto. Linking interactions within the city to
