Chapter 1
Introduction to Health and
Medical Geography
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Tim Brown, Sara McLafferty, and Graham Moon
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As an opening to this volume, we believe that it would be useful for readers to be
aware both of the rationale that underpins it and, perhaps a little more unusually,
of the process that led to its production; especially the critical role played by the
academic reviewers of the original proposal. The former is important because
the idea for the volume materialized out of the recognition that debates regarding
the constitution of the sub-discipline had re-opened (for an extensive review see
Andrews & Evans 2008). In reality this debate has been ongoing since Kearns’
(1993: 144) decisive intervention in the early 1990s, which saw the sub-discipline
rupture (albeit productively) along the now familiar lines of “health” and “medical”
geography. However, although most commentators agree that the scope and scale
of research conducted by scholars on both sides of this divide has expanded considerably and areas of intersection have increased, few agree upon the nomenclature
under which this endeavor takes place. Are we health geographers, medical geographers, post-medical geographers, or something else entirely?
This volume was initially conceived as a prime opportunity to reflect upon this
expansion, to highlight the variety of research that is conducted by scholars associated with the sub-discipline, and also as an opportunity to reflect further on the key
debates that had been taking place. This ambition is clearly demonstrated in the
opening paragraphs of the proposal that we submitted to the publishers for possible
inclusion in the Blackwell (now Wiley-Blackwell) Companions to Geography series:
The global strength of the sub-discipline is in part related to the shift away from its
traditional focus on disease ecology, disease mapping, and health service provision.
This change followed substantial debate regarding the sub-discipline’s apparent overreliance on positivism and quantitative methods, which was argued to limit its ability
to engage with themes important to theoretically minded human geographers: most
notably those influenced by the “cultural” turn. Arguably the result of this debate is a
more nuanced sub-discipline, one that is concerned with questions of culture and difference, inequality and power, representation and meaning. At the same time, health
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TIM BROWN, SARA McLAFFERTY, AND GRAHAM MOON
mapping and modeling has been reinvigorated by the application of GIS, multilevel
modeling and advanced spatial analytic methods and by its engagement with questions
of health inequalities, population health and environmental degradation. In sum, the
sub-discipline has emerged as one that now speaks to a much broader body of scholars
both within and beyond the discipline of Geography.
Clearly, the tenor of this passage reflects the hyperbole that is necessary to sell an
idea. However, when stripped of this excess, it should be apparent that the paragraph set out an image of a sub-discipline that had expanded beyond its “traditional,” and dare we say parochial, roots to embrace ideas and debates, notably
those associated with the “cultural” and “spatial” turns, that had become well
established within the wider discipline and beyond. Not to be seen as partisan, and
reflecting the expertise of the various editors, this all important opening statement
also acknowledged that the sub-discipline has made significant theoretical and
methodological advances in other areas, some of which might be regarded as being
more closely associated with its “traditional” foci. So, an image of a methodologically and theoretically rich sub-discipline, and one capable of speaking to a diverse
range of scholars located within and beyond the discipline of geography, was presented to the publishers and ultimately to the reviewers. Further, this difference was
reflected in the detail of the book, which was organized thematically, but with
chapters from differing ontological and epistemological perspectives positioned
adjacent to each other. For example, chapters on disease modeling and mapping
were closely followed by ones that would reflect upon the experience of living with
disease or being labeled as diseased.
Almost inevitably, the “vision” that we set out in our proposal was questioned;
the original organization of the volume, its coverage, its rationale, and so on, all
came under critical scrutiny. However, we recognize that the process of writing is
a relational one and the input from the reviewers was regarded as valuable; so
much of this critique was received with appreciation and taken up in subsequent
iterations. Why mention this in an introduction? Amongst all the critical commentary that we received, there was one observation that came as a surprise. We will
not quote this commentary directly, as this does not seem appropriate, however in
summary the reviewer felt that the proposal that we presented to the publishers
was in danger of re-enforcing, rather than seeking to relax as was our implicit
intention, the sub-disciplinary boundaries between health and medical geography
and, at the same time, disavowing research that sought to work across and rupture
them (notably here research that might be defined as “post-medical”). We were in
short accused, albeit very politely, of boundary maintenance (on which, see Douglas
1966).
