tempt confusion for the reader when changes in deathrates are discussed within the context of the (as yet

unrevealed) ‘‘model’’. Part of this confusion stems fromthe mixing of relative and absolute terms such as‘‘relative rates of deaths’’ and ‘‘constituencies in which

death rates have risen’’ when the whole analysis iscentered on relativity, against an overall background offalling mortality.

Refreshingly, results are presented in the form of

circular cartograms of electoral constituencies of Brit-ain. This is a pleasing style of presentation which seeksto overcome the visual distortion that geographical

variation in the physical size of constituencies introduceswhen information is displayed as a map. However, eventhese maps can be difficult to interpret, especially when

presented side by side. A particular example concerns acartogram for young women, which appeared to show aconsistent over-estimation in the fall in death rates for

almost all constituencies of Scotland. Yet this perceptiondoes not correspond with the text which states that themodel performed best for young women. The mapsfurther hint that while their overall model explained a

large proportion of the change in mortality the residualpattern still reflects the overall original geographicalpattern of death, but this is simply brushed aside as

being due to ‘‘area effects’’.The methodological foundations of Inequalities in Life

and Death lie within Chapter 6. It is here that we find

that the preceeding chapters have been built upon shakyground. Essentially the authors imputed the numberof people falling into each possible combination ofindividual characteristics of sex, age, class, and employ-

ment status, for each constituency of Britain. Thisinformation is not available from the census. Theauthors therefore employed data from the Longitudinal

Survey (LS) using iterative proportional fitting. The LSalso provided death rates. The LS is a 1% sample of thepopulation of England and Wales taken from the census

and linked to death records. As such, the informationimputed for Scotland is probably less secure than thatfor England. The authors acknowledge that the manner

in which they manipulated these data could introduce

many possible sources of error, but stress that theyemployed several means of detecting and correcting for

this. However, while I feel that the methods they used todetect systematic errors are necessary, they are notsufficient to be certain that errors are random or

minimal, because there are so many unknowns.It is within an understanding of the limitation of the

authors’ methodology that we see that the predictionsthey present are no more than simple actuarial adjust-

ments. These assume that a simple transfer of indivi-duals from lower socioeconomic classifications to higherones will result in their attainment of the life expectation

of the higher group. This assumption would appear tobreak down when we contemplate what the effectmight be if everyone were transferred to Social Class I,

or to Social Class V (reductio ad absurdum). Unfortu-nately, our understanding of health creation or reduc-tion at a local level is insufficient to have confidence in

what the authors predict.Despite reservations about the methodology, given

the audience it is aimed at, Inequalities in Life and Deathis an important report, which contains plenty of ideas

that deserve further investigation. It illustrates thatsocial class is still a strong determinant of mortality, andthat the role of unemployment in explaining variations

in mortality has increased. It further highlights thatmacro social policies are more likely to produce greaterimprovements in the health of the population than local

based initiatives. Ultimately, and to its credit, the reportserves the broader political aim of making Members ofParliament more accountable for the health experienceof their constituents, and reminds the present govern-

ment of their many public statements of intent on wealthredistribution.

Philip McLooneMedical Research Council,

Social and Public Health Sciences Unit,

University of Glasgow,4 Lilybank Gardens,

Glasgow G12 8RZ, UK

E-mail address: p.mcloone@msoc.mrc.gla.ac.uk

Therapeutic landscapes: the dynamic between place and

wellness

Allison Williams (Ed.); University Press of America,New York, 1999, 243pp

An expanding body of research within the geography

of health has begun to explore the healing benefitsassociated with particular places and/or landscapes.

Situating himself between the ‘new’ cultural geographyand health geography, Gesler (1991) first introduced

geographers to the term ‘therapeutic landscapes’. Heargued that by incorporating theory from culturalgeography such as sense of place and symboliclandscapes, health geographers could begin to examine

‘locations of healing’ as symbolic systems. Since Geslerfirst introduced the concept of therapeutic landscapes in

PII: S 1 3 5 3 - 8 2 9 2 ( 0 1 ) 0 0 0 1 6 - 8

Book reviews / Health & Place 7 (2001) 345–348346

1991, many health geographers have taken on the taskof applying this new body of theory to our under-

standings of the interconnections between health andplace.

Allison William’s edited collection Therapeutic Land-

scapes: The Dynamic Between Place and Wellnessis an excellent example of a diverse set of researchpapers that seek to demonstrate the therapeutic orhealing aspects of landscapes, both physical and

symbolic.This book consists of eleven chapters and is

divided into three sections each exploring a different

perspective of the dynamic links between healthand place. The first section, ‘Therapeutic Landscapesas Healing Places’, examines the healing properties

associated with particular physical environments.Three of the chapters within this section explorethe health-related qualities of ‘natural’ landscapes,

such as the National forest in England (Chapter 2),Alaska’s Denali National Park (Chapter 3) and asummer camp in New Hampshire (Chapter 4).In the final chapter of this section, Williams

(Chapter 5), utilizing notions of sense of place andattachment to home, explores the factors relating to theplace-identities of home care nurses working in a

medically under-serviced region in Sault Ste. Marie,Ontario, Canada.

