Breadth and depth in research on health disparities: commentary on the work of Nancy Krieger

Geocoding and spatial analysis of data describing populations and health events are important methods in health social science now carried out using GIS technology. This commentary considers Nancy Krieger’s work on health disparities in light of the various ways individuals and organizations use geocoded population and health data: analyzing spatial patterns of health and disease including health disparities, aggregating data spatially, assessing health status of individuals based on characteristics of aggregates, modeling neighborhood contextual factors affecting health, designing observation and intervention studies, and delivering health interventions and services. The extent to which her work addresses each of these purposes is considered. The strengths and limitations of the research including choice of spatial analytic units and techniques as reported in the published work are discussed. Krieger’s work, with her colleagues, has used standard methods of spatial analysis to raise the profile of GIS and spatial analysis in the public health community.     

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.     

Krieger’s conceptualization and measurement of discrimination and internalized oppression in studies of adverse health outcomes

Embodiment is a central concept in Krieger’s ecosocial theory, and is said to be of relevance to the understanding of the relationship between social conditions and a variety of adverse health outcomes. The most detailed empirical investigation of this in Krieger’s work is to be found in her studies of the relationship between racial discrimination and high blood pressure. Of especial relevance here is the idea of internalized oppression which is said to explain the observed association between self-reports of no racial discrimination and increased levels of blood pressure among working-class African Americans. Here we critically examine the empirical evidence pertaining to internalized oppression. Specifically, we focus on the measurement of the construct and the quality of the empirical evidence that has been presented in support of the hypothesis that there is an association between internalized oppression and adverse health outcomes. We argue that the validity of the concept has yet to be established and that the available data linking it to poor health outcomes are open to alternative explanations, notably measurement error and misclassification.

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Putting health inequities on the map: social epidemiology meets medical/health geography––an ecosocial perspective

To put on the map: according to the Oxford English Dictionary, whatever is so placed occupies “an important or prominent position” and is “of some account or importance.” In this brief commentary, I take the opportunity to reflect on several articles by medical/health geographers and others regarding our Public Health Disparities Geocoding Project and my research, as a social epidemiologist, on the myriad ways racism can harm health. In both cases, my work on these topics has been motivated by my desire, starting a quarter of a century ago, to put health inequities on the map: as a topic of public concern, research, and action. The insightful and informative points and questions raised by the geography-oriented articles underscore the importance of bringing the best of our respective disciplinary insights and expertise to illuminate the profound connections between social justice and public health, between our bodily truths and the body politic, so as to further the goal of embodying equity––in an ecologically sustainable world.     

On global forces of nature driving the Earth’s climate. Are humans involved?

The authors identify and describe the following global forces of nature driving the Earth’s climate: (1) solar radiation as a dominant external energy supplier to the Earth, (2) outgassing as a major supplier of gases to the World Ocean and the atmosphere, and, possibly, (3) microbial activities generating and consuming atmospheric gases at the interface of lithosphere and atmosphere. The writers provide quantitative estimates of the scope and extent of their corresponding effects on the Earth’s climate. Quantitative comparison of the scope and extent of the forces of nature and anthropogenic influences on the Earth’s climate is especially important at the time of broad-scale public debates on current global warming. The writers show that the human-induced climatic changes are negligible.     

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.     

Female newcomers’ adjustment to life in Toronto,Canada: sources of mental stress and their implications for delivering primary mental health care

Stress disorders and other mental ill health may be brought on by the disruption caused by resettlement. We examine female newcomers’ experiences of adjusting to a new place, metropolitan Toronto, Canada and a new health care system. We consider sources of mental stress experienced during adjustment. We frame this adjustment as a process that happens over place and through time. Thematic findings of interviews (n = 35) with female newcomers from five cultural-linguistic groups are reported. Sources of stress in adjusting to life in Toronto include: navigating a new place, personal safety concerns, adapting to a new lifestyle, and finding employment. Sources of stress in adjusting to a new health care system include: learning how to access care, not having access to specialists, and adapting to a new culture of care. We conclude by considering the implications of what newcomers report for the delivery of primary mental health care (i.e. ‘first contact’ care).     