If this thoughtful commentary on our original proposal is read alongside current
debates about the role of geography textbooks, and of course their authors/editors,
in maintaining, and legitimizing, particular disciplinary visions (e.g. Johnston 2006;
Hubbard & Kitchin 2006), and as such as a form of disciplinary politics, it might
be regarded as being critical indeed. It is, in part, for this reason that our introduction to this volume begins with this discussion. What follows is inevitably a reflection of our collective thoughts on the sub-discipline that we have seemingly
(re)constituted as being only “health” and “medical” geography, on the areas of
INTRODUCTION TO HEALTH AND MEDICAL GEOGRAPHY
3
research that we regard as being of particular significance to it, whether in the past,
present, or perhaps even in the near future, and on those topics that we believe
should coalesce within the individual themes that we have identified in the book.
Although this is the case, we do not regard this as an attempt at reifying a
particular “field of vision” or at demarcating what might be regarded as problematic sub-disciplinary boundaries. Rather, we responded to the reviewers by rethinking the ways in which the book would work, by considering how a broader range
of perspectives and positions could be incorporated within it without extending
the scope and scale of the book too far, and how we might acknowledge the
significance of both health and medical geography without being bound by the
restrictions that these two terms appear to connote. Further, we encouraged
the authors of the individual chapters to play their part. Thus, they were asked
not only to describe the current content of their particular sub-fields but, where
appropriate, to question the boundaries and limitations of them, to think about
where research has gone in the past and where it might go in the future, and to
use our guidance on the chapters as an indication of what might be covered but
not as a strait-jacket. In this sense, we have encouraged the authors to talk for
themselves.
A “Companion to Health and Medical Geography”
Though slightly altered and adapted, the main chapters in this volume continue to
be organized thematically and begin with “Debates in Health and Medical Geography,” which incorporates three chapters that seek to chart developments that have
taken place within the sub-discipline and includes chapters on “Health Geography”
(by Robin Kearns and Damian Collins), on “Medical Geography” (by Jonathan
Mayer), and a chapter entitled “Doubting Dualisms” (by Mike Dorn, Carla Keirns,
and Vincent Del Casino). For those already knowledgeable about such matters, the
inclusion of Kearns, Mayer, and Dorn appears particularly apposite. After all, we
have in these individuals the main protagonist for, and some of the key critical
commentators on, the emergence of a distinct geography of health in the early 1990s
(see Kearns 1993; Mayer & Meade 1994; Dorn & Laws 1994). There were, of
course, others already calling for a shift in perspective prior to Kearns’ groundbreaking paper (see for example Jones & Moon’s (1987) call for the establishing of a
“critical medical geography”); however, the debates that took place both at this
time and subsequently have helped to define the contours of the sub-discipline that
we see today.
What is interesting about these first three chapters is that they reflect upon and
offer a critique of these debates; though they do not dwell on them. Kearns and
Collins use this productive rupture in the sub-discipline to explain why it is that a
focus on health and place, especially one that foregrounds theory, remains such a
crucial element of what we do. As they argue, the importance of the turn to “health”
was its recognition that medical geography, as then conceived, tended to employ
geometric constructions of space that limited our understanding both of the ways
in which ill-health and disease (and for that matter good health) were experienced
and lived and what role “place” played in this regard (see also M. Brown 1995).
Their chapter offers much more than this, however; as they also trace the emergence
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TIM BROWN, SARA McLAFFERTY, AND GRAHAM MOON
of key and emerging themes within this sub-field: “wellbeing,” “criticality,” “risk,”
and “care” being chief amongst these. Kearns and Collins complete their chapter
with an air of caution; reminding readers that the ongoing concern with health, and
more recently with wellbeing, should remain a critical and place-sensitive endeavor.
Further, that in addition to whatever theoretical or intellectual interests that health
geography may pursue, it should remain committed to the dual concerns of equity
and social justice.
