Table Of ContentMedical
GeoGraphy
T h i r d e d i T i o n
Melinda S. Meade
Michael emch
The GUilFord preSS
New york London
Medical GeoGraphy
© 2010 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, microfilming, recording, or otherwise, without written
permission from the Publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Meade, Melinda S.
Medical geography / Melinda S. Meade, Michael Emch.—3rd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-60623-016-9 (hardcover: alk. paper)
1. Medical geography. I. Emch, Michael. II. Title.
RA792.M42 2010
614.4′2—dc22
2009046573
preface
Much has changed in the world and in the discipline of geography since the sec-
ond edition of this text was published in 2000. For the most part, progressing glo-
balization has extended and intensified the processes of ecological simplification,
demographic transition, and cultural/economic/technological connectivity that
result in world patterns of disease. These and other processes and their impacts are
integrated in place, in region—in geography, which spatially analyzes and socially
explains patterns in cause of death and etiology of health or disease. This text is
about both geography as integration in place, and geography as spatial analysis.
Specific post-2000 changes worthy of attention here include the following:
• World population has grown to about 6.7 billion; its fertility rate has dropped
to 2.6 children; and its growth rate has decreased to only 1.2% a year. The richest
European countries (and Japan) have raised life expectancy to about 80 years, but
their birth rates have dropped so low that they have negative population growth
today. The youthful rural population that resulted from the high fertility rates of 20
years ago has picked up and headed for the cities, sometimes internationally.
• The poorest countries still have the highest mortality: More than 10%
of infants in these countries never reach their first birthday, and life expectancy
remains less than 50 years. A million of the poorest still die every year from tuber-
culosis, and another million from malaria.
• Whereas AIDS had just emerged before 2000, it now causes 2 million deaths
annually. About 30 million people are HIV-positive, with the highest prevalence
rates of about 25% in southern Africa. AIDS has become a modern global plague of
enormous demographic and social impact; however, we are little closer to a cure for
it than we were two decades ago. Although there has been great progress in devel-
oping treatments for this disease—enough that some people in the richest countries
v
vi preface
are starting to consider AIDS a chronic disease—there are huge disparities in who
gets the drugs.
• China has developed faster than any other society in history. It has completed
one massive project of environmental engineering (the Three Gorges Dam) and has
plans for others, all concerned with redistributing the flow of water from south to
arid north. There has been devastating environmental degradation associated with
this alteration, as well as industrial growth and insatiable coal burning.
• Other new diseases have emerged; old diseases have been redistributed; and
the basis for horrific epidemics of cancer and chronic diseases has been laid in a
world population no longer as young as it once was.
• What may be the first impacts of climate warming on human health have
been expressed in increasing drought conditions in arid lands and increasing flood-
ing and cyclone severity, which have already destroyed crops and villages and have
displaced tens of millions in sub-Saharan Africa and South Asia.
Health promotion has become the world theme. Biomedicine has been forced
off its pedestal. A genetic component has been discovered for many diseases; how-
ever, the environmental context for the expressions of those genes is more than
ever something that must be explored in order to understand the diseases’ complex
etiologies. Social science has developed an interdisciplinary theoretical perspec-
tive and a new vocabulary for addressing old processes. Geographic information
systems (GIS), with their ability to manage and portray spatial data, have become
the dominant tools in geography and have transformed the structuring of public
data and health analyses. Medical geography as a subdiscipline has become less
concerned with the optimization of health service delivery or a dichotomy between
health service and disease ecology (etiology). Instead, it has become increasingly
concerned with health geography as a behavioral and social construction, and with
disease ecology as an interface between the natural (physical world) and cultural
dimensions of existence.
This text still endeavors to provide a broad-based, comprehensive survey of the
rich diversity of medical geography for upper-division undergraduates and gradu-
ate students, while also serving as a sound reference for the complexities of classifi-
cations, processes, and systems. Our perspective remains holistic and international.
We still hope to provide the necessary biological background for geographers to
understand disease processes, as well as the necessary geographic background for
health researchers to understand spatial processes. Students who have used the
text in the past decade have included medical doctors pursuing doctorates in epi-
demiology; graduate students in geography working on their doctorates; graduate
students from such public health disciplines as epidemiology, biostatistics, health
behavior, nutrition, health administration, and public policy; undergraduate geog-
raphy majors; and premedical undergraduates with majors in chemistry or biology,
but little background in the social sciences or geography. It is difficult to meet the
needs of such varied students, with their different competencies in statistics, map-
ping, and geography. The vignettes (fewer than in past editions) offer focused dis-
cussions, usually of techniques or other topics that not all teachers will want to go
preface vii
into (in chapters). Some may want to teach the vignettes with chapters other than
the ones in which they are presented. We have added a chapter on GIS in health
and disease research, and have expanded the chapter on spatial analysis. We have
also added a chapter on neighborhoods and health, which is an area that has grown
exponentially during the past decade.
Something also needs to be said about references. We have attempted to write
a general textbook that can be read without the constant interruption of strings of
citations, most of which are publications themselves citing the common source of
an idea/term or general knowledge in a field (“It is hot in the tropics [x, 1958]” or
“The malaria plasmodia (schistosome, tick, etc.) has several life stages [y, 1999]”).
Where possible, we have referenced the seminal ideas and influential discussions,
not all of which represent the most recent applications of those ideas. Our references
are not meant to be comprehensive bibliographies of works in medical geography.
The approaches, information, or examples we have consulted (i.e., actually used in
writing the chapter) are listed under “References.” Students can usually identify
relevant material simply by its title. “Further Reading” contains relevant geographic
studies or foundations that have not actually been used in writing the chapter.
Some of the “Further Reading” entries were cited in past editions or are important,
somewhat parallel, works. Many of them are suitable for term papers and further
study. Finally, specific original ideas, quotes, or individual studies used for data are
specifically cited in the body of the text. Thus the chapter on disease diffusion has
more references than the others, because so many of the ideas, methodologies, and
research findings have been contributed by a few individuals, and so few of these
have yet become general knowledge.
Our hope is that this text will be a sound foundation for the future development
and practice of medical geography, and that it will inspire geographers and others
to bring their own special subdisciplinary knowledge and theoretical approaches to
enrich and advance this growing course of study. Finally, we wish to acknowledge
and appreciate the examples and even words in this text that belong to the three
coauthors of the first and second editions, John W. Florin, Wilbert M. Gesler, and
Robert J. Earickson, whose work has become an indistinguishable part of the text.
We also acknowledge Cameron Taylor, a University of North Carolina at Chapel
Hill medical geography undergraduate student, who helped with graphics, cartog-
raphy, and picture taking in Malawi.
Melinda S. Meade
Michael eMch
Contents
1. Questions of Medical Geography 1
What’s in a Name? 2
A Brief History of Medical Geography 9
Definitions and Terminology 17
The Challenge of Medical Geography 21
References 22
Further Reading 24
2. The human ecology of Disease 26
Health 27
The Triangle of Human Ecology 30
Transmission and Creation of Infectious Disease 44
Nutrition and Health 55
Conclusion 65
References 65
Further Reading 67
VIGNeTTe 2.1. BIoLoGICaL CLaSSIfICaTIoNS of IMporTaNCe To heaLTh 68
3. Maps and Geographic Information Systems in Medical Geography 73
Cartography of Disease 74
Types of Maps: Some Issues 77
Geographic Information Systems 83
Disease Maps on the Web 91
Conclusion 93
References 94
Further Reading 95
ix