Dodging alligators,rattlesnakes, and backyard docks: a political ecology of sweetgrass basket-making and conservation in the South Carolina Lowcountry,USA

There is growing recognition among political ecologists of the need to examine shifting natural resource regimes and their effects on livelihoods in “First World” places. This emerging literature has variously examined the “Third World within,” the persistence of “subsistence activities” in the “First World,” and the “reterritorialization” of land tenure and access. However, much of this work has tended to focus on traditional extractive industries in the American West, indigenous claims to lands and resources in the U.S. and Canada, and non-timber resources on public lands. In contrast, we use a case study of African-American sweetgrass basket-makers, associated with the Gullah culture, in South Carolina’s lowcountry to examine the ways in which ongoing amenity-driven residential development is fundamentally reshaping resource access on private lands. Historically, basket-makers harvested the materials (primarily sweetgrass or Mulenbergia filipes) needed for their culturally important art form from accessible, rural, and privately held tracts of land in close proximity to their communities, but development pressures and changes in resident interpretation of property rights has decreased access to basket-making resources. The case is particularly illuminating, as it examines the emergence of ‘conservation subdivisions’ in the region and raises important questions about what “rural uses” and users are being conserved through responses to exurban, suburban, and urban development in formerly rural areas.     

Young people’s voiceless politics in the struggle over urban space

This article discusses the particularity of young people’s politics as it unfolds in the practice of everyday life. By exploring a conflict concerning the use of a public park in the City of Oulu, Finland, we discuss how young people may participate in struggles over urban space trough politics that is not based on voice but voicelessness. This political engagement can be understood as a form of nonparticipatory politics that is easily left unnoticed—politics that shirks civic involvement, customary participatory practices and articulated resistance. We deem it important to acknowledge such action as political for two reasons. First, voiceless politics is a weapon of the weak: It is used when other political agencies are not feasible e. Viewing non-participation as apolitical will only further marginalize those who practice politics in such ways. Second, it is important to find ways of acknowledging nonparticipatory action because, while not commonly understood as politics, it is not easily bypassed in political struggles either. By distinguishing political aspects from young people’s urban behaviors, instead of hearing their presence as mere noise, provides tools for bringing their politics to the public agenda and thus developing more democratic urban spaces.     

Identifying China’s leading world city: a network approach

This paper reports our research on China’s world cities. Formal network analysis of air passenger linkages for recent years among China’s most populous cities and among many of the world’s largest cities allows us to identify the country’s leading world city from among the leading Mainland candidates, Beijing, Shanghai and Guangzhou. We theorize our findings about China’s world cities in relation to both global forces (and China’s increasing entanglement with them) and the policies and actions of the national state. We examine the national and global urban network through a longitudinal, two-level analysis of airline passenger travel for four time points between about 1990 and 2005. We show that Beijing was China’s leading world city at the beginning of the time period, a status it lost nationally in as early as 1995, and then globally 10 years later. On the other hand Shanghai became China’s leading world city, and it acquired this status first nationally in 2000, and then globally in 2005. The changing status of the Chinese capital corresponds to the country’s increasing involvement with the capitalist world economy. Shanghai’s ascendance as the leading world city in China may indicate that global forces have come to play an increasingly important role relative to that of the developmental state.

Atlanta’s urban heat island under extreme heat conditions and potential mitigation strategies

