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Department
Geography
Course
GEOG 1HB3
Professor
Walter Peace
Semester
Fall

Description
Part III Population and Health Geographies Population: The Big Picture September 18 2008 Outline for Lectures Social/Cultural Dimensions of Population Population Health and Health Care (I) Population and Health Care (II) Chapter Four Introduction - October 1999 world population reached 6 billion (1985 = 5 billion) - Where was child 6 billion born? Probability is that it is in a country where the birth rate is high, most likely a lower industrialized country - Each year, 83 million births, of which, only 1 million (1.2%) are born in advanced, industrial nations - Demography: the study of population - demos: populace, people - graphe: to write about - population geography: study of the spatial components of demography - Some questions: 1) Where do 6.5-6.7 billion people live? 2) What factors underlie this distribution? 3) How is world population changing terms of its numbers? - Carrying capacity: limit in terms of food, resources, energy, etc. - Currently: History of Population Growth - what factors have contributed to population increases/ decreases during the Holocene (the last 10 000 years) 12000 yrs BP 4 million 2 000 years BP 250 million 1650 AD 500 million 1804 AD 1 billion - pg. 150-153 Figure 4.10 pg.153 - significant increase associated with: - First agricultural revolution (9 000 years ago) - Industrial Revolution (18 century) - From “The Beginning” to 1927: population reaches 2 billion - From 1927, < 50 years to reach 4 billion - From 1974, 25 years to reach 6 billion - see figure 4.10, pg. 153 The Current Situation - Population continues to increase, but at a decreasing rate (world total) - Population expected to plateau at 9 billion by 2050 (vs. estimates of 12 billion in 1970s) - Spatial variation in fertility, mortality, natural increase (‘developed’ vs. ‘less developed’ nations) - So what happened to these trends from the 1970s to present? (why do we expect 9 billion in 2050 instead of 12 billion that was forecast in the 1970s) - Perhaps certain things were not foreseen, specific policies that have an impact on birth rates, widespread of birth control? Changing family dynamics? Increased cost of living? - Consider the following: “At some point in the 1970s, an unidentified person claimed there were more people alive (then) than had ever lived.” - Does this make sense? (note: world population reached 4 billion in 1974) Population: How many is too many? - Geography’s concern with population: (“what is where, why there, and why care?”) i.e. why do particular aspects of population growth occur where they do, and what are the implications for the future? - 1994: International Conference on Population and Development, held in Cairo, identified the “most pressing problem” as How many people can the world adequately accommodate with food, water, clean air, and other basic necessities for the enjoyment of happy, healthy, and satisfying lives? Two Issues - number of people - quality of life Historical Trends - Beginning of Holocene (10 000 years BP): 6 million 1804 1 billion 1927 2 billion 1974 4 billion 1999 6 billion 2030 8.3 billion 2050 9.4 billion Commentary - Why do numbers matter? - Population is one element in a global system of human-environment relations; - Population is linked to: environmental quality; health; political stability; economic development…. - Future shaped by demographic forces: • total number of people • differential growth • health (HIV/AIDS) – see pg. 137-141 • international migration – pg.171-183 • refugees; internationally displaced person see pg.183-187 September 19 2008 Global Myth #1 - At some point in the 1970s, an unidentified person claimed that there were more people alive than had ever lived. Is this true? - Challenges: i) reliability and scarcity of data ii) When to start counting? - 1995 Carl Haub “Population Today” - estimated population at beginning of Holocene = approx 5 million - estimated the birth of Christ =300thillion - estimated population in mid 17 century = 650 million - “Achingly slow” population growth for first several millennia, so, isn’t the myth true? - no; Haub estimated there had been 106 billion births since the dawn of humanity (i.e. 5-6 million years ago in east Africa) (today’s 6.3 billion = 6% of 106 billion) - you come up with a much greater number than what is present right now - therefore it is a MYTH Historical Perspectives on Population and Health - life expectancy is much greater now than it was before - average life expectancy, on a global scale, continues to increase Elements of Population Geography - distribution: see figure 5.1 pg.168 - density: see figure 5.1 pg.168, how many people per unit area Fertility - fertility: see pg. 128-135; figure 4.1, pg.129 - Crude Birth Rate (CBR) = total live births (annual)/ per 1,000 people - would see that birth rates are much lower in lower industrialized countries, whereas opposite for greater industrialized countries Factors affecting fertility: - biological - nutrition: healthier population, greater births - economic: standard of living increases, fertility rates go down - cultural: beliefs about birth control, etc Mortality - Crude Death Rate (CDR) = total