Health Explaining Geographies g p
GEOG 303 Health Geography - Prof. N. Ross
Readings for Today
Gatrell Chapter 2
GEOG 303 Health Geography - Prof. N. Ross
Objectives for Today
The wide variety of research that falls under the umbrella of health geography has differing underlying p g y g philosophical p approaches
GEOG 303 Health Geography - Prof. N. Ross
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Positivist Explanation
Searching for regularities, patterns, laws and generalizations q Often quantitative Seeking causes of disease patterns but cause is often elusive Example Gatrell raises is the study linking poverty to asthma hospitalizations in children in NYC
GEOG 303 Health Geography - Prof. N. Ross
More on Positivism
The idea that all true knowledge is scientific knowledge Often linked to empiricism what we know is derived from experience or observation Typically linked to reductionism e.g., societies are reducible to actions of individuals ignores the `emergent properties' of social groups or places
GEOG 303 Health Geography - Prof. N. Ross
Key criticism: reductionist No concern for individual interpretation Usually applies statistics and as large a sample as possible
GEOG 303 Health Geography - Prof. N. Ross
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Classic model of scientific investigation: considering a set of competing hypotheses ( yp (hunches) ) Explanation of pattern Location but not place emphasized
GEOG 303 Health Geography - Prof. N. Ross
Social Interactionist Approaches
In health geography, typically about understanding "lay" interpretations of health, health care Meanings, perceptions are formed from dayto-day social interactions, lived experience Goal: empathetic understanding/explanation rooted in the social world
GEOG 303 Health Geography - Prof. N. Ross
Example The Role of Social Exclusion in Smoking Behaviour in Glasgow
Researchers often frustrated by quantitative research which could not explain the p p patterns Researchers wanted a greater understanding of the "processes involved in shaping health-related behaviours and outcomes."
GEOG 303 Health Geography - Prof. N. Ross
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Social Interactionist Approaches
Usually small numbers of people Qualitative, interpretive Goal is not generalization but rather understanding Intensive research design
GEOG 303 Health Geography - Prof. N. Ross
Example
Interviewing residents about experiences living near different types of waste facilities in Ontario 39 depth interviews What might a positivist say about approach?
GEOG the 303 Health Geography - Prof. N. Ross
Structuralist Explanation
Large scale power relations/dominance lock groups into situations A given population's health is influenced by p political and economic systems rather than y individual behaviour Emphasis in these types of studies is on macro-scale social, political and economic "structures" Paul Farmer's work would fit into this broad category of explanation
GEOG 303 Health Geography - Prof. N. Ross
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Diabetes in the Marshall Islands
Yamada and Palafox (2001), Gittelsohn et al., (2003)
30 low lying coral atolls southwest of Hawaii in the Pacific Ocean p Population: 54,000 Site of US military operations since WW2 including atomic bomb tests culture of dependence with the US US has exclusive military rights and Marshallese may live and travel in US
GEOG 303 Health Geography - Prof. N. Ross
"Fat dumping" heavy marketing of unwanted high fat foods to disadvantaged populations (corned beef, turkey t il ) b f t k tails) Vegetables cost the same as meat Larger body shape viewed as attractive Shared plate eating common hard to monitor consumption
GEOG 303 Health Geography - Prof. N. Ross
Yamada and Palafox (2001) argue that a biopsychosocial model fails to account for the ecology, history and p gy, y political economy Consequences at the level of individual biology including weight gain, altered metabolism, and diabetes Film: Marshall Islands
GEOG 303 Health Geography - Prof. N. Ross
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A Second Example
Diabetes in Native American populations in Arizona Film: Bad Sugar: Diabetes in two Native American communities segment from "Unnatural Causes.....is Inequality Making us Sick?"
GEOG 303 Health Geography - Prof. N. Ross
A Middle Ground Structuration Theory
Duality of structure and agency Structures constrain and enable individuals Individual behaviours construct and reconstruct structure
GEOG 303 Health Geography - Prof. N. Ross
Summary
Why are some people healthy and others not? Question could be answered from multiple perspectives Gatrell warns not to put too much emphasis on the rigidity of the categories
GEOG 303 Health Geography - Prof. N. Ross
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For Next Class
Read: Rootman and Raeburn (1994); Meade and Erickson (2000); Smith (1981) For Smith think about the following questions:
What is the author's main point? How does she make that point? Are you convinced?
GEOG 303 Health Geography - Prof. N. Ross
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