Some might regard Mayer’s account of “medical” geography as an all too
obvious attempt to counter-balance the chapter that precedes it; after all, it was
medical geography that Kearns (1993) called into question. Yet, Mayer’s is a much
more nuanced chapter than this. Indeed, from the very outset he questions the use
of the term “medical geography” as a sub-disciplinary nomenclature; noting that
there is actually very little that is “medical” about medical geography. In this sense,
he forces us to concede that the original name adopted for the sub-discipline was
perhaps a compromise and one whose origins are difficult to determine (what is
interesting here is that historians of medicine are as likely as historians of medical
geography to comment on the origins of this field of inquiry. See for example Rupke
(2000)). Further, Mayer offers a considered, and quite personalized, account of
the role that he and several colleagues played in the response to Kearns’ call for a
“post-medical” geography of health. Here he acknowledges that, in retrospect, it is
apparent that Kearns did not seek to confine medical geography to history but to
open up new possibilities and to more carefully define the intellectual territory that
some health geographers were concerned with.
This acknowledgement allows Mayer to take the chapter on “medical” geography in a range of fruitful directions rather than simply pursue what might be
regarded as rather sterile debate. To this end, he not only traces the intellectual
stimulus afforded the field by scholars such as Jacques May, Andrew Learmonth,
Mansell Prothero, and more recently Gerald Pyle, Neil McGlashan, Melinda Meade,
and, quite rightly, of himself, but he also highlights the ways in which shifts in
geographical methods and concepts have been adopted to great effect by current
practitioners. More specifically, Mayer notes that through their knowledge of, and
critical engagement with, disease ecology and with advances in spatial modeling and
mapping techniques, medical geographers, however defined, are able to make a
considerable contribution to the understanding of epidemic disease. Thus, medical
geographers are not only able to offer commentary on why it is that specific diseases
might occur in certain places but are also extremely well qualified to chart the
passage of diseases through time and across space.
The final chapter in this opening part builds on the previous two; however it
does so by engaging more critically with them. To this end, Dorn and colleagues
adopt a novel approach to their reading of the sub-disciplinary trajectories of both
“health” and “medical” geography. More specifically, they employ Foucault’s genealogical method to further disrupt, and bring into question, the authority of this
dualism. In using this approach, Dorn et al. do not attempt to trace lineages or
locate the intellectual origins of these two seemingly divergent pathways. Rather,
they present their endeavor as a productive enterprise, one that starts by problematizing the dualism of health and medical geography, and seeks to explore alternative
pathways and open up new ways of thinking. In this sense, then, they are critical
INTRODUCTION TO HEALTH AND MEDICAL GEOGRAPHY
5
of attempts to define too narrowly the boundaries of what is or is not “health” and/
or “medical” geography and to bring into question what they regard as key tensions
that exist in many accounts of these sub-fields. For example, that one is oriented
towards medicine and the other towards health, that one is scientific in epistemological terms and the other humanistic, that one is objective and the other subjective
and so on.
These “tensions” would, we are certain, be acknowledged by the authors of the
previous chapters. However, by employing a genealogical approach Dorn et al.
bring these tensions to the foreground and force us to try and think beyond, or as
they state, to doubt, the dualisms that we appear to have constituted for ourselves
and for our sub-discipline. It is with this spirit in mind that we encourage readers
to approach the remainder of the volume. It is organized, perhaps a little awkwardly, into a further four parts: “disease,” “health and wellbeing,” “public health
and health inequalities,” and “health care and caring.” However, as we have already
argued, readers should not simply seek to map these parts onto the sub-disciplinary
dualisms discussed by Dorn et al. It is not our intention to rehearse these dualisms
in this volume and this point should become apparent when the content of each of
the parts is read in more detail.
If we start with the part on “disease,” there are a total of seven contributions
with topics ranging from disease ecology (Oppong and Harold), disease mapping
(Rican and Salem), disease diffusion (Sabel, Pringle, and Schærström) and disease
modeling (Gould), to emerging and re-emerging diseases (Emch and Root), the
politics of disease (Donovan and Duncan) and the lived experiences of those people
affected by either chronic or infectious diseases (Del Casino Jr). Inevitably some of
these chapters align themselves more closely with “traditional” descriptions of
medical geography; however, when taken as a whole the part encourages readers
to consider the many and varied ways in which geographers approach this important
topic.