The urban heat island (UHI), together with summertime heat waves, foster’s biophysical hazards such as heat stress, air pollution, and associated public health problems. Mitigation strategies such as increased vegetative cover and higher albedo surface materials have been proposed. Atlanta, Georgia, is often affected by extreme heat, and has recently been investigated to better understand its heat island and related weather modifications. The objectives of this research were to (1) characterize temporal variations in the magnitude of UHI around Metro Atlanta area, (2) identify climatological attributes of the UHI under extremely high temperature conditions during Atlanta’s summer (June, July, and August) period, and (3) conduct theoretical numerical simulations to quantify the first-order effects of proposed mitigation strategies. Over the period 1984–2007, the climatological mean UHI magnitude for Atlanta-Athens and Athens-Monticello was 1.31 and 1.71°C, respectively. There were statistically significant minimum temperature trends of 0.70°C per decade at Athens and −1.79°C per decade at Monticello while Atlanta’s minimum temperature remained unchanged. The largest (smallest) UHI magnitudes were in spring (summer) and may be coupled to cloud-radiative cycles. Heat waves in Atlanta occurred during 50% of the years spanning 1984–2007 and were exclusively summertime phenomena. The mean number of heat wave events in Atlanta during a given heat wave year was 1.83. On average, Atlanta heat waves lasted 14.18 days, although there was quite a bit of variability (standard deviation of 9.89). The mean maximum temperature during Atlanta’s heat waves was 35.85°C. The Atlanta-Athens UHI was not statistically larger during a heat wave although the Atlanta-Monticello UHI was. Model simulations captured daytime and nocturnal UHIs under heat wave conditions. Sensitivity results suggested that a 100% increase in Atlanta’s surface vegetation or a tripling of its albedo effectively reduced UHI surface temperature. However, from a mitigation and technological standpoint, there is low feasibility of tripling albedo in the foreseeable future. Increased vegetation seems to be a more likely choice for mitigating surface temperature.     

Increasing public awareness of natural hazards via the Internet

NOAA’s National Geophysical Data Center is using state-of-the-art Internet tools for natural hazards education, public outreach, and access to natural hazards data. For example, NGDC acquires, processes, and provides access to geologic hazards event data that are useful in natural hazards risk assessment and hazards-related research. In addition, a collection of natural hazards slides and a teacher’s guide on volcanoes are available online. NGDC also created an online “Kids Hazards Quiz” to test the user’s knowledge of disaster safety information. An online Natural Hazards Data Resources Directory provides access to information and links to organizations that provide natural hazards data and information. Expanded access to these data and information by the public and researchers can increase public awareness of natural hazards, improve hazards research, and ultimately reduce the devastating impacts of natural disasters.     

Evidence of women’s empowerment in India: a study of socio-spatial disparities

Various national and international communities have addressed women’s issues and taken various efforts to empower them so as to enhance their social and health status and involve them in developmental activities. The Indian DHS survey (National Family Health Survey, 1998–1999) provides an opportunity to study women’s empowerment in India. The survey collected information on several dimensions of women’s empowerment from 90,303 ever-married women (ages 15–49), from all the states of India. Utilizing these data sets, four indices – household autonomy index, mobility index, attitude towards gender index and attitude towards domestic violence index – are constructed to measure the different dimensions of empowerment. Using these indices, the spatial and socio-economic and cultural disparities that exist within India are analyzed. Finally, an attempt is made to identify some important determinants for women’s empowerment using multiple logistic regression analysis. The results show that at the national level, 43% of the women have high household autonomy; 23% of the women have high freedom to move outside their home; 40% of the women have no gender preference attitude; and only 43% of the women defy domestic violence. But there are significant divergences in these indices of women’s empowerment across the different states and socio-economic and cultural settings within India. Women’s educational levels emerged as an important predictor for all the four dimensions of women’s empowerment. Additionally, media exposure and age have emerged as the important predictors for some dimensions of woman’s empowerment. This paper was presented by Prof. Kamla Gupta at the International Geographical Union Conference (IGU), held in Canada, 2002.     

Impact of satellite observed microwave SST on the simulation of tropical cyclones

The impact of realistic representation of sea surface temperature (SST) on the numerical simulation of track and intensity of tropical cyclones formed over the north Indian Ocean is studied using the Weather Research and Forecast (WRF) model. We have selected two intense tropical cyclones formed over the Bay of Bengal for studying the SST impact. Two different sets of SSTs were used in this study: one from TRMM Microwave Imager (TMI) satellite and other is the weekly averaged Reynold’s SST analysis from National Center for Environmental Prediction (NCEP). WRF simulations were conducted using the Reynold’s and TMI SST as model boundary condition for the two cyclone cases selected. The TMI SST which has a better temporal and spatial resolution showed sharper gradient when compared to the Reynold’s SST. The use of TMI SST improved the WRF cyclone intensity prediction when compared to that using Reynold’s SST for both the cases studied. The improvements in intensity were mainly due to the improved prediction of surface latent and sensible heat fluxes. The use of TMI SST in place of Reynold’s SST improved cyclone track prediction for Orissa super cyclone but slightly degraded track prediction for cyclone Mala. The present modeling study supports the well established notion that the horizontal SST gradient is one of the major driving forces for the intensification and movement of tropical cyclones over the Indian Ocean.     

