Placing racism in public health: a perspective from Aotearoa/New Zealand

This commentary reflects on Nancy Krieger’s thinking in light of the links between place, ‘race’ and public health from our vantage points as Maori (indigenous) and Pakeha (settler) researchers in Aotearoa New Zealand. We propose an addition to Krieger’s list of pathways through which racism impacts upon the health of indigenous peoples: the systematic alienation of indigenous lands and subsequent degradation of ecosystems that undermine traditional economies. We believe that this proposal, along with the forging of new community-based research partnerships, will increase the potency of Krieger’s challenge: to name and claim racism as a public health issue.     

Placing sexuality in health policies: feminist geographies and public health nursing

Despite the increasing public profile of same-sex issues, health policies are often shaped by heteronormative assumptions. The health concerns of lesbian, gay, bisexual, transsexual/transgender, two-spirit, intersex, queer and questioning (LGBTTTIQQ) people are complex and require broadening from an often exclusively sexual health and risk focus to a more holistic approach. In this context, this paper illustrates how a critical feminist geography of health, with its focus on the mutual construction of gender relations, space and place, potentially enhances and extends current understandings of public health policy and practice. Moreover, the use of a policy lens foregrounding gender and other power relations suggests that feminist research and coalitions facilitate participatory processes that address “the politics of discourse.” In particular, public health nursing practice can enhance the construction of spaces of resistance that challenge heteronormative discourse through research strategies focused on sexual minority communities’ health experiences and their visions for supportive care. In this respect, two strategies consistent with public health priorities to increase knowledge and participate in alliances are described. Ethnographic research with childbearing lesbians demonstrates that attention to institutional dynamics that foster safe spaces can facilitate access to public health services. Public health nurses’ involvement in community coalitions can enhance dissemination of community knowledges. The implications for gender inclusive and place-sensitive public health nursing practice include the development of sensitive educators, meaningful educational curriculum and related program planning, explicit policies, community partnerships and political leadership in institutional and research venues.     

Fluoride in Quaternary groundwater aquifer,Nile Valley,Luxor, Egypt

The occurrence of fluoride in ground water is the focus of the public and has attracted the attention of many scientists all over the world due to its importance in public health. Deficiency or increase of fluoride uptake is considered a public health problem due to the narrow permissible limit which should not exceed 1.5 mg/l according to the World Health Organization (WHO). The range of fluoride tolerance and toxicity is narrow. Deviation from the optimal levels therefore results in dental health effects such as caries and fluorosis. Many studies have found fluorosis to be invariably associated with high concentrations of fluoride in drinking water. Fluorosis is a considerable health problem in many areas of the world including Brazil, China, East Africa, Ghana, India, Kenya, Korea, Malawi, Mexico, Pakistan, South Africa, southeastern Korea, Spain, Sri Lanka, Sudan, Taiwan, Tanzania, and Turkey. Fluoride in groundwater of Quaternary aquifer of the Nile Valley, Egypt, does not gain the attention of the authors in the Nile Valley which makes the public health status of fluoride is not certain. The present work aims at investigating the fluoride concentration of Quaternary groundwater aquifer at Luxor as a representative area of the Nile Valley to be a base line for subsequent studies and criteria for public health. Ground water samples were collected from Quaternary groundwater aquifer at Luxor area, Egypt and analyzed for the purpose of investigating fluoride content. The results showed that fluoride concentration in the study area ranges between 0.113 and 0.452 with an average of 0.242 mg/l. Sources of fluoride in the study area can result from the natural dissolution from fluoride-rich minerals, fertilizers and from groundwater recharge. It is worth mentioning that low fluoride content in the study area is considered a public health threat specially limited growth, fertility, and dental caries. Corrective measures should be taken to avoid the public health impacts of fluoride deficiency at Luxor area as well as similar areas in the Nile Valley. A public health program should be initiated to account for the deficiency of fluoride in groundwater and deal with the other supplementary fluoride sources in food or fluoridation of drinking water supplies.     