Further, this part, like all of the others, is not self-contained. The authors, to a
lesser or greater extent, talk across and blur its boundaries. For example, Oppong
and Harold’s discussion of disease ecology is picked up, albeit indirectly, in later
chapters that cover the close association between environmental risk and public
health concerns (Jerrett with Gale and Kontgis; Curtis, Riva, and Rosenberg) and
Del Casino’s chapter on the lived experience of disease might easily be read alongside the chapters on the geographies of care (Milligan and Power) and on complementary and alternative medicine (Andrews, Adams, and Segrott). Thus, although
we have tried to distinguish between the various fields that make up the subdiscipline we recognize that each is connected to the other in what should be
regarded as interesting and productive ways.
This attempt at encouraging critical dialogue between the chapters and across
the various parts of the volume is repeated throughout. In the following part, which
covers “health and wellbeing,” we have included six chapters and again there
is considerable diversity in topics. The part begins with a wide-ranging review of
the therapeutic landscapes concept by Allison Williams, and is proceeded by
chapters on sexuality and gender (Sothern and Dyck), impairment and disability
(Chouinard), mental and emotional health (Parr and Davidson), landscapes of
despair (DeVerteuil and Evans), and is brought to a close by Craddock and Brown’s
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TIM BROWN, SARA McLAFFERTY, AND GRAHAM MOON
contribution on the representation of healthy and unhealthy bodies. There is, of
course, a degree of interconnectivity amongst these chapters; however, there also
exists a good deal of (productive) tension. For example, where Williams tends to
foreground the health-promoting value of therapeutic landscapes, Davidson and
Parr point to the ways in which this logic was deployed, in quite specific historical
contexts, in support of the construction of asylums that were designed to separate
spatially the “mad” from mainstream society. Further, elsewhere in the volume we
are reminded that what remain for some as spaces of exclusion and containment
have once more been recast for others as therapeutic sites where stressed individuals
can seek solitude and respite from the world outside (see Andrews, Adams, and
Segrott).
In this part we are also encouraged to engage with many of the other forms of
dualism that are encountered in society: for example, between the healthy and
unhealthy, the normal and the impaired, and, perhaps most importantly of all,
between the male and female body. Here, Sothern and Dyck’s contribution stands
out because it not only highlights the ways in which health and illness are experienced differently by men and women but it also problematizes these very categories.
More specifically, they remind us that dualisms are socially constituted and refer
readers to the autobiographical writing of Jim Sinclair, whose intersexuality prompts
us to not only reflect on the meaning of gender but also on the powerful role that
medicine plays in defining and defending its very boundaries; a perfect example, if
any were needed, of why geographers should not lose sight of the need to engage
critically with medicine.
Clearly, the chapters in this part take us much further than this brief discussion
of dualisms allows for and each illustrates how our understanding of health and
wellbeing has been enhanced considerably by the application of critical thinking. In
Chouinard’s chapter we are presented with a comprehensive account of the contribution of critical social and feminist scholarship, which, inspired by the disability
rights movement, enabled us to move beyond medical models of disability. Davidson
and Parr build upon this chapter and chart the sub-discipline’s engagement with
mental health and emotional geographies, and they demonstrate the significance
that the “spatial turn” in theory has had in this regard. They finish by suggesting
that there is a need to explore the limitations of contemporary social policy, especially with regards to the notion of social inclusion. This call is, to some extent at
least, taken up by DeVerteuil and Evans whose chapter on “landscapes of despair”
highlights the potentially negative outcomes of poorly thought out social policies
that reposition care in the community.
