Medical or health geography? Populations,peoples and places

While medical geography has grown eclectic to the point where a growing number of medical geographers prefer the terms health geographer, health geography, or the geography of health, schisms have nonetheless developed between Mayer et al. and those who have urged medical geographers to seek new epistemologies. Lost in this debate is the rapid and considerable growth of research by medical and health geographers. The author first reviews recent research on the mapping and modeling of diseases, then examines the literature on the access, delivery, and planning of health services. He then considers the debate over medical geography versus a geography of health. Opportunities are identified where medical, health, and population geographers can productively collaborate. Sharing many of the same theoretical and methodological strengths, weaknesses, and frustrations, medical, health, and population geographers need to work together toward creating inclusive geographies.     

UV-B radiation: a health risk in the Arctic?

Seasonal stratospheric ozone depletion in the Arctic has raised the question of whether the associated increases in ultraviolet-B (290-320 nm) constitute a significant health risk in Arctic populations. Increases in skin cancer in Europe and the USA from excess UV-B resulting from ozone depletion have been predicted. Skin cancer is, however, rare in Inuit populations.
UV-B also causes a selective down regulation of the immune system which may be a natural regulatory mechanism evolved to prevent autoimmune attack on sunlight-altered skin. The action spectrum for UV-B immunosuppression implicated a unique skin photoreceptor molecule, urocanic acid (UCA), which isomerizes from the trans to the cis isomer on exposure to UV-B, the cis isomer being immunosuppressive. This form of immunosuppression is important in skin cancer and possibly in infectious diseases.
The epidemiology of non-Hodgkin's lymphoma shows a relationship with UV exposure, postulated to be via the immunosuppressive effects of UV-B. Cancers which show an excess in Inuit populations include nasopharyngeal and salivary gland cancer. Genetic factors appear to be involved, but these are thought to be virally related cancers possibly associated with the high viral load in these populations. In several studies on non-Arctic populations, salivary gland cancer has been linked to ultraviolet exposure. A potential role for UV-B exposure in these cancers in the Arctic needs to be explored.
In view of the high levels of POPS in some Arctic regions, potential interactions between the immunosuppression caused by some of these pollutants and the effects of UV-B need to be investigated.     

Regional differences in the health status of Chinese residents: 2003–2013

Health inequality is an increasing concern worldwide. Using the coefficient of variation, Theil index, exploratory spatial data analysis, and spatial panel econometric model, we examined the regional inequality, spatio-temporal dynamic patterns, and key factors in the health status of Chinese residents from 2003 to 2013. We found that China’s residential health index (RHI) decreased from 0.404 to 0.295 in 2003–2013 at an annual rate of 2.698%. Spatially, resident health status, based on the RHI, has improved faster in the western region than in the eastern and central regions. Inequality in resident health status continued to increase between 2003 and 2013; inequality between regions decreased, but health status inequality expanded within regions. Furthermore, disparities in health status grew faster in western regions than in the eastern and central regions. The spatial distribution of resident health status formed a “T-shaped” pattern across China, decreasing from east to center then to the west with a symmetric decrease north and south. Using the change in Moran’s I from 2003 to 2008 and 2013, we found that the distribution of resident health status across China has narrowed. All the hot spots and cold spots have decreased, but they are also stable. Resident health status formed a stable cold spot in the western regions, while the east coastal area formed a stable hot spot. Selected explanatory variables have significant direct impacts on resident health status in China: increasing per capita GDP, per capita spending on health, and urbanization, and improving environmental quality all lead to better resident health status. Finally, we highlight the need for additional research on regional inequality of resident health status across multiple time, spatial, and factor domains.     

Long-term rates of sediment accumulation in the Tonle Sap,Cambodia: a threat to ecosystem health?

The Tonle Sap is an invaluable resource for the people of Cambodia, and is a globally significant ecological site. Much of the literature published on the environmental health and management of the lake suggests that its sustainability is threatened by accelerated rates of infilling related to unfettered land-use in the catchment. However, the evidence for supposedly increased sedimentation rates is confused and contradictory, and there have been very few studies that have attempted to actually measure the rate at which sediment is accumulating on the bed of the lake. This research measures long-term sedimentation rates in the Tonle Sap in an attempt to provide an empirically derived baseline against which more recent and allegedly accelerated sedimentation rates can be compared. Radiometric dating techniques (¹⁴C, ²¹⁰Pb, ¹³⁷Cs) reveal that sediment has been accumulating in the lake at an average long-term rate of less than 1 mm per year. There is a clear and consistent decline in the rate of sediment accumulation in the lake basin over time, with the highest rates recorded in the middle to early Holocene epoch. It is recommended that research be directed toward measuring changes in the morphology of the lake margin over time, rather than focus on changes in the bathymetry of the lake basins themselves, which are here shown to be effectively stable in terms of sediment accumulation.     

