Public spaces, social relations and well-being in East London

Nessun Abstrac

A suite of methods for representing activity space in a healthcare accessibility study

BACKGROUND: "Activity space" has been used to examine how people's habitual movements interact with their environment, and can be used to examine accessibility to healthcare opportunities. Traditionally, the standard deviational ellipse (SDE), a Euclidean measure, has been used to represent activity space. We describe the construction and application of the SDE at one and two standard deviations, and three additional network-based measures of activity space using common tools in GIS: the road network buffer (RNB), the 30-minute standard travel time polygon (STT), and the relative travel time polygon (RTT). We compare the theoretical and methodological assumptions of each measure, and evaluate the measures by examining access to primary care services, using data from western North Carolina. RESULTS: Individual accessibility is defined as the availability of healthcare opportunities within that individual's activity space. Access is influenced by the shape and area of an individual's activity space, the spatial distribution of opportunities, and by the spatial structures that constrain and direct movement through space; the shape and area of the activity space is partly a product of how it is conceptualized and measured. Network-derived measures improve upon the SDE by incorporating the spatial structures (roads) that channel movement. The area of the STT is primarily influenced by the location of a respondent's residence within the road network hierarchy, with residents living near primary roads having the largest activity spaces. The RNB was most descriptive of actual opportunities and can be used to examine bypassing. The area of the RTT had the strongest correlation with a healthcare destination being located inside the activity space. CONCLUSION: The availability of geospatial technologies and data create multiple options for representing and operationalizing the construct of activity space. Each approach has its strengths and limitations, and presents a different view of accessibility. While the choice of method ultimately lies in the research question, interpretation of results must consider the interrelated issues of method, representation, and application. Triangulation aids this interpretation and provides a more complete and nuanced understanding of accessibility

Allergic to the Twentieth Century: Intentional Communities and Therapeutic Landscapes in The Village and Safe

The concept of therapeutic landscapes has been used to explore diverse spaces and places of healing or wellness, from hospitals to gardens, libraries to smoking areas. A central strand of this work considers rural and/or natural landscapes as affording particular healing experiences. In this paper, I draw on this lineage of work alongside research into the formation of intentional communities in rural settings and the body of writing on representations of rural landscapes and country life. The two representations I analyse are films: The Village (M. Night Shyamalan, 2004) and Safe (Todd Haynes, 1995). In the former, an apparent settler village in rural Pennsylvania is revealed, in the film’s denouement, as an intentional community built as a retreat from the violence of contemporary urban life, guarded by Elders and a shared mythology about border-policing creatures. In Safe, the health hazards of modern suburban living, which lead the central character to develop multiple chemical sensitivity (MCS), can only be escaped by a similar retreat to a wilderness commune in the American desert. In both films, the spaces of rural life are constructed as therapeutic landscapes through their nostalgic, anti-modern withdrawal, and their protective boundary keeping

Sõnad haigetoas. Keel, tervis ja koht

The role of place in medical encounters that involve language is examined using theoretical arguments backed by empirical studies. Links between language and place, health and place and especially language and health are discussed. The language-health link is elaborated in terms of explanatory models; how language is used in medical encounters; and power, dominance and resistance relationships. It is also shown how considerations of place enhance knowledge about this link. The paper closes with a set of research questions that focus on the role of place. Translated into Estonian by Kristin Haugas and Anne Kaaber. Source: Gesler, Wilbert M. 1999. Words in wards: Language, health and place. - Health & Place 5, pp. 13-25

The place of chiropractors in health care delivery: A case study of north Carolina

Three perspectives on the place of DCs in the United States health care delivery system were derived from the social science literature; system status, cultural congruence, and utilization patterns. North Carolina was used as a case study site to examine these perspectives from a geographical point of view. It was found that DCs were located in smaller places than MDs. DC/population ratios were associated with white populations and higher incomes, but were not associated with those aged 18-64, rural populations, and religious groups that used touch in healing. DCs were located in more rural and lower income areas than were MDs.chiropractors manpower distributions health care delivery

Reconsidering the concept of therapeutic landscapes in J. D. Salinger's 'The Catcher in the Rye'.

Researchers usually examine therapeutic landscapes, spaces that have or are felt to have healing properties, in positive terms. We reconsider the therapeutic landscape notion by applying it to J. D. Salinger's The Catcher in the Rye. The main character, Holden Caulfield, is sickened by his transition between childhood and adulthood, and he relies on therapeutic landscapes as an imaginary escape. Yet his therapeutic landscapes are oversimplified and unrealistic. Through examples from Holden's experiences, we explore therapeutic landscapes as ambivalent, nuanced spaces. We argue that therapeutic landscapes should be considered beyond exceptional cases, in everyday experience

Geographical patterns of heart disease in the Northeastern United States

A 49-county region surrounding the urban corridor from New York through New Jersey to Philadelphia was the focus of an investigation of the spatial patterns of mortality from four types of heart disease: major cardiovascular, acute ischemic, chronic ischemic and cerebrovascular. The data used were age-adjusted mortality rates for white males and white females for the period 1968-1972. Central to the research was interest in the existence of county clusters with similar rates, high and low risk areas and possible associations of mortality rates with environmental and socioeconomic conditions. The tasks completed in this first phase of a projected multi-phase project led to the identification of four country clusters within the region. High major cardiovascular rates appear to make the Southern New Jersey cluster a high risk zone. In contrast, a Central Corridor cluster has relatively low rates for all the diseases. No clear pattern was in evidence for the Northwestern Periphery cluster. Finally, a stark contrast between acute and chronic ischemic rates appeared in the Urban Spur. The next step in this research will be to search for either consistency or deviation from these patterns in the 1973-1976 period. A risk factor data set will be created to analyze the patterns in greater detail.

Client characteristics at Kissy Mental Hospital, Freetown, Sierra Leone

In- and out-patient data from the only Western mental health instution in Sierra Leone, Kissy Mental Hospital in Freetown, were analyzed using basic epidemiological techniques. Although it could not be proved conclusively with the available data, the educational and occupational levels of the patients appear to be far above that of the general population. Very possibly females are also underserved by the hospital. Contrasts between the two patient populations show that in-patients were more seriously ill, older, more likely to be male, more likely to be single, less educated, less likely to have social support, more likely to express Western ideas about the causes of mental illness and have more previous Western treatment, than out-patients. The literature on mental illness suggested the examination of possible associations among diagnosis, illness beliefs and types of previous treatment as response variables and several patient characteristics as explanatory variables. Out-patients who were older and those with lower status occupations had more severe illnesses. Married in-patients and out-patients with higher educational and occupational status had more Western as opposed to native beliefs about the cause of mental illness than their counterparts. More previous Western rather than native treatment was reported by in-patients who were older, from certain tribes, or had Western beliefs and by younger out-patients. Points of agreement and disagreement of study results with findings from Africa and the United States are discussed.

Disease ecology and a reformist alternative: The case of infant mortality

This paper attempts to shed some light on the recent debate between those who advocate a reformed medical geography and those who respond that reform is not necessary. We show that disease ecology and a reformist alternative display certain tendencies in the ways in which they address issues of health and disease. We use the example of geographic variations in infant mortality rates to show how two non-positivist perspectives from social theory, political economy and humanism, support a reformist viewpoint, while also acknowledging the value of a complementary disease ecology approach. Two concepts, the social construction of health and illness and social relevance, are used to portray the political economy approach; humanism is described in terms of the meaning of individual experience and the importance of place. The paper concludes with a discussion of the respective roles of disease ecology and a reformist approach in models of infant mortality and a summary of the main differences between the two perspectives.medical geography disease ecology political economy humanism