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movements obviously shape such diffusion
patterns, and some time ago Maegraith
(1969) mused on what ‘jet age medical geog-
raphy’, speeded up by the pace of world-
wide travel andmigration, might eventually
look like.
This first stream of medical geography has
been complicated by a concern with facets of
ill-health for which themetaphorof disease is
arguably less relevant, things such as malnu-
trition, obesity and stress, and extending to the
vexed domain of ‘mental illness’ (as in Giggs,
1973, recognized as a classic of medical geog-
raphy: seedisability). Aspects of the social
environment have also begun to feature, call-
ing attention to phenomena such as employ-
ment, income, housing quality, lifestyle issues
and related factors that predispose the ill-
health of (certain) peoples in (certain) places,
and demanding that medical geography foster
dialogues with the likes ofsocial geography,
urban geographyand other sub-disciplinary
geographies (a decisive point made by Hunter,
1974; also Mayer and Meade, 1994). Add-
itionally, as Dorn and Laws (1994, p. 107)
underline, it becomes important to register
the humanbodyas more than just ‘a host to
some lesion or pathology waiting to be ‘‘dis-
covered’’ by the medical practitioner’, and
thus to recognize the variability of the human
body, complete with differing material circum-
stances and cultural ascriptions bound up with
its particular place in socio-spatial hierarchies
of difference (Dear, Wilton, Gaber and
Takahashi, 1997). Variable configurations of
the body, marked byclass,ethnicity,gen-
der,ageing,sexuality, being a traveller or a
refugee and so on (as discussed by Curtis,
2004, chs 3 and 4; see also Gesler and Kearns,
2002, Ch. 6), explain the greater or lesser
likelihood of (certain) population cohorts in
(certain) places ‘getting sick’, being interpreted
as ‘sick’ and in need of assistance or avoid-
ance, or as themselves being the possible
sources of ‘sickness’ in others (as happened
with the Chinese in nineteenth-century San
Francisco: Craddock, 2000a). The emerging
picture hence becomes less the hypothesized
causal relations between easy-to-define envir-
onments, stable resident populations and their
ill-health indicators, maybe cross-cut by the
migrations of people bearing diseases, and
more a mosaic of ‘health inequalities’ traced
out across diverse, multiple and fluid bodies
and places, wherein ecological influences enter
into entangled admixtures alongside ones
more obviously social, cultural, economic
and political in origin (Curtis, 2004: echoingEyles and Wood, 1983; Jones and Moon,
1987; Gesler and Kearns, 2002). Further
challenges are posed by Smith and Easterlow
(2005) when critiquing the ‘strange geogra-
phies’ of health inequalities research that
emphasize how places determine (variable
resilience to) death and disease, butneglect
how such placed ill-health is itself bound into
a more systematic operation of ‘health dis-
crimination’ – notably within labour and
housing markets – fundamental to ‘the struc-
turing of society and space’ (a thoroughly
compositional matter, not a mere contextual
effect).
The second stream of medical geography,
concerned with health care as linked into
health systems and planning, appeared in the
1960s when researchers began to study the
spatial distributions of medical facilities.
Questions were asked about spatial regularities
in the locating of both hospitals of various
kinds (Mayhew, 1986) and surgeries run by
GPs, dentists and other primary service-
providers (Curtis, 2004, 133–43), as linked
to the accessibility and utilization of such faci-
lities (Joseph and Phillips, 1984), and spatial
mismatches were identified between provision
and demand as a potential input to the more
efficient spatial planning (location-allocation
modelling) of healthcare systems (Clark,
1984). More recently, it has been argued that
the basic geometries of health care cannot be
explained solely by the principles advanced in
spatial sciencebut, rather, by recognizing the
competing pressures on health managers in
choosing where to locate facilities which arise
from a wider socio-economic landscape that is
itself unevenly constituted at a range of spatial
scales (Mohan, 2002). Beyond such decisions,
moreover, researchers have explored the polit-
ical economy of health care, whether delivered
by thewelfare state(a public sector sup-
posedly guaranteeing equality of access to
all), an emergingshadow state(comprising
voluntary-sector involvement) or an increas-
inglyneo-liberal statein whichallactors
are compelled to pursue private-sector prin-
ciples, entering or creatingmarkets(internal
or otherwise) to ensure competition and effi-
ciency gains,andaiming at deregulation (even
as legal–administrative demands are continu-
ally reinserted). More baldly, ‘there has been
explicit recognition by health geographers of
the underlying social forces that create inequ-
alities, often expressed in terms of the impact
of the capitalist economic system on health
care provision’ (Gesler and Kearns, 2002,
p. 51; see also Jones and Moon, 1987). PartGregory / The Dictionary of Human Geography 9781405132879_4_M Final Proof page 452 1.4.2009 3:19pmMEDICAL GEOGRAPHY