As we note above, we do not regard these as self-contained parts but recognize
that they talk to each other. Craddock and Brown’s contribution is a good example
here. Not only could it be read alongside the chapters on disease in the previous
part but it also speaks to the discussion that takes place in the following part, which
covers public health and health inequalities. After all, their exploration of the
ongoing relevance of social constructionist theory to the sub-discipline focuses on
historical and contemporary representations of diseased/sick and healthy/well
bodies. Importantly, such concern invites critical reflection on key ethical and moral
questions regarding the ways in which certain bodies are normalized and others
stigmatized, whether because of their shape, size, or appearance (e.g. the fat or obese
INTRODUCTION TO HEALTH AND MEDICAL GEOGRAPHY
7
body) or because of the social and cultural values associated with the acquisition
of specific types of disease (e.g. tuberculosis or syphilis). Though the questions raised
by Craddock and Brown are, in some ways, quite distinct from those that we
encounter in the part on public health and health inequalities, they do share in
common an ongoing interest with the issues of equity and social justice, which are
regarded as so important by Kearns and Collins.
Opening with an extensive review of the association between health geography
and public health (Curtis, Riva, and Rosenberg), this part goes on to examine
a range of topics: “migration” (Boyle), “health inequalities” (Kulkarni and
Subramanian), “neighborhoods and health” (Ellaway and McIntyre), “environmental risk” (Jerrett with Gale and Kontgis) and “environmental risk perception and
neighborhood response” (Elliot), “health behaviors” (Twigg and Cooper), and
finally “governance, risk, and health” (Brown and Burges Watson). Though diverse,
empirically and in some cases epistemologically, this collection of chapters reflects
the scope and scale of geographers’ engagement with public health issues. As Curtis
et al. reveal, this engagement, like much else within the sub-discipline, has long
roots and could, if we were so minded, be linked to the work of the Victorian sanitary reformers or even to Hippocrates’ On Airs, Water and Places. The connection
here lies in a shared concern with the “environment” or, more precisely, with the
idea that diseases, whether infectious or chronic, are a product not only of a person’s
behavior but also of the interaction of people with their environments.
This interconnection is, perhaps, most explicitly outlined in the two chapters
that focus on environment and risk. In the first of these, Jerrett and colleagues
review trends in what they refer to as “environmental health geography.” In addition to outlining key theoretical and methodological developments that have taken
place within this field, the authors draw on the concept of environmental equity
or justice as a means to frame their discussion of research that explores the healthrelated consequences of inequitable exposure to environmental toxins. As they
demonstrate, a geographical perspective is not only invaluable to exploring the
impact of such exposures in the present but, because of advances in statistical
methods and spatial analysis, can help understand the significance of potential risks
in the future; most notably here the possible implications associated with global
climate change. Although similarly focused on environmental risks, Elliot’s contribution is quite distinct from Jerrett and colleagues. Here, an understanding of the
close interrelationship between environmental pollution and human health remains
important; however, Elliot shifts attention to the individual and community
responses to such exposure. In so doing, she reveals that the impact on human
health of such exposure can be manifested in both physiological responses (e.g.
increased rates of cancer) and psychological terms (e.g. increased rates of chronic
disease).
Of the remaining chapters in this part, Ellaway and McIntyre’s is the one that is
most clearly concerned with the association between environment and health.
However, their contribution extends our view of the environment to incorporate,
more obviously, what might be referred to as the “social” as well as the physical
environment. This chapter also directs the reader to key debates that have been
taking place within the sub-discipline, notably that relating to the idea that it is not
simply “who we are” (composition) but “where we live” (context) that affects our
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life chances. Drawing on their extensive research in this area, Ellaway and McIntyre
provide a comprehensive overview of current research on this topic and cover such
important issues as deprivation, ethnicity, and gender. It is worth noting here, that
they also highlight research that is specifically concerned with children and young
people (which the editors acknowledge is an area that is underserved by this volume,
especially given the recent growth in the sub-field).
