The Dictionary of Human Geography

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(Doel and Segrott, 2004); psychotherapy and

counselling (Bondi with Fewell, 2003) –

alongside diverse retreats and centres offering

massage, yoga, nature therapies and many

other healing techniques. Attention is

prompted to the intimacy of embodied en-

counters performed through these sites of

non-mainstream health care (Conradson,

2003b, 2005b), but another option is to regard

the latter as servicing the new ‘health con-

sumer’ who can pick and mix from whatever

kinds of health care, medical or otherwise, are

available to them locally (or perhaps further

afield for the ‘health tourist’). Gesler and

Kearns (2002, ch. 8) discuss this issue of ‘con-

sumption, place and health’, and a further

direction might follow Michel Foucault’s

claims about ‘technologies of the self’ (Martin,

Gutman and Hutton, 1988) – alighting on

issues of personal, especially sexual, health –

when considering myriad instances of people

past and present workingontheir own health.

The French Revolution’s dream of complete

‘dehospitalization’ (Philo, 2000b) and everyone

becoming ‘their own physician’ has arguably

now come to pass – partly fuelled by govern-

ments cajoling populations into a ‘care of the

self’, partly bycapitalism’s courting of health

consumers – and the emerging geographies of

health care, exploding beyond the hospital

gates, signal a challenging new frontier for crit-

ical research. (See alsobiopolitics.) cpp

Suggested reading

Curtis (2004); Gesler (1992); Gesler and Kearns

(2002).

heartland Many core regions are referred to

as heartlands. For example, the Midwest of

the USA is often termed ‘the Heartland’,

with the implication that it is not only central

in a geographical sense but also foundational

in a normative sense, the place where the core

American values that come from thefrontier

process are to be found (cf.homeland).

The most important use of the term, how-

ever, was by British geographer Halford Mack-

inder (1861–1947). Mackinder argued against

the late-nineteenth-century belief that sea-

power was the basis for global supremacy.

Mackinder (1904) suggested that the re-

sourcesof a secure land-power could now be

moved around more easily with the develop-

ment of transcontinental railways. Further, he

proposed that the largest basket of resources

of what he termed the ‘World Island’ (europe,

asia,africa) lay in Eastern Europe and west-

ern Russia. The core of this region was

inaccessible by ocean-going navies. Gunboat

diplomacy was ineffective against it. Were

Russia, Germany or an alliance of the two to

prevail in this region, they could mobilize re-

sources that would make them invincible

rulers of the World Island and almost certainly

ultimate rulers of a World empire. Thus,

Mackinder’s advice to the leaders drawing up

a political map of Europe after the First World

War was: ‘Who rules East Europe commands

the Heartland: Who rules the Heartland com-

mands the World-Island: Who commands the

World-Island commands the World’ (1919,

p. 194). From this followed two main strategic

priorities: first, to separate the Soviet Union

and Germany with a viable network of buffer

statesand, second, to prevent the Soviet -

Union acquiring the string of warm-water

ports that would enable it to extend its land-

power on to the ocean-ways of the world. The

first of these was close to the state-building

that was attempted from the ruins of the em-

pires of Eastern Europe after the First World

War. The second of these was close to the

policies of Soviet containment that animated

thecold warafter the Second World War.

There have been many evaluations of Mack-

inder’s ideas. A favourable review that empha-

sizes Mackinder’s prescience is provided by

Parker (1982), while more critical reviews of

the central concepts ofrace,spaceand history

used in Mackinder’sgeopoliticsare provided

by Agnew (2003a) and Kearns (2006a; see also

Kearns, 2009). Advocates of the heartland

thesis believe that it expresses more or less time-

less relations between resources, space and mili-

tary strategy. Critics argue: that in modernwar,

land- and sea-power have ceased to be distinct

modalities; that far from being impregnable, the

heartland has actually been occupied by hostile

forces more than once in recent history (by the

French under Napoleon, and the Germans

under Hitler); that forceful relations between

states do not exhaust the forms ofinterna-

tional relationsand that ignoring peaceful

co-operation and multilateral institutions in

fact makes the resort to force more likely by

presenting it as inevitable; and, finally, that as

technology changes, new resources will be val-

ued and the geography of the competition for

resources will shift. Despite these criticisms, our

present hydrocarbon economy seems destined

to focus attention for some time to come on

parts of Mackinder’s heartland, with the

Caspian Basin still vital in theresource wars

between the world’s Great Powers.

It is clear, then, that Mackinder’s heartland

thesis has been very heavily cited and must

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HEARTLAND