The Dictionary of Human Geography

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medical geography A concern for ‘medical

geography’ has been around for centuries,

since Hippocrates, the Ancient Greek scholar

associated with the origins of modern

medicine, stated the importance of ‘airs,

waters, places’ as an influence on human

health, achievements and history. Such an en-

vironmental perspective has prevailed in many

situations over the centuries, supplemented on

occasion by a spatial perspective, and nowhere

more obviously than in the celebrated case of

Dr John Snow in mid-nineteenth-century

London. Snow ascertained from empirical ob-

servations on the spatial distribution of cholera

outbreaks something about the causal factors,

contaminated water from a particular pump,

within the transmission of this malaise. It is

easy to detect the deep historical roots of med-

ical geography, then, as a particular way of

connecting many dimensions of human ill-

health to a variety of environmental precondi-

tions through the analysis of spatial patterns

(revealing something about causes or vectors

of transmission).

In more recent times, formalized in the First

Report of the Commission on Medical Geog-

raphy to the IGU (May, 1952), a sub-discipline

of medical geography has arisen within aca-

demicgeographyand on the fringes of medical

and related sciences. Prompted by contribu-

tions by the likes of May (1958) and Stamp

(1964), the sub-discipline flourished, becoming

the basis for research groups organized nation-

ally (e.g. the AAG Medical Geography Special-

ity Group; the CAG Health and Health Care

Study Group; the RGS–IBG Geography of

Health Research Group) and with an inter-

national profile through the IGU Commission

on Health and the Environment, International

Medical Geography Symposia held since the

1980s, its own specialist journalHealth and

Place(founded 1995) and enduring prominence

in the leading interdisciplinary journalSocial

Science and Medicine. Periodic worries have

plagued the identity of the sub-discipline, how-

ever, with some objecting abouttooclose a link

with the concepts and practices of Western bio-

medicine, thus failing to take seriously alterna-

tive and ethno medicines rooted in quite other

personnel, practices and places (Gesler and

Kearns, 2002). Some (esp. Kearns, 1993; cf.

Mayer and Meade, 1994) have speculated

about the need for a broader characterization

of the field ashealth geographyor even ‘post-

medical geography’, where health is defined as

more than just the medically ascribedabsenceof

illhealth and health care as more than conven-

tionally designated ‘medical’ interventions

(Gesler and Kearns, 2002, p. 9; Parr, 2002: see

health and health care).The conceptual bor-

rowings and methodological practices of the

sub-discipline have also varied through time,

with anempiricistandpositiviststream deploy-

ing quantitative, modelling and GIS techniques

being gradually supplemented – and on occa-

sion challenged – by a diversity of approaches

derived from Marxianpolitical economy,

humanism, post-structuralism, feminism

andqueer theory(Litva and Eyles, 1995;

Philo, 1996; Milligan, 2001, Ch. 9; Parr, 2002).

It is often suggested that medical geography

splits into the ‘twin streams’ of ‘geographical

epidemiology’ and ‘health systems planning’

(Mayer, 1982), or ‘geography of disease/ill-

health’ and ‘geography of health care’ (Litva

and Eyles, 1995); although Gesler and Kearns

(2002, p. 8) respond that these streams ‘have

increasingly merged and. .. become more

like a braided river’. One broad trajectory –

connecting with population geography’s

interest inmortality and morbidity – has

studied geographical variations in ill-health at

a range ofscalesfrom the global to the local,

examining many different manifestations of ill-

health for evidence of clear patterns in maps of

prevalence and impact. Initially the interest

here was disease, with the earliest studies con-

centrating on the obvious ecologies of diseases

such as malaria in tropical settings (Pelzer,

1957, pp. 335–43: with links back to the colo-

nial origins of geography), but with subse-

quent studies soon considering all parts of

the globe (Howe, 1977). The ‘natural’

environment, in all of its climatic, topographic,

fluvial, pedological and vegetative complexity,

was inspected for its correlations with different

diseases – chiefly those known to be infectious

(tuberculosis, smallpox, influenza, HIV–

AIDS), but also those with less certain aetiolo-

gies (the cancers, heart conditions, bone and

nervous disorders) – creating an approach to

medical geography readily positioned within

the orbit of tracing human–environment rela-

tions (May, 1958; Learmouth, 1988; Meade

andErickson,2000;Curtis, 2004, Ch. 6). An

offshoot here shifted to a more narrowly con-

ceived spatial epidemiology, building from

basic mapwork to more advanced spatial–

statistical techniques modelling the time–

spacediffusionof contagious illnesses (spe-

cifically influenza and HIV–AIDS) from

person to person, place to place and through

settlement hierarchies (Gould, 1993; Cliff,

Haggett and Smallman-Raynor, 2004: for

a rather different/critical take, see Brown,

1995 – anddisease, diffusion of). Human

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MEDICAL GEOGRAPHY