Do medical marijuana centers behave like locally undesirable land uses? Implications for the geography of health and environmental justice

As of 2013, medical marijuana is legal in 20 US States and the District of Columbia, but few studies have investigated the impact of the retail centers that sell the drug. We draw upon the social construction literature to frame our research and help us determine whether medical marijuana centers in Denver, Colorado, are considered locally undesirable land uses (LULUs). The geography of health and environmental justice frameworks lead us to hypothesize that marijuana centers are more likely to be opened in Hispanic, Black, and poor neighborhoods than in non-Hispanic White and affluent neighborhoods. We also hypothesize that marijuana centers will tend to increase the minority composition and poverty of the neighborhoods in which they are located. Contrary to expectations, we find no empirical support for these two hypotheses. Instead, results suggest that marijuana centers are likely to be situated in neighborhoods with higher crime rates and more retail employment. Thus, despite the view by many planners and law enforcement officials that these centers are problematic, they do not take on LULU characteristics in siting and demographic changes. This finding, while limited to Denver, has important implications for policymakers who are considering similar marijuana policies.     

Uncertainties in the geographic context of health behaviors: a study of substance users’ exposure to psychosocial stress using GPS data

ABSTRACT

This study examined how contextual areas defined and operationalized differently may lead to different exposure estimates. Substance users’ exposures to environmental stress (in terms of two variables: community social economic status and crime) were assessed from global positioning systems (GPS) data. Participants were 47 outpatients with substance use disorders admitted for methadone maintenance at a research clinic in Baltimore, Maryland. From 35.2 million GPS tracking points, we compared 7 different methods for defining activity space. The different methods yielded different exposure estimates, which would lead to different conclusions in studies using only one method. These results have important implications for future research on the effect of contextual influences on health behaviors and outcomes: whether a study observes any significant influence of an environmental factor on health may depend on what contextual units are used to assess individual exposure.     

The potential for the use of Open Source Software and Open Specifications in creating Web‐based cross‐border health spatial information systems

Globalization is contributing to the blurring of borders making irrelevant the distinctions between domestic and international health problems. Cross‐border and global health spatial information systems (CBHSIS) are required to address the new global health challenges. There is a need to build and document alternatives for addressing the technological, economic, and sociocultural–political challenges encountered in the creation and deployment of these systems. This paper documents the building of a prototype Web‐based multimedia GIS system for use in a public health context using Open Source Software and Open Specifications and its deployment across the US–Mexico border. These technologies offer advantages in addressing several of the challenges previously mentioned. We highlight the technological and sociocultural–political issues important in successful collaboration across borders and cultures and in the creation of interoperable CBHSIS.     

The impact of perceived urban human settlement quality on subjective well-being: A case study using urban health examination data in the Yangtze River Delta region北大核心CSCD

城市体检是促进中国城市人居环境高质量和提升城市居民幸福感的创新举措,但却很少有研究正面关注城市体检社会评价对居民福祉的影响。论文基于2021年住建部在长三角地区8个样本城市开展的大规模城市体检社会满意度调查数据,采用主成分分析和多元回归分析相结合方法,分别探讨了长三角地区居民的城市人居环境质量感知因子及其对居民幸福感的影响,并从以人为本视角提出长三角地区城市人居环境高质量发展策略。研究发现:(1)城市体检社会满意度评价指标共提取了7个城市人居环境感知评价主成分因子,分别命名为城市管理、城市活力、城市舒适、城市宜居、城市包容、城市安全和城市便利,累计贡献率达到66.767%。(2)城市人居环境感知评价因子均对长三角地区城市居民幸福感具有显著影响,但不同城市人居环境感知评价因子的影响方向却存在差异性。其中,城市管理、城市活力、城市舒适、城市宜居和城市包容等因子显著正向影响幸福感,城市安全和城市便利等因子显著负向影响幸福感。(3)不同城市规模居民幸福感的人居环境主导因子有所不同,同时不同户口和年龄居民幸福感的人居环境影响因素也有差异。研究结果对促进长三角地区城市居民幸福感提升和指导城市人居环境建设具有重要的决策参考作用。