deaths (annual)/ 1 000 people - see pg. 135-141, Fig. 4.3 pg. 136 Factors affecting mortality - socioeconomic status: wealthier nations tend to have lower mortality rates - standard of living: higher standard of living associated with lower mortality rates - nutrition/ sanitation: connected to the above - Note: the differences in the factors affecting fertility and mortality Role of Natural Increase - annual rate of population growth - (CBR – CDR) - see Fig. 4.5, pg. 142; Table 4.4, 4.5, pg. 141 Some Definitions - epidemiology: the study of the incidence, transmission and control of diseases - epidemic: the temporary but widespread outbreak of a disease - epi- = upon, near - -demos = people - pandemic: a disease occurring over a wide geographic area affecting a high proportion of the population - epidemiological transition: a theory stating that the prevailing forms of illness changed from infectious to degenerative types as the demographic transition occurred - see Fig. 4.11a, 4.11b, pg. 156 - it is easier to stop people from dying but it is harder to prevent them from being born - it takes a longer time to adjust culturally to fertility rates (i.e. changing family dynamics) whereas health care changes can occur quite rapidly - Epidemiological Transition (figure not in text but on webCT) Stages of the epidemiological transition: Stages 1 and 2: - the stages of pestilence and famine - infectious and parasitic diseases were the main cause of human deaths (e.g. plague, cholera) Stages 3 and 4 - The stages of degenerative and human created diseases and an increase in chronic disorders associated with aging (e.g. cardiovascular disease, cancer) - note decline in infectious diseases death (from stages 1 and 2) September 25 2008 Continued: Stage 5 - the stage of the re-emergence of infectious and parasitic diseases - return of diseases thought to have been eradicated or emergence of new diseases (e.g. Malaria, tuberculosis, avian flu, AIDS) Historical Perspectives The Black Plague - history’s most violent stage 1 epidemic - originated in present-day Kyrgyzstan (1347) - reached Western Europe in 1348, Northern Europe in 1349 - estimate 25 million deaths in Europe between 1347 and 1350 (1/2 of continent’s population) - it took 300 years for Europe’s population to reach pre-plague levels - Are there any possible diseases that might cause similar reductions in populations today? Cholera - from Greek Kholera: bile, anger - infectious disease; symptoms=diarhea, dehydration - eg. Hamilton 1840s experienced two outbreaks of cholera, as part of a world wide spread of the disease st - 1816: spread to China, Japan, East Africa, and Mediterranean Europe (1 pandemic) - 1826-1837: North America (2 Pandemic) - 1842-1862: North America, England (3 Pandemic) - cholera was initially retained in India, but through increased contact with countries it spread outward - there is a connection between Colonial nations and the mother countries between the spread of cholera - Dr. John Snow – London, England, 1850s - convinced that contaminated water was responsible for cholera - ½ million died in New York 1832 - 1832- _________ deaths in Hamilton - 1854- 552 deaths in July/ August - was able to identify contaminated pumps and cut them off, immediately the amount of deaths decreased - e.g. in Hamilton, new infrastructure developed in response to the cholera pandemic, Hamilton Waterworks Aids - see pg.137-141 - one of most widespread epidemics of modern times - originated in Africa - since 1981, more than 20 million deaths from AIDS - as of 2006, estimated 39 million people infected with HIV - if a cure is not found by 2015: “AIDS pandemic will have become by far the greatest catastrophe in human history, far worse than the Black Death and the Second World War combined, the equivalent of eight First World Wars.” Harold Foster, Geographer Summary Diffusion - the spread of a phenomenon over space - Norton pg. 66 - “The Geography of Health in Canada 1996” - see table - study of interconnections among population, health, and the environment: Medical Geography Four Concerns 1) Cause and spread of disease 2) Provision and consumption of health care 3) Social construction of health 4) Effects of environmental change on health Population, Health and Health Care (I) Introduction 1) What is meant by the term “well-being”? 2) What factors affect “well-being”? See pg. 285-288 Definition: well-being refers to the extent to which individuals and groups have access to the resources and services required to meet their needs and aspirations (economic, social, psychological) - relates to ‘quality of life’; ‘liveability’ - components of well-being include necessities (food, shelter, health…) and non- necessities What factors make our cities/society more or less liveable? Socio-ecological model - built environment - economy - social cultural groups - environmental quality - local politics - combined (net) effect of outcomes is the liveability of the city, i.e., the level of well-being experienced by groups and individuals - geographic dimensions of well-being --- spatial variation in quality of life as measured by objective indicators September 26 2008 - example of MUMC turning into an all children’s hospital - therefore you are interested in looking at the