Health Geography Exam 2

environmental contaminants

non-living agents of disease

US life expectancy decreased for 3 years following ____ because of…

2014; more processed foods, sedentary lifestyle, preventable deaths (cardiovascular diseases, OD deaths)

biggest pill mill place in the US

Kermit, WV

East Palestine Train Crash

train crash releasing hazardous materials (VOCs) into the air, soil, and water

bio-accumulation

toxins enter food web by building up in individual organisms

bio-magnification

toxins pass from one trophic level up to the next, increasing in concentration up the food web

distance decay

as you get father from the source of a contaminant, the concentration of pollution decreases, consider direction of wind and water drainage

naturally-occurring contaminants

lead, smoke from wildfires, arsenic, radon

synthetic contaminants

emissions

Bangladesh Poisoning

surface water was only source of water

contaminated with feces —> lots of diarrheal disease

especially among kids —> high child mortality

UNICEF came and dug wells

decreased child mortality but everyone got arsenic poisoning

Environmental Kuznets Curve

during industrialization: environmental degradation increases

after industrialization: environmental degradation decreases (govt. programs to protect environment)

Why is PM2.5 so bad?

can get DEEP into lungs and cause more damage

Where is PM2.5 most common and why?

poor or industrializing economies - India

lots of people use fires to cook food, burn waste

aka industrial pollution + individual pollution

Role of Topography in Environmental Contamination

temperature inversion

temperature inversion

warm air rises

mountains trap air on sides, warm air traps cold air beneath it

therefore cold air + contaminants can’t leave

chronic exposure to pollutants - extraneous circumstances

weakened immunity, death from acute conditions, intrauterine growth restriction (smaller babies)

Flint Water Crisis

city of Flint was getting water from Lake Huron

it was getting pretty expensive because they were paying another town to siphon water from them

started building their own water treatment plant to get water from Lake Huron

in the meantime, they didn’t wanna keep paying the other town money to get water from them

started drawing water from the Flint River and treating it in town

everyone complained that it was stinky and weird looking

started treating the water more aggressively

aggressive treatment corroded water pipes, pipes began leaking lead into the water

bunch of lead poisoning

Main takeaway from the Flint water crisis -

marginalized people are more likely to be exposed to and experience adverse health outcomes from environmental contaminants

experimental/clinical study

two groups, expose one to toxins, other is control, observe health outcomes

cohort study

two groups, one has already been exposed, other has not, observe health outcomes

case-control study

start with sick group and healthy group, look for past exposures

cross-sectional study

survey people now about exposures and health, survey same people in the future about exposures and health, look for potential associations

ecological study

use aggregated (not individual) health and exposure data within some unit of analysis (Census tract, zip code, county, neighborhoods, states)

Tuskegee Syphilis Experiment

researchers wanted to study untreated syphilis

recruited impoverished sharecroppers

(1) not told true purpose of study or that they had syphilis —> passed it to partners and offspring

told they were being treated for “bad blood”

(2) undue inducement

given excessive incentives to participate, enough that risks could be ignored

(3) withheld treatment

study in 1930s

treatment in 1947

treated in 1960s

after many death and exposures

Tuskegee Effect

marginalized people don’t trust the healthcare system/workers

functions of a map

communication and analysis tool

• info easier to convey as map

• info easier to compare as map

Broad Street Pump

a bunch of people in London were getting cholera

thought it was because of the bad smells —> miasma

John Snow thought that was stupid

must be because of some unseen contagion

went around interviewing people and seeing who had cholera

made a map and found that all of the people that had cholera were drinking from the Broad Street pump (map was split into units, walking time from pump)

removed the handle from the Broad Street Pump to prove his theory

remote sensing

taking a picture from space

geographic information system (GIS)

stores spatial data in layers, can then run analysis on them

privacy and maps

data aggregation vs. point distribution

point distribution

individual places a point in their location - iffy because of HIPAA and privacy laws

data aggregation

individual states what neighborhood, county, region they’re in - data is clumped together

modifiable area unit problem (MAUP)

where you draw the lines on the map really matters when you’re aggregating data

gerrymandering

splitting up a state into voting districts that favor one party over the other —> changes how their representatives vote

surface mining study and MAUP

does surface mining cause lower birth weight babies?

across all spatial scales, the data says YES

poor health and poverty cycle

poor people don’t have access to health resources, get into bad health, bad health limits ability to work and live, creates poverty

• different incomes = different health outcomes

where someone is born MATTERS

affects how often they see a doctor, food quality, access to vaccines, etc.

health indicator

used to estimate facets of health for an entire population

• life expectancy

• child mortality

• infant mortality

change in probability of death

WV increased, NY decreased

result of deaths of despair

wealth vs. life expectancy

positive correlation

increasing wealth = increasing life expectancy (country scale)

