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Health geography Flashcards

1
Q

What is health according to the WHO?

A

State of complete wellbeing and not the absence of disease (WHO 1946)

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2
Q

What is the main difference between health and medical geography? What is a good source for this?

A
  • Medical is older, more epidemiological and quantitative
  • Health evolved out of medical geography, and is more qualitative

Good source Rosenberg 1998

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3
Q

What is a seminal paper linking socioeconomic and biological determinants of health?

A

Mosley and Chen 1984

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4
Q

What are the 3 original and 2 additional/hypothesised statges of the epidemiological transition model (Omran 1971)

A

1) Famine
2) Pandemics - shifts in age structure
3) “Degenerative [non-communicable] diseases” - CANCER

Additional:

4) Degenerative diseases - DIMENTIA (Olshanky + Ault 1996)
5) Re-emerging infectious diseases (Olshanky et al 1998) - people become less exposed in wealthy countries

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5
Q

Are income and health correlated?

A

Not necessarily - people can inherit wealth and have low incomes; equally people can have a high income having not previously accumulated much wealth

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6
Q

Is income and wealth information readily avaliable?

A
  • No, it is often viewed as too personal

- Proxy for income and wealth often obtained from census data and death certificates

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7
Q

What does the Preston (1975) curve show?

A

Relationship between country wealth and quality of healthcare

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8
Q

What is the shape of the Preston curve?

A
  • As wealth of country increases, healthcare quality increases
  • Increase is rapid initially, before levelling off for wealthiest countries - you can only be so healthy

(Preston 1975)
- Wealth itself not important; rather time and tech

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9
Q

What is a good paper on “high and low achievers”?

A

Cadwell 1986

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10
Q

What are “high and low health achievers”?

A

The countries that exceed or do not meet expected health based on what the wealth of the country would predict using the Preston curve

(Cadwell 1986)

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11
Q

What have “high and low health achievers” studies shown?

A
  • Free healthcare better

- More equal societies exceed wealth predictors and “pull above their weight”

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12
Q

Which scatter plot by Wilkinson and Pickett is the most famous?

A

Index for health and social problems vs income inequality (top/bottom 20% earners) for different countries and US states

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13
Q

What are the two explanations for poorer health in more unequal countries?

A

1) Contextual - inequality leads to both rich and poor to have poorer health (neo-material effects and psychosocial pathways)
2) Compositional - inequality means that more people are poor and less and rich, so could skew average into worse health. Called the concavity effect

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14
Q

Why do neo-material effects influence health?

A
  • Neo-material effects include spending on health services, systems and resources
  • Based on political economy
  • More equality with more neo-material benefits
  • Good links to Dentistry and embedded inequalities
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15
Q

Give an example of the impact of neo-material inequality on health?

A

Marmot report (2020): health spending lowest in poorest areas of UK - exacerbating inequalities

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16
Q

Why is the “Whitehall study” (Van Rossum et al 2000) significant?

A
  • Showed that psychosocial effects of inequality
  • Lower social status = increased likelihood of mortality
  • Not same as Wilkinson and Pickett thesis (both ends / all of social ladder affected)
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17
Q

What is an important aspect of inequalities many studies (and the lecture series) overlook?

A
  • The exacerbated inter-generational effect of inequality over time…
  • Means that people get trapped in poor health
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18
Q

Why is the incorrect use of causal mechanisms of little concern regarding the Wilkinson and Pickett argument?

A

It is designed for the Lay public

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19
Q

Why is the focus on rich countries important for the Wilkinson and Pickett thesis?

A

Social class distributions are more uneven and mixed - social status mixing more common (Ballas et al 2007)

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20
Q

How is place important for health?

A
  • Very important
  • Both contextually and compositionally

(Smith and Easterlow 2005)

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21
Q

What is a good paper on compositional vs contextual health?

A

Smith and Easterlow 2005

22
Q

Why does Smith and Easterlow (2005) offer a solution to the compositional/contextual health debate?

A
  • Studies where people come from and whether people move to poorer places etc
  • Does ignore inter-generational factors
  • Two forms of compositional health: “selective placement” and “selective entrapment”
  • Actually could be a mixture of compositional and contextual factors at play

(Smith and Easterlow 2005)

23
Q

Why is Smith and Easterlow (2005) important for policy?

A
  • Compositional effects can be important in places (and still the consequence of inequality)
  • The focus on contextual health influences has resulted in policies targeting preventions and cures to health inequalities, not helping those who are, and have been for some time, ill
  • Health and disability are solved in different ways. Prevention cannot help people already with disabilities etc. Needs more recognition and less bias against those with poor health

Smith and Easterlow (2005)

24
Q

What is a good paper on green space as an important contextual factor affecting wellbeing?

A

Feng and Astell-Burt 2017

25
Q

What paper advocates for more eclecticism between health and medical geography?

A

Rosenberg 1988

26
Q

What is a good paper for contextual factors (spending, access to green spaces and education) on behavioural health influences?

A

Pampel et al 2010

27
Q

What is an ecological fallacy?

A

When information based on an entire population is extrapolated down to the level of the individual

(Covered in Gravelle 1998)

28
Q

What are the two possible explanations (hypotheses) for inequality correlating with poorer health?

A

1) Absolute income hypothesis
2) Relative income hypothesis (Wilkinson and Pickett thesis)

(Covered in Gravelle 1998)

29
Q

What are some tenuous aspects of Gravelle 1998?