The section entitled Therapeutic Environments

and the ‘‘Marginalized’’ discusses the ways in whichmarginalized groups, in particular, the mentally illand the homeless, create therapeutic landscapes forthemselves under adverse conditions. Geores and

Gesler (Chapter 6) discuss the conflicts surroundingthe constitutional rights of the mentally ill, living inthe United States, to receive care within therapeutic

environments. Parr’s research (Chapter 7) focuseson deinstitutionalization and the intersections ofindividual and collective identities, community care

and public space in Nottingham, UK. Finally, Bridgman(Chapter 8) examines the ‘street’ as a therapeuticmetaphor in the lives of the homeless in Toronto,

Canada.The third and final section, ‘Symbolic Landscapes in

Health Care’, examines the therapeutic landscapesassociated with sites of health care delivery. Kearns

and Barnett (Chapter 9) explore the symbolism implicitin naming the Auckland children’s hospital ‘‘Starship’’.Their research demonstrates how the name ‘‘Starship’’

symbolizes a change in the marketing techniques ofhospitals as well as an attempt to reorient children’shealth. Scarpaci (Chapter 10) discusses landscapes of

revolution and health care delivery in Havana and theirpotential for creating therapeutic environments. In thefinal chapter of this book, Mohan (Chapter 11) explores

the possibilities for developing therapeutic landscapes inthe context of historical and current reforms in the

British NHS which have both embraced and erasedplace.

The ten papers included in this collection representan informative and innovative area of research withinthe geography of health. However, a key element

missing from much of the discussion on therapeuticlandscapes included in this collection is scale.Gesler (1991, p. 166) posed the questions ‘On whatscale is place encountered?’ and ‘What are the bounds of

a place that has significance to those within it?’ Despitethis, the papers in the book generally overlookthe different scales at which therapeutic landscapes

are manifested and experienced. One exception is Parr’s(Chapter 7) research in which she explores howpeople with mental illness can create therapeutic

landscapes that exist across multiple scales (e.g.,individual and collective). Other important issues miss-ing from this collection are discussions of the

cultural and/or gendered specificity of therapeutic land-scapes.

In addition, as Williams (p. vii) notes in herintroduction, ‘‘exploring the positive, healing or ther-

apeutic characteristics of placeFan increasingly impor-tant determinant of healthFis consistent with thedevelopment of health promotion throughout the world

(emphasis added)’’. While the healing properties ofplaces are important, so too are the negative healtheffects associated with particular places. To understand

fully the role of place in shaping health we mustbroaden our understandings of therapeutic landscapesby exploring the negative impacts of placeexperiences on health. However, this issue receives very

little attention in this book. Scarpaci’s chapteris the only research that specifically addresses this issueby exploring how landscapes of revolution in

Post-Socialist Havana are being transformed intotherapeutic landscapes (see also Frazier and Scarpaci,1998).

Perhaps the most significant shortcoming of the bookis the lack of a concluding chapter that ties together thevarious elements woven throughout this collection.

Rather than drawing together emergent themes anddiscussing the utility of therapeutic landscapes for‘‘public health practitioners, medical and health profes-sionals, urban planners and policy makers, as well as

academics and students’’ (p. vii), each section standsalone.

Despite these limitations, Therapeutic Landscapes:

The Dynamic Between Place and Wellness offers valuableinsights into the complex interconnections betweenhealth and place. This collection of papers has reasserted

the importance of place by embracing perceptions ofboth material and symbolic landscapes in relation tohealth. This book is well worth reading and will be of

interest to researchers and students in health and socialsciences.

Book reviews / Health & Place 7 (2001) 345–348 347

References

Frazier, L.Z., Scarpaci, J.L., 1998. Landscapes of state violence

and struggle to reclaim community: mental health and

human rights in Iquique, Chile. In: Kearns, R.A., Gesler,

W.M. (Eds.), Putting Health into Place: Landscape,

Identity, and Well-Being. Syracuse University Press, Syr-

acuse, pp. 53–74.

Gesler, W.M., 1991. The Cultural Geography of Health Care.

University of Pittsburgh Press, Pittsburgh.

Kathleen WilsonCIHR Postdoctoral Research Fellow,

Department of Geography,Queen’s University, Kingston,

Ont., Canada K7L3N6

PII: S 1 3 5 3 - 8 2 9 2 ( 0 1 ) 0 0 0 2 0 - X

Book reviews / Health & Place 7 (2001) 345–348348