health effects in Hamilton - looking at the Spatial Pattern of the Annual Death Rate per 1000 of Males in 55- 64 Age group in the Hamilton District (therefore looking at a group that would be affected by this decision) - Why are all of the areas on the map not shaded the same? because there is a spatial variation in health Medical Geography - medical geography: the geographic i.e. spatial context f health (the spatial patterns and processes of health and medical well-being) The four Ds of medical geography 1) Distribution: spatial patterns of health, disease, etc. 2) Diffusion: spread of disease over space 3) Determinants: factors affecting health status 4) Delivery: provision of health care services - note: emphasis on health and space - mortality: death - morbidity: disease - NOTE: the difference between these two definitions - special patterns and processes variation at all scales Question: What role does geography play in our health status? i.e. is our health affected by where we live? “…good health, unlike real estate, is not a matter of location, location, location.” (The Hamilton Spectator 31 May 2002). Definitions of Health - 1980’s World Health Organization (WHO) defined health as “the absence of disease” - more recently, health viewed as a composite of physical, social, and emotional well-being, i.e., as a resource for everyday living (a necessity’ which affects our quality of life and the liveability of our cities What does it mean to be healthy? Canada Health Act (1984) – 5 principles: 1) access to health care (make health care available) 2) portability (province to province) 3) publicly administered (vs. private) 4) universality (available to all) 5) comprehensiveness (covers everything) - In light of these principles, should we expect that health and well-being are uniform across space? - some evidence --- at the local level (Hamilton): • mortality for both males and females is higher in the five lower income census tracts in the city centre • mortality for males is also higher in the census tracts in the city’s industrial north end - significant spatial inequalities (as indicated by mortality rates) despite the fact that everyone has access to the same health care services/ system Questions: 1) Why do these inequalities exist? 2) What factors affect health status? Some Explanations 1) Processes of natural and social selection - health status confers social status (not the reverse) - those who are chronically unhealthy are disadvantaged in terms of occupation./ education opportunities --- mobility (social/economic) is limited 2) Behavioural/ lifestyle hypothesis - Inequalities in health status are the result of behavioural patterns - Individuals/ groups chose to engage in either health-damaging activities (drug and alcohol abuse) or health-promoting behaviour (exercise, diet…) 3) Structuralist approach - Individual’s choices (behaviour) are constrained by income. Occupation (socio- economic status), which in turn, affect such things as: diet; type of food consumed; quality/location of housing; exposure to environmental hazards at home/work; etc. (health is a function of our opportunities and constraints which are determined by our socio-economic status) - unhealthy lifestyle behaviours are a way of coping with a stressful life caused by low socio-economic status So, why are some people healthier than others, and what role does geography play? The Big Picture Description --- What? - Patterns of Morbidity and Mortality Explanation --- Why? - Determinants of Mortality and of Morbidity - environmental - socio-behavioural - political-economic - biological Prescription --- So What? - delivery of Health Care Services Note: recall previous discussions regarding explanation and the ‘truth’ in the social sciences – there are no right or wrong answers; some explanations (or combinations thereof) are more complete than others October 2, 2008 Consider the following: - Estimated deaths/year resulting from pollution 1400 Toronto 300 Hamilton - Avg. daily mortality rate 1980-91 50.6 Toronto 8.5 Hamilton - Mortality on bad smog fays: 53.9 Toronto 9.4 Hamilton - Estimated deaths/year from smog-causing pollutants: 1800 (Ontario) - need to be critical about this - this is not a causal relationship Population, Health, and Health Care (II) Health determinants at the Local Level: A Case Study - purpose: to examine the relationships between characteristics of a place and the health of the local population - based on the premise that neighbourhoods are characterized by socio-economic determinants of health and related risk factors - problems of defining ‘neighbourhood’ - 4 neighbourhoods studied: 1) Downtown 2) Northeast 3) Chedoke 4) Mountain - place with different socio-economic characteristics - lines are arbitrary in the sense that they fall along the census lines rather than cultural or what people would consider the actual boundary lines Example chart differences in neighbourhoods: factors such as “didn’t complete high school”, income, smoking, close friends, poor coping when sick, self rated health - found that there are differences between the neighbourhoods that are rather distinct - sweeping generalizations: Chedoke and Mountain are more affluent, in comparison to the Industrial and Downtown area, based on these factors - Is place a determinant of health? Are you healthy or not because of where you live? Conclusions 1) Reduced health status and unhealthy lifestyle behaviours are associated with disadvantaged neighbourhoods in Hamilton 2) Having friends and the ability to cope may be vital for better self-rated health. Neighbourhoods and local features were not important. Looking more on a personal and individual level. 