Geographies of Health References

• Context and composition are not mutually exclusive but places encompass both the people within them and the wider environment

• People of higher socioeconomic status often have better access to resources, money, knowledge, power and networks that promote better health

• Place is an ecosystem made up of people, systems and structures so to separate context and composition is to oversimplify

• Health varies with age, ethnicity, occupation, physical environments and social/spatial inequalities

• Historical events such as C19th industrialisation or Thatcherism can also impact health

Bambra, 2016

• The second Marmot Review highlighted that people can now expect to spend more of their lives in poor health

• Improvements to life expectancy have stalled and health inequalities grow

Marmot et al., 2020

• Income inequality and health have been linked in the US, UK and Brazil; often interpretations of this ignore contextual determinants

• Income inequality can impact health through perceptions of place in a social hierarchy leading to antisocial behaviour, reduce participation and low community cohesion

• There is a clustering of conditions impacting population health interacting with hierarchy impacts

• Social capital in terms of trust, belonging and volunteering could be more important than economic GDP

Lynch et al., 2000

• ‘People make places, and places make people’ shows the interconnectedness of context and composition

• To separate context and composition is to oversimplify the relationship between place and health where it acts like an ecosystem

Macintyre & Ellaway, 2003

• Clustering can see unemployed people living near other unemployed people

• On small scales, places can create conditions such as pollution but also perceptions on health and healing

• Places where fewer people are ill would be expected to have higher levels of social capital and community showing the connection

• On smaller scales, differences in health are often seen as a product of the individual but internationally area affects are often seen as more important

• The history of a place is important in the life course of the place as well as genetic inheritance

Tunstall et al., 2004

• Greenspace creates a venue for exercising to improve physical and mental health

• It can also be sen to improve cognitive functioning and sleep quality

• Those with greater greenspace deprivation levels have been shown to have shorter life expectancies that those less deprived

The Health Foundation, 2024

• Wellbeing is a network of reinforced individual, community and place impacts that are often associated with use of green space, civic agency and neighbourhood cohesion

• The individual and context of a place are in a reciprocal relationship as one’s health will be based on the resources available as well as other factors

• Individual factors have been seen to be the strongest predictors of well-being as financial difficulties and physical health have strong connections to poorer wellbeing

• Individuals often do not have control over place based conditions such as COVID limiting access to greenspace

• Joint decision making is important in increasing feelings of civic agency, neighbourhood purpose and optimism

• Hearth is important as it informs on wider policy, future work should unpack more complex relationships

McElroy et al., 2021

• Place is often underestimated in its contribution to disease risk, this should be understood better to inform policy interventions

• Context of place is importance as it constitutes social relations and physical resources

• Relational perspectives are important in understanding how context impacts health through feedback loops and dynamic natures of place

• Power relations are important as actors control and maintain health influencing factors, there can be places of prescription or negotiation and exogenous processes can also impact local places

• Access to resources is not necessarily the same as geographical proximity, relative position is important

Cummins et al., 2007

• Multilevel modelling allows for better separation of individual and contextual factors seeing how there can be direct and indirect impacts of the two

• There should be better frameworks and comparisons used for understanding health outcomes as well as the dynamic nature of places subject to processes such as migration

• There is a focus on context which may take the blame away from the individual and onto the government

• It is time for more interconnected and humanistic theories of health variation, it is not isolated but policy should strive for greater depth

Smyth, 2008

• The Dahlgren-Whitehead rainbow model broadens horizons to allow people to think beyond the health sector into local environments, it escapes the idea that health is determined by formal health services

• It allows people to work together on a common goal with each sector taking responsibility, it is easy to understand and includes more than just risk

• It consists of layers and focuses on health as a whole rather than specific diseases

• The model is not about inequality and is not an analytical tool but simply a visual representation

• In the future it aims for better illustrations of links, focus on commercial determinants and the idea of racism as a driving force

Dahlgren & Whitehead, 2021

• Minority ethnic groups have been disproportionately impacted by COVID-19 through multiple pathways as a result of social processes and hidden structural racism

• Ethnicity is a socially constructed idea tat causes inequalities to rise through broader social mechanisms

• There are impacts of differential expose, vulnerability, disease consequences, social consequences, effectiveness or control measures and adverse consequences of control measures all leading to unequal health outcomes

• Ethnicity must be better understood in order for action to be more meaningful

Katikireddi et al., 2021

• The Preston curve states a strong positive relationship between national incomes and life expectancy in poorer countries and also sees that this relationship is changing with life expectancy increasing at all levels

• There is a dispute over which mechanisms is the most important

• The relationship is also true for individuals speaking of their relative income and how it places them in the social hierarchy

• Arguments for redistribution lack evidence from the curve but there is clear importance of technological innovation and resource allocation

• There may be a reverse link between health and wealth that would have important implications for economic development and poverty reduction

Bloom & Canning, 2007