Ageing in Place, Ageing in Space: Proposal for a Joined-Up System

PresenterHamish Robertson

PhD CandidateAustralian Institute of Health Innovation

University of NSW

Contents

• Introduction• Why space matters• Theorising space and place • Spatial linking of complex systems• Some illustrations• Social policy domain is always spatial• Conclusion

Introduction

• Ageing is an increasingly global phenomenon – how do we manage/work with the global and across multiple scales of experience?

• Space and place involve multidisciplinary perspectives and, often, antagonistic positions

• Health and social services make limited use of currently available spatial science and technology

• A spatial perspective offers a solution to working with current and emergent trends including highly complex and dynamic fields like ageing

Why Spatial Knowledge Matters

Theorising Space and Place

• ‘Space’ is a deep, complex and interdisciplinary concept (space, time, spacetime etc) – ontological and epistemic effects of use and non-use (Massey, 2005)

• Foundational to human experience including cognition and behaviour – neurobiology to evolutionary and cultural development (Clarke, 2011)

• Maps and mapping precede human literacy by millennia – spatial awareness, cognition, memory and abstract reasoning

• Place is more than a proxy for location – philosophy to geography and more (Entrikin, 1992; Cresswell, 2004; Malpas, 2006)

• Place(s) as multiple, affective, relational, diverse and multidimensional, multi- and cross-cultural -> diverse

• So why is spatial knowledge still so weakly developed in health and ageing policy, research and practice and what does its integration (potentially) offer?

Why Space Matters in Ageing

• People – environments, diversity, composition, health status, supports etc – all unevenly distributed in space

• Health system – complex, variable, volatile, also unevenly distributed in space

• Social support system – formal and informal structures and human resources (see above)

• Extensive micro and macro system factors to consider e.g. climate change and increased variability in local/regional/national weather patterns

• Space as a context (dimension) for the integration of complex systemic knowledge, planning and preparedness

Practical Mapping and Analysis

• Modern mapping is digital and mathematico-statistical (Berry calls this ‘map-ematical’)

• We can have multiple data sets within the one ‘map’ and apply relevant, appropriate analytical techniques

• Maps are (selective) representations of reality – we deliberately include some things and leave (turn on/turn off) other things out

• We can map increasingly complex natural and environmental phenomena and the relations between them

• We can map specific social variables (e.g. age 65+) or composite variables (e.g. vulnerability) and include physical phenomena such as hospitals, GPs, pharmacies, ambulance stations etc

• We can also map known data or model likely scenarios (spatial probabilities) and relate the two for pattern seeking and analysis – hypothesis development and testing -> scientific applications

Vulnerability as a Factor in Health Care

• 2011 Gawande publishes The Hot Spotters article in the New Yorker – location is back on the healthcare agenda, sort of - c.f. Dartmouth Atlas, Krieger, RWJF, Dorling…

• Social and situational characteristics affect peoples’ exposure to risk, access to services and specific types of adverse health events

• Social category membership affects (mis)treatment in a variety of contexts (age, gender, disability, ethnicity, SES etc)

• Social vulnerability characteristics also follow spatial patterns – uneven distribution in space of everything

• Spatial analysis can inform vulnerability analysis including analysing patterns of social, systemic and environmental risk

Booth’s Poverty Map 1892

Viewing Social

Inequalities from Space

Life Expectancy Variations by US County

Female Life Expectancy by LGA- Victoria

Multi-Scalar Ageing and Spatial Integration

• Globalisation of population ageing as a demographic and social trend – policy shifts etc

• Regional and national issues and perspectives – inter-governmental agreements e.g. pension transfers

• Sub-national level ageing patterns – internal variation• Urban, rural and remote – and intervening/mediating

concepts and structures e.g. analysis of variability• Social process modifiers – e.g. tree change/sea change• Local and micro-geographies of ageing – e.g. ageing in

Randwick vs ageing in Penrith

Melbourne Modelled Vulnerability

Melbourne Modelled Vulnerability and Hospitals

Melbourne Modelled Vulnerability + Hospitals + 5 km Bands

Visual Patterning of Accessibility to Services

Making the Knowledge Accessible

Conclusion• Population ageing is challenging, complex and highly dynamic – our

knowledge is growing and changing quickly• It is also an example of how reality constantly challenges our beliefs,

understanding, methods and skills• Spatial science enhances understanding of the known and can help

develop knowledge where it is lacking• Space/place concepts and characteristics can be quantified, qualified,

analysed and visualised for exploration and development• Knowledge integration and evidence making – how to link and extend

a complex system and break down knowledge silos using a spatial perspective – and without it, what do we have?

• Social policy is inherently spatial even when this is ignored, underplayed or denied – inputs and outcomes are spatial

• Spatial literacy will become more important as complexities grow and limitations of traditional knowledge paradigms are exceeded