PLACE AND HEALTH

Kristin Eccles

February 9th , 2015

University of Ottawa: EPI 6181

Introduction• Difference between space and place

• Space (where): the location• Place (what): the interpretation of space, subject to interpretation

• How can place affect health?• Physically

• Eg. Living near busy roads

• Socially• E.g. social networks, sense of community, perceptions

• Structurally• Eg. How health care is structured, rural vs. urban

JECH 58(1), 6-10.

Space

• Physical aspects- “the built environment”• contextual factors (the nature of the place itself)• Easy to measure

• Eg. distance to point source pollutant emitters

https://trigirlck.wordpress.com/2012/06/22/cycling-in-the-hammer/

Place• Compositional factors (the nature of the people who

assemble in particular places)

• How do people interact with their environment (social and physical)? • Structure vs. agency debate

• How do they feel about where they live?• Some environment can be therapeutic

• Eg. green space, park, access to the outdoors, therapeutic landscape, • Other environments can have a negative effect

• Eg. living in an environment that does not promote healthy living

• Much harder to measure

Berkman, Kawachi, Glymour, (2014)

Relationship Between Place and Health

• Space and place are highly intertwined

• Cultural embodiment of place• First Nations and Inuit

• Traditional/ country food

• Relationship between place and health• Place and social class

• Varying health is caused by varying socioeconomic statuses

• Place and capital

• Social capital and materialistic capital Berkman, Kawachi, Glymour, (2014)JECH 58(1), 6-10. http://www.turtleisland.org/healing/healing-wellness.htm

Conventional vs. Relational

Social science & medicine, 65(9), 1825-1838.

Health Inequality vs. Health Inequity• “Health inequality is the generic term used to designate

differences, variations, and disparities in the health achievements of individuals and groups.”• How disease is distributed in a population

• “Health inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice.”• Most health inequities are seen across social groups (eg. class and

race)• Unjust because they reflect an unfair distribution of the underlying

social determinants of health (eg. access to educational opportunities, safe jobs, health care)

JECH, 56(9), 647-652

Brief Intro to Spatial Analysis• Spatial Indicators

• Moran’s I• Getis and Ord’s G*• Nearest Neighbour

Perfect dispersion =-1 Perfect clustering = 1

http://edndoc.esri.com/arcobjects/9.2/net/shared/geoprocessing/spatial_statistics_tools/spatial_autocorrelation_morans_i_spatial_statistics_.htm

Inequity Case Study: Code RED

http://thespec-codered.com

http://media.metroland.com/thespec.com/statistics_flash/

SDOH in the City of Hamilton

http://thespec-codered.com/map/cancer/lungMortalityZoom.html

http://thespec-codered.com/map/cancer/breastMortalityZoom.html

Challenges of Geographic Analysis• The place is “bigger than the sum of it’s parts”

• Research is mostly cross-sectional• Hard to incorporate this: social capital, history, life course• Much of this effect ends up in the model residuals

• Ecological Fallacy• The ecological fallacy occurs when you make conclusions about individuals

based only on analyses of group data.• Scale of Analysis

• What is the correct level and unit of analysis? • Modifiable Area Unit Problem (MAUP)• Changing the level of analysis of boundary delineations can change the results!

• Spatial Autocorrelation• People who live close together are more likely to have similar traits• Pose problems when modeling because we want the independent variables to be

statically independent• Solution: Spatial Autoregressive model, and geographically weighted regressions

JECH 58(1), 6-10.

http://geog214-7.wikispaces.com/Modifiable+areal+unit+problem+(MAUP)

MMR Immunization Uptake Rates• How the Measles, Mumps, Rubella (MMR) immunization

rate uptake change over space, and time?

2004 2005 2006 2007 2008 2009 2010 2011 201275

80

85

90

95

100

North

Ed-mon-ton

Cen-tral

Cal-gary

South

Year

% o

f Coh

ort I

mm

unize

d

Eccles, K.M., Bertazzon S. (2015)

Eccles, K.M., Bertazzon S. (2015)

Alberta Trends in MMR Uptake• Low immunization rate clusters in the North Health Zone

and in the South Health Zone

• Limiting factors in the North• Rurality limits access facilities

• Limiting factors in the South• High Mormons, Mennonites, Hutterites, and Netherlands Reformed

Congregations population • Refuse immunizations for cultural reasons

• These groups experience regular outbreaks:• Mumps outbreak in 2005 • Pertussis outbreaks every three to five years• Previous Measles outbreak in 1997

Eccles, K.M., Bertazzon S. (2015)

New Trends in Place and Health• Public health problems- diseases of the environment• Building or redesigning where we live so it create health

people• Interdisciplinary

• Collaborations between doctors, public health practitioners, urban planners, city officials

• makeCalgary: Healthy Symposium (http://makecalgary.com/?page_id=8101)

• Redesigning urban core• Bike lanes• Make it more pedestrian friendly

References• Berkman, L. F., Kawachi, I., & Glymour, M. (Eds.). (2014). Social

epidemiology. Oxford University Press.• Cummins, S., Curtis, S., Diez-Roux, A. V., & Macintyre, S. (2007).

Understanding and representing ‘place’in health research: a relational approach. Social science & medicine, 65(9), 1825-1838.

• Eccles, K.M., Bertazzon S. (2015). A Spatio-Temporal Analysis of Regional Differences of MMR Immunization Uptake in Alberta, Canada. Manuscript submitted for publication.

• Kawachi, I., Subramanian, S. V., & Almeida-Filho, N. (2002). A glossary for health inequalities. Journal of epidemiology and community health, 56(9), 647-652.

• Macintyre, S., & Ellaway, A. (2000). Ecological approaches: rediscovering the role of the physical and social environment. Social epidemiology, 332-348.

• Tunstall, H. V. Z., Shaw, M., & Dorling, D. (2004). Places and health. Journal of epidemiology and community health, 58(1), 6-10.

Discussion• How do you define place?• Sociological Perspective

• How do sociological perspectives tie into place and health?• What side of the structure/ agency debate are you on?

• Structure: our actions are influenced/limit the choices and opportunities available (Top-down)

• Agency: is the capacity of individuals to act independently and to make their own free choices (Bottom- up)

• What do you think shapes place the most? Why?• How practical a value does this research have?  • What intervention possibilities arise?