Risky bodies: Public health, social marketing and the governance of obesity

The inclusion of obesity within public health rests on a proven and accepted biomedical link between body weight and health status. Drawing on the 2005 controversy over annual death rates attributable to obesity in the US, this paper contends that uncertainty as to the causal mechanisms linking body weight and health are undermining the development of effective obesity prevention policies. Consequently, this also weakens the justification of the inclusion of such policies within public health. This work draws on recent interest in ‘critical geographies of public health’ and the continued attention to the recursive relations between people and places in the context of health which may offer a useful theoretical viewpoint from which unpack such aetiological uncertainty. Without an agreed or universal risk from obesity, the paper argues that public health obesity prevention through social marketing should be geographical in outlook. The three examples of 5 a day, Jamie’s School Dinners and Sesame Street’s Cookie Monster are discussed to illustrate the effectiveness of communicating risk in a manner that allows intention to be effectively translated into risk-minimising behaviour within the dictates of locale.     

‘The germs are not harmful’: health risk perceptions among consumers of peri-urban grown vegetables in Kumasi,Ghana

Consumption of peri-urban grown vegetables has raised public health concerns due to potential risks of contamination from pathogens, pesticides and heavy metals. Understanding how the public perceives of risk is key in managing the population at risk of consuming contaminated vegetables. However, health risk perceptions research of consumers has largely been given little attention. Using both quantitative and qualitative research techniques, and drawing on risk perception theory, this study examined consumers’ health risk perceptions in relation to urban vegetable consumption in the Oforikrom sub-metropolitan area of the Kumasi Metropolis in Ghana. Results suggest that heath risk perceptions of consumers of urban-grown vegetables is generally low, an indication that consumers’ perceptions have not changed a decade after similar results were reported in Ghana. Consumers’ interpretation of the quality of vegetables and associated health risks deviates from scientific health risk assessments which, does not translate into desired risk mitigation behaviour. Continuous public education on potential health risks of consuming these vegetables and appropriate health risk mitigation measures could be vital in reducing the population at risk.     

The impact of energy consumption on environment and public health in China

Fossil energy consumption is one of the main reasons for the deterioration of environmental pollution and decline in public health. This paper tests for the long-run and short-run relationship among energy consumption, environment pollution and public health using the autoregressive-distributed lag approach in China for the period 1985–2014. The study used energy consumption variables (i.e., the proportion of coal consumption, that of oil and clean energy, abbreviated as PCC, POIL and PCE, respectively), environmental pollution ones (i.e., SO₂ emissions, abbreviated SO₂, soot and dust emissions,), two health proxies (i.e., the proportion of cardiovascular and respiratory diseases mortality, abbreviated as PCD and PRD, respectively). These variables were selected due to vital importance in China. The overall results indicate that there was co-integration relationship under the study with statistically significantly positive relationship between environmental pollution and energy consumption, public health and environmental pollution in the short and long run. Comparing the long-run and short-run coefficients of energy use variable with respect to SO₂ and soot indicates that the long-run coefficients are the same as the short-run. The long-run coefficients of soot and dust emissions with respect to PCD and PRD, respectively, are higher than the short-run coefficients. This implies that environment pollution level is found to worsen with respect to fossil energy use presently and over time, while public health level descending with reference to soot and dust emission over time in China. The Granger causality results suggested a unidirectional Granger causality between energy use and environment pollution, environment pollution and public health. The results emphasized the importance of energy transformation and sustainable development policies that help to adjust the structure of energy consumption and to improve public health level.     

Social epidemiology as medical geography: Back to the future

There is something very traditional about Nancy Krieger’s decidedly modern work. She advances a social epidemiology that is multidisciplinary, advancing a “quantitative population science” that is also spatial in its approach and method of analysis. Many geographers see their work as affirming the potential of medical cartography and geography as disciplines critical to public health studies of disease incidence. This article argues that the history of epidemiology and public health are historically spatial and geographic, a link lost in the research of many twentieth century health researchers. A review of the history of medical geography, and of public health, insists upon the spatiality of disease studies as a critical groundwork not simply for contemporary disease studies but for the history of disease studies as they have slowly developed over for more than 200 years.     