• not true for counties/states - big differences in life expectancy

wealth vs. infant mortality

exponential, negative correlation

no wealth = high infant mortality

teensy bit of wealth = low infant mortality

lots of weatlh = low infant mortality

wealth vs. child mortality (1960)

negative correlation

increasing wealth = decreasing child mortality

wealth vs. child mortality (now)

no correlation

wealth doesn’t seem to play a role in child mortality

social determinants of health (think of an example for each!)

individual factors, individual behaviors, community networks, living and working conditions, social/economic/cultural environment

individual factors

age, gender, genetics

individual behaviors

smoking, exercise, diet

opioid pre-cursor

opioid 1st wave

post civil war:

• morphine used for pain

• in purest form = highly addictive

• also used in OTC kids meds

1920s:

• govt. noticed addiction, increased regulation

• puritanical/prohibition movement = drugs criminalized

• sellers and users are criminals, not a public health issue (nowadays we know better)

1990s:

• Purdue Pharmaceuticals creates new “non-addictive” form of opioid - Oxycontin

• used for cancer hospice pts, chronic pain

  • lots of chronic pain in Appalachias - coal mining

• emergence of “pill mills”

• govt. noticed and shut down pill mills

• Purdue Pharmaceuticals now selling drugs to help ppl overcome opioid addiction

pill mill

doctors, clinics, pharmacies - EVERYONE prescribing controlled prescription drugs inappropriately

• walk ins welcome!

gateway to drugs is ______

trauma

opioid 2nd wave

also 1990s - Mexico:

• many poor, unemployed farmers

• started farming poppies to make black tar heroin (alternative to pills when govt. shut down pill mills)

• USA used to import from Asia, cheaper to get it from Mexico now

• great business model, avoided detection by DEA

  • sellers didn’t use

  • sold in small cities without pre-existing drug network = no gangs

  • sellers went to users instead of users coming to sellers

• cons

  • sharing needles = heroin is more deadly

  • OD deaths increased over time

opioid 3rd wave

2011:

• growing poppies is unstable - dependent on weather, climate, storms, drought

• make fentanyl in a lab = more stable

opioid now

“deaths of despair”

lose job = lose hope = substance abuse

vulnerability

social conditions put some people at greater risk for health-compromising events

resilience

ability to cope and rebound from events affecting a person

How do you increase resilience?

increase economic stability

developed vs. developing country

global north vs. global south, colonizer vs. colony

four income levels

looking at the transportation, cooking, etc. of people - can divide into 4 sectors

developing doesn’t always mean socially behind

Iran has a lower fertility level than the USA right now

WIC/SNAP

should we put a nutritional threshold on SNAP?

period poverty

period products are expensive

no money = no period products

no period product = can’t go to work

can’t go to work = no money

food desert

no access to nutritional food because of cost, proximity, etc.

in other cultures, if people don’t have access to processed/western foods, they instead eat

local cuisine

the western influence on cuisines

lots of processed food

negative health consequences arising from food

too much, too little, wrong food

food culture affects health

grow own food? eat with fam?

obesity paradox

other countries:

poverty = malnourished & underweight

america:

poverty = malnourished & overweight

the globalized western diet has led to

increase in lifestyle diseases and BMI

increase in poverty and the wealth gap

today’s cultural ideal figure of thin/muscular =

increased body dysmorphia and eating disorders

cultural practices are subjective - female and male genital mutilation

female genital mutilation

• good according to patriarchal Africa

• bad according to West

male circumcision

• good according to Muslim countries + USA

• bad according to other people (bodily autonomy!)

circumcision rates over time

have gone down in the name of increased bodily autonomy

different identities have different expectations for and behaviors with health

Black Americans have consistently higher maternal deaths, infant mortality, lower life expectancies

Why did so many more Black Americans get COVID than white Americans?

more Black people living in urban areas, urban areas are denser, higher transmission

How does RACE influence health?

socioeconomic status differences between racial groups

racial identity issues generate health impacts (racism)

race norming

adjusting test scores based on race/ethnicity of taker

NFL Racism

players who suffered concussions in the NFL are getting payouts for cognitive decline

Black players assumed to have lower baseline cognitive level

therefore decline is smaller

therefore white players get larger payouts

What causes differing socioeconomic statuses that affect health outcomes?

racism, cultural norms/practices

Latina/Latino Paradox

Hispanic people in the US have higher life expectancies, lower maternal/infant mortalities, etc.

Why?

• greater support system - community

  • healthier lifestyle choices

People with ____ have more obstacles to navigate

disabilities

Kaci Hickox

does the government have the right to enforce quarantine or procedures on a person in the name of societal protection? is that an infringement on individual rights and freedoms?