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Social Science & Medicine 65 (2007) 169–171

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Concluding commentary

Report from the Eleventh International Symposium in MedicalGeography: A comment from the senior editor

This collection of papers come from the 11thInternational Symposium in Medical Geography, abiennial event convened in 2005 in Fort Worth bythe team of health geographers at University ofNorth Texas. As Guest Editor for this Special Issue,Professor Earickson provides an introduction thatincludes some reflections on how medical/healthgeography has developed over time.

All those working in this field recognise that,while Bob Earickson was Senior Editor for MedicalGeography at Social Science & Medicine, publica-tions in this journal have made major contributionsto the development of this sub-discipline in geo-graphy, and have charted its progress over time. Thevital role of the Medical Geography Office of Social

Science & Medicine under his stewardship cannot beover-estimated in this respect. The 11th Interna-tional Symposium in Medical Geography was afitting occasion for health geographers from aroundthe world to thank him for all his excellent work forthe journal and for geography.

Bob Earickson’s editorial overview also high-lights the diversity of conceptual and methodologi-cal approaches now current in health geography.We might also note, how the application of thesevarious approaches advances knowledge and theoryabout space and place in relation to health, whichforms the core of geographical research in this field.For example, the papers here contribute to ourunderstanding of conceptual spatialisation, throughwhich ideas about health and illness are constructedand differentiated, in varying ways, by differentsocial and demographic groups. We also see theexemplified potential of spatial analysis as a tool tohelp us understand the geographical clustering ofhealth outcomes. The collection also includesillustrations of studies of particular places and

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individuals, which reveal the socio-cultural pro-cesses by which places constitute social relations

influencing health and access to health care andprovide symbolic representations of therapeutic en-

vironments devoted to improving health. Thefollowing paragraphs elaborate briefly on thesepoints.

Some of the papers here use theoretical andempirical models to describe and explain the‘conceptual spatialisation’ through which ideas of‘health’ are constructed. Using a principal compo-nents analysis of survey data collected in the Swisspopulation, Charis Keller-Lengen, Jorg Blasius andThomas Kistemann have applied an approachsimilar to Bourdieu’s theoretical and empiricalinterpretation of ‘social space’ to an analysis of‘health space’ (Keller-Lengen, Blasius, & Kiste-mann, 2007). The results draw our attention, forexample, to debates about the importance for socialconstruction of health of distinctions made betweenphysical and mental illness. Other health geogra-phers have also drawn on these ideas about‘spatialisation’ to study lay constructions of health(e.g. Gatrell, Popay, & Thomas (2004) who alsodraw on Bourdieu’s theories) and medical profes-sional constructions (e.g. Philo (2000), referring toFoucauldian interpretations of medical knowledge).A ‘position paper’ in the Special Issue by GavinAndrews, Malcolm Cutchin, Kevin McCracken,David Phillips and Janine Wiles focuses attentionon the conceptual construction among academicresearchers (as well as wider society) of the health ofolder populations (Andrews, Cutchin, McCracken,Phillips, & Wiles, 2007). Socio-geographical differ-ences in health among people in this growingdemographic group, spanning cohorts of people intheir 60s as well as significant numbers aged over 80,

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are not always well captured by clinical diagnosticcategories, or conventional mortality and morbidityindicators. These authors call for a perspective morestrongly influenced by geographical understandingsof the ways that places and spaces ‘constitute’differences in health in old age and contribute to thesocial relations that govern the social and medicalstatus of older populations. In passing, we mightnote as well how the varying construction of healthand illness in different lay and professional dis-courses reflects the differences in relative social andgeographical positioning of the groups involved.

Several of the papers in this Special Issueillustrate increasingly critical and analytical ap-proaches to the identification of attributes of thesocial and physical environment that impinge onhealth. The complex spatial configurations of theseattributes is used to help distinguish their possibleeffects on health. For example, the paper publishedhere by Robert Pampalon, Denis Hamel, Maria deKoninck and Marie-Jeanne Disant explores theconstruction of health related features of placesamong populations in three areas in Quebec,Canada (Pampalon, Hamel, de Koninck, & Distant,2007). Their study, using multi-level analyses ofperception of neighbourhood characteristics, showsthat social construction of area attributes varies byarea as well as among individuals. This suggests thatthere are shared, collective understandings of localarea attributes which can be considered as ‘con-textual’ characteristics of places, and that these areassociated with health experience. Their paper alsocontributes, from a geographical perspective, to agrowing multi-disciplinary literature that distin-guishes material deprivation and dimensions of‘social cohesion’ or ‘social capital’ as somewhatindependent groups of factors that are importantfor socio-geographical health variation.

