Geoscience Reference
In-Depth Information
over the life course. The scale of health and place research tends to be highly
localised around spheres of human activity, often the home.
Places have associated with them material infrastructure (housing, investment,
institutions, connectivity to other places) and collective social functioning and prac-
tices (empowerment, norms, values, social capital and capacity) that affect health
(Macintyre et al., 2002; Bolam et al., 2006). Macintyre (1997) and colleagues
(Macintyre et al., 2002) have theorised three pathways linking place to human
health. First,
compositional
effects relate to health behaviours or outcomes arising
from the aggregate characteristics of people who populate a place, such as age,
income, or social class. Second,
contextual
effects arise from the characteristics of
the places themselves, such as dilapidated housing, crime, or limited access to ser-
vices. Finally,
collective
effects stem from the historical or socio-cultural aspects of
communities including norms and values, such as a lack of economic investment
due to negative perceptions about a place. These pathways can be understood in
terms of fi ve types of features: physical features of the environment shared by all
residents; availability of healthy environments at home, work, school, and play;
availability of services needed to support people in their daily lives; socio-cultural
features of the area; and the area's reputation (Macintyre et al., 2002).
Early work in health and place theorised the differences between compositional
effects and contextual effects (Macintyre et al., 1993), while more recent research
challenges include conceptualising, operationalising and measuring neighbourhood
effects, understood as both contextual and collective effects of and on place (Diez-
Roux, 2000; Macintyre et al., 2002; Oakes 2004). Multi-levelling modelling, which
arose from educational research, has been valuable to geographers in separating out
individual or household effects from neighbourhood effects, with relatively modest
variation in a range of health impacts attributed to neighbourhood-level variables
(Duncan et al., 1993; Pickett and Pearl, 2001).
Environment conditions, often byproducts of industrialisation and capitalism, as
well as those emanating from socio-political processes, are problematised in terms
of how they affect health and well-being. Factors studied are diverse: rat bites in
children (Bunge and Bordessa, 1975); accessibility to supermarkets (Morland et al.,
2002; Smoyer-Tomic et al., 2006); and harmful social environments (Sampson,
2001). The physical features, availability of health-promoting environments, service
provision, socio-cultural features and reputation of a place create a suite of interre-
lated, dynamic processes that infl uence health behaviours and health outcomes
(Macintyre et al., 2002).
Signifi cantly, health and place research tends to frame humans separately from
the environment, with people experiencing adverse health effects caused by their
environments. To more fully engage with the human-environment-health nexus,
health and place researchers can benefi t from EJ, political ecology and vulnerability
approaches that pay more attention to how people constitute their environments.
In this way, geographers can continue to refi ne theoretical understandings of the
duality of human-environment relations, with people as a constitutive part of, rather
than outside of, their environments.
Shared Assumptions and Concerns
Both
health
and
environment
are subject to defi nition from differing perspectives
that vary in emphasis, scope and complexity. Health can be defi ned narrowly in