Giant radio galaxies: Old long-lived quasars?

The properties of giant radio sources (GRS’s) are considered with the aim of identifying conditions contributing to their formation, using data from the literature, the Sloan Digital Sky Survey (SDSS), and the APM catalog. The optical and radio properties of normal-size radio sources, (≤1 Mpc), are compared. The following conclusions are reached. (1) The fraction of objects with broad emission lines among GRS’s with high-excitation spectra is the same as for isotropic samples of radio sources; in the framework of the “unified scheme,” this testifies to an isotropic distribution of angles between the radio jets of GRS’s and the line of sight, i.e., GRS’s do not represent a population of objects whose radio jets are in the plane of the sky. (2) Giant radio sources do not differ from normal radio sources in the distributions of various asymmetry parameters for their extended radio components; in the unified scheme, the similarity of the asymmetry distributions for giant radio galaxies and giant radio quasars suggests that the origin of the asymmetry of their extended radio components is inhomogeneity of the external conditions. (3) The observed powers of the radio jets of giant and normal radio sources do not differ, making it unlikely that the large sizes of the GRS’s are due to this factor. (4) The richness and character of the environments of giant and normal radio sources do not differ: giant host galaxies are found in both isolated fields and in clusters of up to Abell class 1 in richness. This argues against the idea that a low density of the environment is the only origin of GRS’s. (5) The relatively large fraction of radio sources with two pairs of extended radio components (so-called double-double radio sources) among GRS’s testifies that the lifetimes of GRS’s are approximately an order of magnitude longer than those of normal radio sources.Given the equal spatial densities of nearby (z < 0.1) GRS’s and FR II radio sources with powers P _{1.4 MHz} > 10²⁵ W/Hz, this indicates that ∼10% of FR II radio sources have lifetimes an order of magnitude longer, and evolve into GRS’s. (6) The small (∼0.1) ratio of the number of known GRS’s to the number of normal FR II radio sources, together with the observed spatial density of GRS’s at z ∼ 0.6, which is an order of magnitude lower than the predicted value, suggests that a considerable number of GRS’s were missed by surveys at z > 0.1, possibly due to observational selection effects because of their relatively low radio powers and radio surface brightnesses. (7) The absence of “double-double” giant quasars suggests that these objects have a shorter activity time scale than GRS’s. In an evolutionary scenario that is an alternative to the unified scheme uniting “radio loud” quasars and radio galaxies, radio quasars evolve with time into radio galaxies, and the observed relative number of radio quasars among the GRS’s (∼10%) can be interpreted as reflecting the existence of a long-lived population of “radio loud” quasars comprising ∼10% of all radio quasars, with such a population of long-lived radio quasars being the parent population for giant radio galaxies.     

Place,gender and the appeal of video lottery terminal gambling: unpacking a focus group study of Montreal youth

Youth gambling has become an important public health issue in Canada and elsewhere owing to the known associations between gambling and delinquency, family dysfunction and suicide. Modern electronic and virtual gambling activities like video lottery terminals (VLTs) may have particular appeal to youth who have been raised in social environments that are increasingly dependent on information and communication technologies. The main objective of the study was to explore why youth gamble and what makes gambling activities like VLTs popular to youth in the places where youth live, study and play. The research is framed within a population health perspective that recognizes the role of social and physical environments in influencing health-related behaviours. Group discussions were conducted with youth to explore the popularity and appeal of gambling and VLTs, and how gambling fits into the daily routines of youth and the spaces they occupy. Methodologically, this research was conscious of responding to calls in the literature to analyze focus groups as an interactive group process rather a collection of individual responses, and to exercise analytic rigour by explicitly making the research team’s positionality and the data collection process transparent. Group discussions revealed gender differences in the appeal of particular gambling activities with young males being more likely to discuss poker, dice, sports-betting and online gambling as exciting social activities, while females described lottery and scratch (instant win) tickets as fun solitary activities. Substantive results point to the need for interventions to address social aspects of gambling that appeal, in particular, to young males potentially through increased provision of healthier alternatives to social engagement and greater attention to young people’s use of space.     