Closely related to this contribution are the two chapters by Twigg and Cooper
on “health behaviors” and by Subramanian and Kulkarni on “social inequalities in
health.” Though related, both are, of course, quite distinct. In the former, Twigg
and Cooper consider how geographers have approached the question of healthrelated behaviors. As they note, the particular, and perhaps even unique, contribution made by geographers to this sub-field is their recognition that such behaviors
(whether related to diet, physical activity and exercise, tobacco consumption, and
so on) are influenced by place and space. In making this observation, Twigg and
Cooper build quite explicitly on the ideas of “context” and “composition” discussed
by Ellaway and McIntyre. However, their chapter extends this discussion by providing a wide-ranging review of the influence that advances in statistical modeling, and
especially multi-level modeling, have had. That said, Twigg and Cooper do not limit
their intellectual gaze to the quantitative side of the sub-discipline, as they finish
their chapter with some thoughtful observations on the potential value of other,
more qualitatively oriented, approaches to enhancing further our knowledge in this
area.
In the chapter by Subramanian and Kulkarni we also have a contribution that
seeks to engage critically with current debates. The authors deliberately distinguish
between “health inequality” and “social inequalities in health” because the latter
reflects their explicit concern not only with the social factors and conditions that
explain disparities in health but also with issues of fairness and justice. This chapter
is not, then, simply a review of previous research, but it is an attempt to reconceptualize an already extant idea. In seeking to reposition inequalities in health
research in this way, and especially by turning to Bourdieu’s notion of relational
interaction (see also Dunn & Cummins 2007; Cummins et al. 2007), Subramanian
and Kulkarni highlight the ways in which the sub-discipline continues to interact
with, and engage in, debates taking place in the social sciences more broadly.
This is perhaps no surprise given the current and past disciplinary affiliations of
these particular authors. However, it is an observation that is pertinent to many
other chapters in this volume, including those by Boyle and Brown and Burges
Watson, which open and close this part respectively. In the former of these, Boyle
builds on the “mobility turn” in the social sciences to discuss the significant impact
that population movement has on health. Boyle’s is an extremely nuanced chapter.
He opens with an account of the ways in which mobile populations have historically
been represented as the harbingers of epidemic disease and, as such, have been prone
to often exclusionary and stigmatizing discourses. Here there are clear overlaps with
the chapter by Craddock and Brown. However, once established, he moves beyond
the representational to consider how the migration of people impacts upon our
understanding of the distributions of disease and exemplifies this through reference
to a wide array of research.
In the chapter by Brown and Burges Watson, we return to the question of healthrelated risk, which either implicitly or explicitly runs throughout many of the con-
INTRODUCTION TO HEALTH AND MEDICAL GEOGRAPHY
9
tributions in this part of the volume. However, for these authors, the question is
not so much about defining the factors of risk that shape people’s health in the
present/future but considering the implications of this in terms of the Foucauldian
concept of governmentality. Put differently, they seek to problematize the ways in
which ideas relating to health and wellbeing are made visible through factors of risk
and are mobilized as a form of (self) governance within contemporary society. Thus,
although quite distinct from other contributions in this part of the book, and
perhaps more generally, the chapter encourages geographers to think carefully about
their scholarly endeavor and suggests that there is scope for critical reflection even
in the seemingly universally accepted search for health and wellbeing.
The volume is brought to a close with a part on “health care and caring,” which
alongside chapters on such “traditional” concerns as “health care provision”
(Barnett and Copeland), “location-allocation planning” (Tanser, Gething, and
Anderson), and “access to health care” (Ricketts) includes chapters that focus on
much more recent areas of concern, such as the “geographies of care and caring”
(Milligan and Power) and “complementary and alternative medicine” (Andrews,
Adams, and Segrott). In making this observation, we do not imply a pejorative
reading of the “traditional” rather we merely seek to highlight the expansion – in
empirical focus, theoretical influence, and methodological approach – that has taken
place in recent years. Of course, such change is not limited to differences that might
be apparent between the individual chapters but is also reflected in the ideas that
are explored within them.
We begin this final part, then, with Barnett and Copeland’s chapter on health
care provision. This chapter offers an in-depth and comprehensive review of key
changes that have taken place in national health care provision over the last twenty
years or so. However, as the authors note, this particular sub-field, has shifted from
studies that employed such notions as the “inverse care law” or “distance-decay”
to search for “universal empirical regularities” in the provision of health care to
those that recognize the influence of a changing socio-economic landscape, of shifts
in governmental ideology, and of place more broadly on patterns of health service
delivery. Such intellectual manoeuvres do not deny the important contribution that
earlier research has made, and in some instances continues to make; however, they
do help us to identify what might be regarded as the significant gaps in, and limitations of, such studies.