Caring about ‘brain drain’ migration in a postcolonial world

The migration of health professionals has been accompanied by politically and morally charged discussions on the effect of such migration on the health of those left behind in their countries of origin. In the UK, the National Health Service, which has long been dependent on overseas migrants to bolster its own staffing, has responded to critics accusing it of ‘poaching’ health professionals from poorer countries with a range of measures to limit health worker mobility. These measures counterpose the right to mobility of health workers with the right to health for those they leave behind, posing academics working on brain drain with a quandary: how do we think ethically about brain drain migration? This paper aims to address this question by exploring the spatial and temporal ontologies that are being mobilised in current thinking around the brain drain. It explores how these ontologies shape both public debates and policy initiatives, foreclosing other ways of thinking about health worker mobility. It argues that routing discourses of brain drain through insights drawn from care ethics and postcolonial thinking will highlight the historical transnational connections that mark medical labour markets and how the category ‘medical worker’ is precisely dependent on this transnationalism.     

Health profiles of Hamilton: Spatial characterisation of neighbourhoods for health investigations

This paper is part of a larger research program which employs a mixed-methods approach to study the determinants of health at the local level using specific neighborhoods in Hamilton, Ontario, Canada. In this paper, multivariate, spatial statistical techniques and geographic information systems are used to address questions about the characterization of neighbourhoods, based on socioeconomic determinants of health and risk factors such as smoking. While neighbourhood characterization has been a component of public health surveillance for some time, geostatistical techniques can now be used to derive more accurate representation of neighbourhoods for use in subsequent analysis. We utilize principal components analysis to reduce the data and extract the components that represent the underlying local processes. Principal components are also overlayed on comparative mortality figures to visualize where the socio-demographic determinants of health correspond spatially with mortality patterns. Predicted values from the components are then analysed for spatial clustering using local indicators of spatial association. The findings reveal a pattern of distinct neighbourhoods that will be used in subsequent quantitative and qualitative stages in the larger research programme. The results can also be used to inform public health policy and to target public health interventions.     

The impact of health financing and CO<Subscript>2</Subscript> emission on health outcomes in Sub-Saharan Africa: A cross-country analysis

The current paper examines the relationship between health financing (public and out-of-pocket health financing), CO₂ emission and health outcomes in 35 Sub-Saharan African countries for the period of 1995–2012. The panel unit root and cointegration tests are conducted as pre-tests, followed by the estimation of the parameters using the FM-OLS and DOLS techniques. The findings of the study show the importance of public health financing as one of the major factors that lead to better health outcomes, whereas the out-of-pocket expenditure is found to be harmful to population health since it leads to increase under-5 mortality rate. Although the results show a negative relationship between CO₂ and health outcomes, still these results remain inclusive. In addition, the findings reveal the importance of socioeconomic factors such as income and education as key determinants of health outcomes.     

Confronting the data-divide in a time of spatial turns and volunteered geographic information

Geography is enjoying a period of unparalleled visibility, driven by the growing use of geographic methods and concepts across the sciences and humanities—the so-called spatial turn—and the pervasive use of geospatial Web technologies and their concomitant influence on society, especially the phenomenon of volunteered geographic information (VGI). The field of public health is beginning to harness spatiality with gusto; however, the geospatial Web and its social phenomena are underexplored in this context even though they may be particularly useful for public health enquiry, especially in low-resource settings that lack traditional data collection mechanisms. A case study framed within these two current phenomena is presented to illustrate the influence of geography and its potential for addressing the data-divide—the disparity in availability of data for scientific enquiry and decision-making most felt in low-and middle income countries. A facilitated VGI data collection initiative collected public health-related injury data in Cape Town, South Africa, as a pragmatic alternative given the lack of data from traditional sources. Emergency medical services personnel interacted with a GeoWeb interface to volunteer their informed opinions of high-incident injury locations. Previously unrecorded injury location data were created, and combined with traditional injury data for use in an ongoing study examining the environmental determinants of injury in this setting, which speaks to the possibility for hybrid authoritative/asserted data collection strategies. This study speaks to the growing influence of geography and one of its driving forces, the techno-social revolution in geospatial technology and data. Future work should continue to examine their potential to address the data-divide.     