A
  • Does not disprove that individuals are affected by relative income inequality
  • Focuses on mortality, not psychosocial effects
  • Higher alchohol consumption by rich could be the case, but can easily source solutions
30
Q

What could inter-generational inequality be called?

A

A genealogy of inequality

31
Q

What is the difference between longitudinal and cross-sectional studies?

A
  • Longitudinal over several years

- Cross-sectional at one point in time, but a representative sample from/of a population

32
Q

Why is the longitudinal analysis by Christian et al 2017 important?

A
  • Christian et al attempting to ascertain the role of environmental (contextual factors) on walking exercise
  • Longitudinal (8yrs) allows for people to be studied when living in different places with different neighbourhood environments
  • Findings disprove the compositional health effect in this scenario

Christian et al 2017

33
Q

What is an issue with the longitudinal analysis conducted by Christian et al 2017?

A

Slightly unrepresentative - focussing on middle-class families and neighbourhoods in Australia… what about other social status groups? What about poorer countries?

Christian et al 2017

34
Q

Why is the relative income hypothesis (Gravelle 1998) important to consider?

A
  • If inequality affects just the poor (either as a result of being less wealthy or due to stigma etc), then the rich would not necessarily have an incentive to give to them
  • BUT if it also affects the rich, then there is an incentive

(Dorling and Barford 2009)

35
Q

What are Jan et al (2008) findings and what is Dorling and Barford’s (2009) criticism?

A
  • Jan et al 2008: inequality only impacts on the poor, not the rich (hence rich don’t need to care)
  • Dorling and Barford (2009) point out that self-rated health (metric used by Jan) does not correspond with objective health
  • Disparity between self-rated and objective interesting in itself
36
Q

What is a really good quote from Dorling and Barford (2009)?

A

“In the United States the best you can do if you are poor and ill, is often to try to tell yourself that you are neither really ill, nor that poor, and that things will get better soon. It is either that, or accept the truth, and the truth is far more frequent premature death than in any other rich nation.” - damning!! Very good links to the “land of the free” public discourse narrative

Dorling and Barford 2009

37
Q

What were the two key findings from Preston 1975?

A

1) Wealthier countries are healthier (longer life expectancy) than poorer countries (although less difference in health for richest countries, linear up to then), as shown in the Preston curve
2) life expectancy is improving over time for all countries: it is more equitable.

(Preston 1975)

38
Q

Does increased wealth ITSELF CAUSE improvements in overall health of populations?

A
  • Could be with trickle-down effect
    BUT
  • Health improvements causing increase in income?
  • Could be covariance over time with technological/infrastructural improvements
  • There is a lag with tech improvements; wealthy always benefit first

Bloom and Canning 2007

Wealth also does not cause happiness increase so much as equality (Ballas, et al., 2007)

39
Q

By how many years does USA punch below its GDP weight?

A

2.87 years BELOW its weight

Freeman et al 2020

40
Q

What are some reasons for countries punching below their weight?

A
  • Universal healthcare very important regardless of wealth
  • Less political participation problematic, as in the US where there are few unionised workers
  • Consumer habits
  • International issues (TNCs and climate change etc)
  • Affects all people across the entire income distribution

Freeman et al 2020

41
Q

How bad are north-south UK inequalities of health?

A

People in south live 2 years longer than those in the south

Bambra 2019

42
Q

How bad are health inequalities in Stockton-upon-Tees?

A
  • Among the worst in the world
  • Men living in neighbourhoods 2 miles appart have a 15 year difference in life expectancy

(Bambra 2019)

43
Q

What are the 3 determinants of poor health in places according to Bambra 2019?

A

1) Compositional (“who lives there”)
2) Contextual (“what the place is like”)
3) Political economic factors (shops, jobs, green space etc) - AKA “Neo-material” factors

All 3 are not mutually exclusive

Bambra 2019

44
Q

How has austerity affected health?

A

Austerity has disproportionately affected existing poorer areas, especially those in the north

45
Q

What did the Marmot report review (2020) reveal?

A
  • Health stopped improving in the UK for the first time since about 1900 (for 2010-2019)
  • Slowdown not due to cold winters - majority during mild winters post-2011
  • Other countries have seen life expectancy increase, so not pinnacle of human biology either
  • No health strategy post-2010. Ironic considering covid 19!! - structural unpreparedness

Marmot et al 2020

46
Q

Why is the stagnation in health improvement of concern?

A
  • Significant because the health of individuals in a society is a proxy indicative of the health of society at large… concerning

(Marmot et al 2020)

47
Q

What is the principle of Popperian theory?

A

Popperian theory is about showing that unexpected results could still be explained based on the original theory

(adopted by Wilkinson and Pickett 2015)

48
Q

What is a good paper for an attempt to prove causality for the relative income hypothesis?

A

Wilkinson and Pickett 2015

49
Q

Who has advocated for reduced social class mixing as a solution to psychosocial effects of income inequality?

A

Odgers (2015 and 2018)

50
Q

Are there alternatives to Odgers’ proposals for reduced social class mixing as a solution to psychosocial effects of income inequality?

A

Yes… (Odgers’ work is based on violence in mixed communities…)

  • Reduce inequality at the source instead of trying to cover it up
  • Provide support for inconspicuous consumption
  • School uniforms useful in this respect
  • Mixing is helpful for reducing stigmatization; education is also important for everyone
51
Q

Why is inequality important in geography?

A

“Economic distance” between different groups at opposite ends of inequality spectrum (Odgers 2015)

Human (6 decks)

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