In further examples of spatial modelling of healthoutcomes, Graham Moon, Gemma Holt, SteveBarnard, Liz Twigg and Bill Blyth have appliedmulti-level synthetic estimation to uncover a com-plex set of population factors associated with the‘obesity epidemic’ in the UK (Moon, Holt, Bernard,Twigg, & Blyth, 2007). These different populationfactors each have distinct geographies, contributingvariably to local concentrations of obesity indifferent parts of the country. The papers byAniruddha Bannerjee and by Clive Sabel, JeffGaines Wilson, Simon Kingham, Catherine Tischand Mike Epton provide illustrations of the use ofadvanced spatial modelling strategies, approaching

ecological analysis of health variation in space inways which are not constrained by administrativegeographical boundaries (Banerjee, 2007; Sabel,Wilson, Kingham, Tisch, & Epton, 2007). Thesestrategies examine the different spatial patterning ofhealth outcomes that become apparent through theuse of varying analytical models of the likelyunderlying causes of health variation over spaceand time. For example, controlling for some of the‘well-established’ risk factors in these models allowsresearchers to visualise spatial patterns suggestingother, less obvious, and less researched aspects ofhealth variation. Matthew Cox, Paul Boyle, PeterDavey and Andrew Morris have also used geogra-phical strategies to explore the relevance of thesocial selection hypothesis regarding health inequal-ity (Cox, Boyle, Davey, & Morris, 2007). Theirresearch analysed how far regional populationmovement operates selectively according to healthstatus to influence the prevalence of Type-2 diabetesin Scotland. Studies like these illustrate the evolvingcharacter of the classic ecological strategy ingeography of health, which identifies interestingpatterns at the population level, and formulateshypotheses about the pathways that may causethese. Robert Earickson’s introduction to thiscollection rightly identifies that these studies illus-trate the increasing sophistication of geo-infor-matics, geographical information systems andspatial statistics, leading towards fascinating futurescenarios for ecological research in health geogra-phy and epidemiology.

We also see illustrated in this Special Issue astrong theme in geography of health concerning theways that places help to constitute power relationsthat are important for health and health care, oftenwith a strong emphasis on the significance ofFoucault (1973, 1979) ideas of surveillance andsocial control. Elaine Jennifer Hanford, F. Benja-min Zhan, Yongmei Lu, and Alberto Giordano’sreview of the situation relating to Chagas disease inTexas includes, for example, discussion of howgovernmental and political processes play a role incross-border health issues (Zhan, Hanford, Lu, &Giordano, 2007). This raises interesting questionson how certain infectious diseases are identified forroutine surveillance and control measures and howthese should be implemented among internationallymobile populations. Sarah Lovell, Robin Kearnsand Wardlow Friesen report on intensive qualitativeresearch that shows how social and cultural barriersin specific settings influence the use of preventive

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services for socially marginalised individuals(Lovell, Kearns, & Friesen, 2007).

Several authors at this Symposium also employedideas about the therapeutic symbolism of specificplaces that is stressed in the literature on therapeuticlandscapes (Gesler, 1992). Robin Kearns’ interpre-tation of a new medical school building in terms ofits salutogenic features applies these ideas of placeand health to a single location (Kearns, 2007).Anne-Cecile Hoyez’s paper on the production andreproduction of therapeutic landscapes symbolisinghealth-giving attributes of yoga also shows us howglobal networks of places can be interpreted usingsimilar geographical ideas about well-being, placeand health (Hoyez, 2007).

Thus the papers in this Special Issue illustratemany aspects of the debates in health/medicalgeography concerning space, place and healthvariation. As Bob Earickson comments in hiseditorial, these have advanced enormously overthe last 2 decades and this journal continues to aimto represent the theoretical and empirical researchthat is leading these debates and to situate them inthe context of multi-disciplinary social sciences ofmedicine and health.

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Sarah CurtisDurham University, South Road,

Durham DH1 3LE, UK

E-mail address: geog-ssmeditor@qmul.ac.uk