A composed index of critical accessibility (CICA) to healthcare services in a traditional African City

While empirical works that analyse rural–urban differentials in accessibility to health services are common in the developing countries, systematic studies focusing on intra-urban variations in accessibility to overall healthcare resources remain scant. Yet, many urban dwellers especially in the Sub-Saharan Africa have to travel long distances within the urban space to access basic health services. This study employs composed index of critical accessibility (CICA) to analyse differentials in access to health resources in Ibadan, a traditional African City. Data on healthcare centre location, ownership, doctors’ population were collected through field survey while spatial data on the administrative units and populated places were obtained from archival sources. Also, data on road networks was collected. Results show that the distribution of health facilities across local administrative units varies. In terms health facilities, Ibadan South West has 26 (36 %) of the total number while Ibadan South east has only 7 (9.8 %). The Doctor-Population Ratio also exhibits similar variations as Ibadan North has 20.5 as against 2.2, 1.9 and 0.3 for Ibadan SW, Ibadan NW and Ibadan NE respectively. The CICA analysis shows that 228,938 inhabitants are in high risk of negative accessibility while 49,234 are faced with condition of low risk of negative accessibility, which implies that a significant proportion of the population still finds it difficult to access basic health services as and when needed. The variations in the distribution of this deprived population are also noteworthy as the largest proportion of this group was localized in Ibadan NW. This has grave implication for the health and wellbeing of the population and raises once again the question of spatial equity in the delivery of urban public service. Curiously, these differences in the level of accessibility cut across administrative boundaries which brings to the fore the role of jurisdictional partitioning in ensuring equity in the delivery of urban public services. This opens a vista of research opportunity into the role jurisdictional partitioning in service provision in the urban centres.     

Irrigation with reclaimed municipal wastewater

Land application of municipal wastewater is a well established practice in many arid and semiarid countries of the world. Although irrigation with municipal wastewater is in itself an effective form of wastewater treatment, some degree of treatment must be provided to 1) protect public health, 2) prevent nuisance conditions, and 3) prevent damage to crops, soils, and ground-water. Factors affecting irrigation with reclaimed wastewater include irrigation water quality and public health and regulatory considerations.     

Climate Change and Human Health: Risk Assessments,Early Signals and Response Strategies

Climate change is considered as the biggest global health threat of the 21^st century. The increasing adverse health effects of climate change has been a public concern worldwide. In order to develop the specific health response strategies, a key research project, "Climate change and human health: Risk assessments, early signals and response strategies", was approved by the National Key R & D Program of China in May 2018. This project will integrate researchers from multidisciplinary background, such as public health, medicine, meteorological sciences, disaster management, to address the following scientific questions: ①The impact of climate change on population health and its regional heterogeneity; ②The underlying mechanisms and pathways of how climate change and extreme events impact on health; ③Capture of the early signals of climate system anomalies which may lead to regional health risks; ④The comprehensive health risk assessments and development of coping strategies for tackling climate change. This project will improve our understanding of climate change and health and help policy maker to develop national and local responses to climate change in China.     

Voluntarism,defensive localism and spaces of resistance to health care restructuring

This paper examines the evolving role of volunteers and the voluntary sector in shaping community responses to structural change in health care systems. It contributes to the emerging understanding of the different forms voluntarism can take within and among places, including as a space of resistance to contemporary restructuring initiatives such as regionalization. Within the geographies of voluntarism literature, however, little attention has been directed towards interrogating the local dynamics of such voluntarism, especially as it is reflected in public discourse. We address this deficiency through a media-based case study of public reaction to the recent implementation of Ontario’s Local Health Integration Networks (a type of regional health authority). Specifically, we examine a decade of newspaper coverage in a mid-size Canadian city region to document and characterize how the activities of volunteers and voluntary sector organizations in the community are portrayed in light of the structural imperatives to integrate health care services and regionalize health care governance. The media findings reveal a suite of public concerns and related activities, with the voluntary sector called upon in various ways to defend the autonomy of the community against the perceived threats to local services, employment and vulnerable populations. We interpret the evident complexity of voluntary sector resistance as a form of ‘defensive localism’ and discuss implications for developing informed policy on health care restructuring and for advancing knowledge on the local geographies of voluntarism.     

