The Dictionary of Human Geography

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of this story has also been the growing com-

modification of health care, turning it into

something that ‘customers’ elect to ‘consume’,

quite likely using their (or others’) capital in

the process, not a bundle of resources avail-

able to them as matter of right. The ‘selling’ of

medical facilities, loosely equivalent to the

marketing of places discussed by urban geog-

raphers, has become a sub-theme in the

ongoing research of Kearns and co-workers

(Kearns and Barnett, 1999; Curtis, 2004,

pp. 125–33).

On a different but related tack, researchers

have explored more cultural aspects of health

care (Gesler, 1991; Kearns and Gesler, 1998;

Gesler and Kearns, 2002), prompting enquir-

ies into various cultural influences – the

‘thought-worlds’ of given societies, as well as

everything from buriedideologiesthrough to

the discursive scripting of health policies –

that play out in the geographies of health

care. Attention is paid to how agendas of

power, control, medical authority and fiscal

efficacy translate into the form, content and

spaces of medical facilities, helping to explain

location patterns (within overall systems),

environmental associations (of particular facil-

ities) and even architectures, decorations and

layouts (of, say, hospital wards). At the latter,

distinctly human scale, focus alights on the

embodied relations between the ‘medics’ and

the ‘medicalized’, and on how such relations

are shaped by and performed across an array

of in- and out-patient spaces of treatment,

illuminating how both the power of the former

is extended and the possible agency (maybe

resistance) of the latter is expressed. This

also means taking seriously the grounded

experiences of the people involved, establish-

ing how they perceive, feel about and under-

stand what is occurring within spaces of health

care, and recognizing the tensions that can

fragment professional and lay judgements

about what makes the best kind of ‘place’ for

the delivery of the health care required

(Milligan, 2001). Tellingly, this research strand

begins to press at the limits of what is conven-

tionally meant by ‘health care’, and has started

to consider more ambiguous landscapes of

health care – what Gesler (1992) has termed

‘therapeutic landscapes’ – wherein all manner

of phenomena (mountains and springs, streets

and malls) can be significant in how they pro-

mote or undermine senses of healthfulwell-

being for those who access them. A further

elaborationisworkonhealthpracticesthat

possess an awkward relationship to Western

biomedicine – that is, complementary and alter-

native medicines, as well as the diverse forms of

psychotherapy and counselling – which then

suggests a still more inclusive interest in ‘geog-

raphies of care’ (Conradson, 2003a) wherein

the overtly medical element is largely left

behind (and a large step is taken towards that

post-medical geography speculated about by

Kearns, 1993). cpp

Suggested reading

Curtis (2004); Gesler and Kearns (2002);

Kearns (1993); Meade and Erickson (2000);

Parr (2002).

megacities Very large, high-density urban

centres, usually defined as those with popula-

tions exceeding 5 million. The International

Geographical Union MegaCity Task Force

(http://www.megacities.nl/) identified only

four such centres in the 1950s, but 28 in 1985

and 39 in 2000: it estimates that there will be 60

by 2015. Most of these are in the ‘developing

world’ (especially East and South Asia and

latin america), are growing extremely rapidly,

and face major problems ofinfrastructure

provision and social inequalities. rj

Suggested reading

Hall and Pain (2006).

megalopolis A Greekword (combiningthose

for ‘great’ and ‘city’) coined by Patrick Geddes

and adopted by Jean Gottmann (1915–94: see

Gottmann, 1964) to describe the discontinuous

urban complex of the USA’s northeastern

seaboard. It was also used some decades before

by Lewis Mumford (1895–1988): to him,

megalopolis was the end-state in the process of

urbanization, in which giant, fragmented cities

become dysfunctional, whereas Gottmann

deployed it as a descriptive label for extensive

urbansprawl. rj

Suggested reading

Baigent (2004).

memory An inherently geographical activ-

ity:placesstore and evoke personal and col-

lective memories, memories emerge as bodily

experiences of being in and moving through

space, and memories shape imaginative

geographies and material geographies of

home, neighbourhood, city, nation and

empire. human geography includes an

important body of work on the role of the

built landscape – museums, monuments, arte-

facts, heritage sites – in creating a sense of a

common identity through memory, on how

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MEMORY