This point is also reflected in the contributions by Ricketts and by Tanser et al.
In the former, Ricketts maps out the development of the key theories and concepts
associated with access to health care research. As he reveals, in its narrowest sense,
access might be considered simply in terms of “distance to care”; that is, as a
measure that employs a Euclidean measure of distance. Clearly, access to care
cannot be regarded as simply a spatial problem and, as Ricketts observes, the
concept has been thought about in increasingly broad terms: whether in relation to
the impact that larger societal forces have on health care systems, the positioning
of access to health as a measure of social justice, or the ways in which individual
and/or societal belief systems influence patterns of health service use. However, even
though models have been developed which seek to capture this much broader
understanding, Ricketts notes that many still fail to reflect the ways in which access
is embedded in the complex reality of people’s everyday lives. For Ricketts this is
important because we need to recognize that access is as much about the cultural
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and social practices that influence and shape people’s health-seeking behaviors as it
is about the spatial location of the static structures that make up a health care
delivery system.
To some extent, the “messiness” that Rickett’s describes is also acknowledged
in the following chapter by Tanser et al. However, in their contribution the main
focus of attention is on the development of GIS models that allow geographers to
capture, at least some, of this complexity. Indeed, what Tanser and colleagues
present is a quite detailed explanation of the value of GIS to the problem of locationallocation planning, especially in resource-poor countries where researchers face a
host of other issues, not least amongst which is access to appropriate data. A further
feature of this, and for that matter Ricketts’ chapter, is the emphasis placed on
policy relevance. What is especially interesting here however is also the recognition
that using such techniques as GIS does not necessarily result in health care facilities
being located in what might be regarded as the optimum locations. As Tanser et al.
note, (local) politics and other factors such as economic viability strongly influence
the decision-making process.
Although, as we have indicated already, the last two chapters in this part cover
quite different aspects of “care,” they do, of course, share a common interest in the
concept and how it has been deployed and researched by geographers. In the first
of these chapters, Milligan and Power are primarily concerned with recent discussion about the ethics of care and with the ways in which changing welfare regimes
are implicated in the process of shifting “care” from institutional to family/
community settings. Clearly, the kinds of settings referred to in this chapter are
quite different to those explored both by Ricketts and by Tanser and colleagues.
However, when combined with the contribution from Barnett and Copeland, what
we are provided with in this chapter is a clear insight into the impact that the ideological landscape within which decision-makers operate has had both on the idea
of where responsibility for care and caring lies, on the places within which care
should, and increasingly does, take place, and upon the interrelated question of who
is providing such care (whether informally or formally for example in the so-called
“third sector”). Thus, although debates around access to, and location of, care
overlap with this particular research agenda the principal focus of it lies with these
interrelated issues.
Clearly, this chapter extends our understanding of “care and caring” in interesting and important ways. So too does the chapter by Andrews, Adams, and Segrott.
As these authors reveal, the practice of health care, at least as far as it is experienced
in the formal sector of most advanced industrial nations, increasingly involves
therapeutic practices whose origins lie either in “traditional” medicine and/or
outside the boundaries of western biomedicine. It is upon developing an understanding of the scope and scale of these complementary and alternative practices, and
how we might begin to engage, theoretically and empirically, with them, that
Andrews et al. focus. Of particular importance is research conducted under the
general banner of the therapeutic landscapes concept, which emphasizes forms of
healing that lie well beyond the scope of the biomedical model. However, as
Andrews and colleagues demonstrate, there is also a recognition in recent research,
that the growth of these particular forms of (self)care are also associated with wider
geographies of production and consumption.
INTRODUCTION TO HEALTH AND MEDICAL GEOGRAPHY
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We end our introduction here and will now let the individual authors talk for
themselves.
References
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