某工厂夜光车间环境放射性监测、评价及防护

在黑暗环境中显示仪表指示常采用荧光技术。某工厂夜光车间是利用掺人放射性物质的荧光粉对玻璃制品进行涂抹、描绘等工艺加工的生产车间。由于荧光粉中掺人放射性物质^226Ra、^40K,^226Ra、^40K在自发衰变过程中会放出α、β、γ射线,对人体会产生不同程度的损伤,大剂量或累计照射会对人类造成一定辐射影响。因此,工作时应严防人为等意外因素可能造成超安全计量的放射性损害。为确保夜光车间工作人员和公众人身健康与安全,必须定期对夜光车间及周围环境进行放射性监测与评价。通过环境放射性监测．分析环境辐射水平,寻找可能存在的问题,进而提出保障人体健康的防护措施。     

饮水氟化预防龋齿及其在中国的实践

龋齿目前已成为严重危害我国人民健康的口腔疾病。国内外大量研究与观察证明饮水氟化是最安全、投入产出比最佳的预防龋齿的公共卫生措施。在广州，1965年开始进行饮水加氟试点，龋病发病率曾降低约50％，停止加氟后，龋病发病率再次上升。目前广州已成为全国龋病病情最为严重的城市。考虑到随着人民生活水平的提高，食品中的糖增加而粗纤维减少；随着经济的发展，水资源严重不足，城市供水正由以含氟较高的地下水为主转为以含氟较低的地面水为主，这种趋势将使我国龋病问题日益严重。在牙医严重不足，公众缺乏口腔卫生、牙齿保健知识的情况下，饮水加氟是最安全、有效、经济的防治措施。推广饮水加氟的工作，应当在科学研究和公众参与下，积极稳妥地进行。     

Assessment of scaling properties of groundwater with elevated sulfate concentration: a case study from Ergene Basin, Turkey

In this study, the Langelier saturation index and the Ryznar stability index of the groundwater of the east of Ergene Basin were evaluated to assess the corrosivity or scale-forming tendencies. Corrosion is one of the most complicated and costly problems facing drinking water utilities. Corrosion can affect public health, public acceptance of a water supply, and the cost of providing safe drinking water. For this purpose, total of 17 representative groundwater samples were collected. Except for well nos. 1, 2, and 3 with corrosive characteristics, all the groundwater samples were stable or had a slight tendency for dissolving of scale. Results showed that the amount of precipitation and irrigation caused seasonal variation in corrosive characteristics. Increased ionic concentration of SO₄ ^?2 contributes to the corrosivity of groundwater.     

Mapping groundwater contamination risk using GIS and groundwater modelling. A case study from the Gaza Strip, Palestine

Increasing pressure on water resources worldwide has resulted in groundwater contamination, and thus the deterioration of the groundwater resources and a threat to the public health. Risk mapping of groundwater contamination is an important tool for groundwater protection, land use management, and public health. This study presents a new approach for groundwater contamination risk mapping, based on hydrogeological setting, land use, contamination load, and groundwater modelling. The risk map is a product of probability of contamination and impact. This approach was applied on the Gaza Strip area in Palestine as a case study. A spatial analyst tool within Geographical Information System (GIS) was used to interpolate and manipulate data to develop GIS maps of vulnerability, land use, and contamination impact. A groundwater flow model for the area of study was also used to track the flow and to delineate the capture zones of public wells. The results show that areas of highest contamination risk occur in the southern cities of Khan Yunis and Rafah. The majority of public wells are located in an intermediate risk zone and four wells are in a high risk zone.     

Assessing the possible impacts of temperature change on air quality and public health in Beijing, 2008–2012

Understanding the impact of temperature fluctuations on air quality and public health has gained popularity among environmental and epidemiological researchers. Potentially, increase and decrease in temperature between neighboring days have increased the environmental and health risk worldwide. Based on ordinary least-squares method, this paper aims to examine the impact of temperature fluctuations on air quality index (AQI) and respiratory health outcomes (RHOs) during 2008–2012 in Beijing. Our results show that a drop of more than 3 °C results in the increased impact on AQI and RHO in the heating period. At the same time, a raise of more than 3 °C results in the similar increased impact on AQI in the whole study period and heating period. Furthermore, for a raise of more than 3 °C, a larger impact on RHO is observed in the heating period compared with the whole study period. Additionally, an increase in temperature also results in the increased influence of health risk on females during the heating period. Our results suggest that the air quality and public health in Beijing are significantly influenced by decrease and increase in temperature in the heating period.