Place and health

Dahn Jeong11 February, 2013

EPI6181University of Ottawa

So what about place and health?•Historically…•In the “modern” epidemiology and public health…•Different perspectives on health and place

Illustration by Jason Blower, from Alberta Venture

Conventional vs. Relational views of place

Conventional viewGeographical boundaries

and specific scale

Separated by physical distance

Resident local communities

Static and fixed area definitions

Relational viewNodes in networks,

multi-scale

Separated by socio-relational distance

Individuals are mobile daily and over their life

course

Dynamic and fluid area definitions

Adapted from Cummins S, Curtis S, Diez-Roux AV, Macintyre S. Understanding and representing 'place' in health research: a relational appraoch. Soc Sci Med 2007; 65: 1825-1838.

Defining place• Murdoch (1998):

• Spaces of prescription• Spaces of negotiation

• Context and composition• Interdependent• Mutual reinforcement• Reciprocal relationship between people

and place

©Jasper James, 2012

• Research• Cummins, Curtis, Diez-Roux, Macintyre

(2007):

• Relationship between specific features of places and health outcomes

• Ex: place effects on health of immigrants

• Multi-level models to assess different levels of risk factors in different settings

• Ex: Shouls, Congdon, and Curtis (1996)

Empirical research distinguishing

between context and composition

Processes and interactions

between people and places over time

Applications

Place in time and space• ‘Place’ varies in time and space• ‘Time-Space biographies’

• Movement and exposure: vary individually

• Then, current measures of ‘neighbourhood’ exposures: an underestimation of the effect? Varying contribution of different ‘contexts’ over time and space Life-course factors• Individual life-course• Life-course of the ‘places’: changing

composition of area

• The role of research

Public health programs and policies

• Better identify areas in need of resources to improve the Quality of life

• Health policy implementation and resource distribution

• Reducing health inequities

• Strengthening neighbourhood

In Canada• Large land mass and low

population density• Uneven distribution of population• Unequal distribution of health care

resources• Difficulties accessing some health

services

Rural health in Canada• Rural Canada

• Approximately 95% of Canada’s land mass

• Almost 30% of the Canadian population

• Unique characteristics and values• …

• Indian reserves, Inuit and Métis communities form a significant proportion of Canada’s remote area

Rural health: disparities• Rural Canadians in comparison to urban

Canadians• Poorer health

• Less healthy behaviours• Shorter life expectancies

• Higher mortality rates

• Determinant of health illustrating the disparity• Socio-economic status

• Limited access to health care services• Distance to health care providers and facilities

• Discrepancy between the proportion of rural residents and availability of health care services

Rural health: possible solutions

• Re-defining rural Canada• Developing a common definition of what

constitutes “rural”• A common definition would…• New model centered around the sustainability

• Community-based solutions• Approaches that involve strengthening the

local forces• Community development

• Rural incentive plans• Recruitment and retention

• Telehealth

In conclusion…

References• Cummins S, Curtis S, Diez-Roux AV, Macintyre S. Understanding

and representing 'place' in health research: a relational approach. Soc Sci Med 2007; 65: 1825-1838.

• Dunn JR, Schaub P, Ross NA. Unpacking Income Inequality and Population Health: The Peculiar Absence of Geography. Can J of Public Health 2007; 98, S1: S10-S17.

• Herbert R. Canada's Health Care Challenge: Recognizing and Addressing the Health Needs of Rural Canadians. Lethbridge Undergraduate Research Journal 2007; 2(1).

• Lagacé C, Desmeules M, Pong RW, Heng D. Non-communicable Disease and Injury related Mortality in Rural and Urban Places of Residence. Can J of Public Health 2007; 98, S1: S62-S69.

• Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health 2007; 61: 853-861.

• Patychuk DL. Bridging place-based research and action for health. Can J Public Health 2007; 98 (July-August issue, Suppl 1), S70-S73.

• Schuurman N, Bell N, Dunn JR, Oliver L. Deprivation indices, population health and geography: an evaluation of the spatial effectiveness of indices at multiple scales. Journal of Urban Health: Bulletin of the NY Academy of Medicine 2007; 84(4): 591-603.