Locating diversity: race,nativity and place in health disparities research

Nancy Krieger has been one of the leading voices in documenting how social ‘axes of difference’, including race, ethnicity and class make people vulnerable to poor health and limit their access to effective health care. We discuss the importance of ‘locating’ diversity in health inequalities research. This includes critically dissecting racial and ethnic axes into more nuanced social categories that incorporate differences based on immigration and other factors. It also involves considering how diverse population groups vary in their perception and use of space for health-related activities and exposures. Examples relating to immigrant populations’ health and access to health care are discussed.     

Memorial landscapes: analytic questions and metaphors

Over the past two decades, geographers have probed the intersection of collective memory and urban space. Their sustained interest in the subject reflects an understanding of the social condition of commemoration and the important role that space plays in the process and politics of collective memory. Along with other critical social scientists, geographers envision these public symbols as part of larger cultural landscapes that reflect and legitimate the normative social order. A review of the extant literature indicates that geographers scrutinize memorial landscapes through three conceptual lenses that may be understood via the metaphors of ‘text,’ ‘arena,’ and ‘performance.’ These metaphors are in turn mobilized through a series of analytic questions that serve to identify the interests served and denied by landscape ‘texts,’ the ‘arenas’ in which they are produced, and the ways in which they are enacted via ‘performance.’ This article’s synopsis of the subfield’s predominant metaphors and its attendant questions contributes to the ongoing cultural geographic project of articulating and implementing methods for interpreting landscapes as open-ended symbolic systems.

“This is the mess that we are living in”: residents everyday life experiences of living in a stigmatized community

This paper is part of a larger community health study aimed at delineating the determinants of health in Sarnia. The paper specifically investigates Sarnia residents’ daily lived experiences, perceptions of and responses to living within the St. Clair River “Area of Concern” (AOC) as designated by the federal government based on the hypothesis that relatively high levels of environmental pollution in the region are negatively influencing human health. Results from in-depth interviews (N = 27) show that residents of Sarnia are conflicted by the elevation of awareness about environmental health threats by being labelled within an AOC. Residents use their emotional and sensual experiences to adopt appropriate coping strategies to live within a contaminated community. In contextualizing their everyday lived realities, residents argued that living in an AOC demands personal acceptance of the conditions in Sarnia and awareness of “bad air days” to cope with pollution exposure. Yet, residents were not willing to abandon Sarnia because of their cultural, social, and economical attachments to the place they call home. These findings suggest the need for local health policies that incorporate local concerns and perceptions of how environmental pollution affects people’s experiences and well-being. There is a necessity to involve community members as central participants in the process of policy making.     

Canal-side highway in Ho Chi Minh City (HCMC), Vietnam – Issues of urban cultural conservation and tourism development

Since the city’s founding back in 1698 on the old Khmer city of Prei Nokor, rivers and canals have always been Ho Chi Minh City’s (HCMC’s) primary means of transportation. Despite the decline of the utilization of the city’s abundant waterways due to the increasing development of modern aerial services and more convenient roads, the HCMC’s canal-based urban form, with its water-based socio-economic structures that include port-boat-market activities and canal handcraft villages, still processes a rich cultural and religious diversity that dates back to the history of the city itself. Currently, developments in the city’s transportation systems are having a damaging impact on the canals’ cultural background. Rather than being recognized as a significant cultural asset that identifies the city, the canal system has been physically reorganized as the city’s drainage system and valued as only a supplementary landscape element; canal communities have been evicted, and canal built fabric has been removed due to recent canal-side transportation developments. To revitalize the urban cultural identity that is possessed by the canal system and to enrich it as a contemporary valuable layer in the city’s dynamic regional development, it is critical to implement cultural conservation and tourism in the development of canal-side transportation and supplementary projects in the canal vicinity.