3) Individual characteristics, social AND physical environments are of varying importance for lifestyle and well-being measures - points out the challenge as we have as researchers and non-experts, what are we supposed to take form the information Questions: - What are the main facilitators and barriers? i.e., factors which promote/hinder healthy lifestyles - How much do people want to change? - Do people believe they should or need to change? - How healthy you are is a product of your choices which is dependant on your lifestyle. - So what, exactly, is the role of place? - How different are these neighbourhoods? - How important are these differences? Are these differences resulting in people being more or less sick? Conclusions - Multiple causes/factors that determine health outcomes for individuals, communities, entire populations - Spatial variation in determinants of health as well as in health outcomes. Questions 1) What should be the goals of the health care system? Equity: everyone gets what they need (some need more than others) Equality: everyone gets the same Efficiency: best service/ system per dollar spent 2) Should the system be public or private? 3) To what extent is the Canadian health care system working (in terms of equity, equality, efficiency)? From a Spectator editorial, 31 May 2002 “Poverty, not geography drives rates of illness. In reality it’s not so much where you live as how you live and the options are choices available to you.” Does geography matter, or not? Culture October 3, 2008 So Far: - Perspective: what is human geography? - Context: The Earth and ‘fragile human environment” - Linkages: population + environment + health Now: - Variation: cultural differences within human population What are the big questions?* 1) Who are we? 2) Where did we come from? 3) How did we get here? 4) Where are we going? (We = individuals, families, cultural groups, nations, humanity) 5) What do you believe? 6) Why do you believe it? 7) What are the implications of what you choose to believe and what you choose not to believe? * There are no stupid questions. Culture (see Norton, Ch. 6, esp. pp. 216-227) Introduction Questions: 1) What is culture? 2) When did culture begin? 3) Why are geography/ geographers interested in culture? - “Culture is one of the two or three most complicated words in the English language” Raymond Williams DeBlij and Murphy: culture lies at the heart of geography. Human behaviour suggests something about geography. - Enormous cultural diversity: long history of cultural conflict - Ch. 6 begins with “A World Divided by Culture” (pg. 216) Defining Culture - The way of life of the members of society (Norton, pg. 627) - The sum total of knowledge, attitudes, and habitual behaviour patterns shared and transmitted by the members of a society (DeBlij and Murphy) - A system of shared beliefs - The artistic and intellectual product of a group, i.e., a body of knowledge - A shared, learned way of life. The medium through which meanings, and values are expressed, e.g., language, art, etc. In general: - Culture refers to the specialized behaviour patterns, understandings, adaptations and social systems that characterize a group of people. Question: Is there a Canadian culture or do Canadians and Americans share a single/common culture? - shared cultural traits: language, religion, technology, political beliefs (democracy), economy - Distinctive societal values (national psyche); principles (“life, liberty, and the pursuit of happiness” vs. “peace, order, and good government”) symbols (eagle vs. beaver); geopolitical position (world’s only superpower vs. peacekeeper)… - So, is there one (North American) culture, or are there two, distinct cultures? - Does it matter if we make a distinction? - most would argue that it does matter since culture defines (in part, at least) who we are as a nation One additional observation: - Culture differentiates humanity from other life forms, i.e., we can distinguish between biological adaptations (survival instincts) and cultural adaptations (learned behaviours) Culture and Society Culture --- anthropology Society --- sociology - What are the links with geography? - see box. 6.1 pg. 217 • Culture: ideas, values, artifacts I.e. What? • Society: “relational system of interaction among individuals and groups” i.e. How? • Material cs. non-material components of culture 1) mentifacts: values, language, religion 2) sociofacts: norms, rules 3) artifacts: elements related to livelihood (mentifacts + sociofacts = non-material elements of culture; artifacts = material elements of culture) See Norton pg. 217-220 In Summary - society is the institutionalized way of doing things, i.e., the context - culture is the way of life of a society’s members October 9, 2008 The Origins and Evolution of Culture - when and where did culture begin? - Importance of: language, tool-making 2.5 mya, fire 1.5 mya - conditions encouraging formation of social groups Civilization - what is the connection between culture and civilization? • Civilization: a culture with agriculture, cities, food and labour surpluses, labour specialization, social stratification, and state organization - see Norton, pg. 219-223; Box 6.3, pg. 220 - first civilizations associated with culture hearths, e.g., Mesopotamia, Egypt (see Table 6.2, pg. 223) - civilizations tend to develop around sources of water • Culture Region: an area with a degree of homogeneity in cultural characteristics (pg. 627) - based on different cultural criteria; - change over time - applied at all scales - requires ‘boundaries’, which applies a boundary or a limit which may be too definite, there are more transition zone between the ‘regions’ - box 6.4 pg.225 The European cultural region Final Thought about Culture - culture: one of the most complicated words in the English language - nature: the material world excluding humans but, are humans separate from or a part of nature; - and, what about the view of nature that its meaning is ‘socially constructed’ - according to Williams (1976; 184) “nature is perhaps the most complex word in the language” - so, isn’t is interesting that geography consist of two subfields that like what are possibly the two most complex words in the English language, i.e., nature (physical geography) and culture (human geography)? Some definitional matters: - culture: a group’s way of life, including the shared system of social meanings, values, and relations that is transmitted from one generation to the next (includes: language; music; religion; legal systems…and all learned behaviour, beliefs and values) - I think that our definitions, such as culture and civilization, which are human constructed definitions, are the premises that allow us to separate ourselves from the “other” which is nature. Anything that is not cultured or civilized would be classified at nature. This idea of culture and civilization implies some sort of advancement and exclusion from nature, which is perhaps the justification which allows us to rape the world and to rape “nature”. In response to the question asked in lecture today, whether animals exhibit culture, I think by the definition itself we have constructed the definition in order to exclude other animals and to create space between humans and animals. • subculture: values, beliefs, lifestyle of a minority (or ‘sub-’) group within society, often applied to youth: skinheads, punks, ethnic gender, sexual groups - often associated with resistance or opposition of the dominant culture, resistance expressed through dress, behaviour, etc. • counterculture: term used in context of 1960s groups that questioned the dominant cultural; values of ‘the Establishment’ - arose out of opposition to the Vietnam War - “…counterculture may now be extended to the values, beliefs, and attitudes of any minority group that opposes the dominant culture…in a relatively articulate and reflective manner. • cultural geography: the spatial context of cultural identities - So, how do we differ from one another? - human identity/ variability based on: • language • religion • ethnicity • nationality • class • gender • race - These are all elements of culture therefore we are all defined by culture, meanings of which are socially constructed: what does this mean? - socially constructed meanings are learned or acquired, i.e., they are not inherited; we are not born with them - knowledge/ meaning depends on the social setting/ context, e.g., the cultural meaning of gender, religion, etc. varies from one social setting to the next - these socially constructed variables are manifested through: landscape, sense of place, cultural regions In other words… - group A from group B in terms of these variables (language, religion, ethnicity, …) and as a result the place/ landscape where group A lives is different from the place/ landscape where group B lives Language October 16, 2008 Preamble Floccinaucinihilipilification- to judge something as being trivial, longest word in the Oxford English dictionary - loss of Australian twang within a few decades, change will come about as the need for Australians to distinguish themselves from their English connections - loss of Canadian Oxford English dictionary, will this have an effect on Canadian language Language Toponyms: place name - how /why are places named? why is this important? - e.g. Niagra peninsula – townships, etc., named by Gov. Simcoe (late 1700s) after places in Lincolnshire County, England (Simcoe’s birthplace), e.g., Barton, Saltfleet, Ancaster, Grimsby, …. all found on the map of Lincolnshire - attempt was made to recreate England by virtually naming places after places in England - sensitive nature of changing places names, e.g. • Mount Logan: proposal to re-name it in honour of Pierre Trudeau • the “new” City of Hamilton; towns/suburbs retain names despite being in Hamilton - peoples identities are attached to places and with places come names Vanishing Languages “When the last speakers go, they take with them their history and culture” - prediction – by the end of the 21 century half of the worlds 6 000 languages amy become extinct - not a new phenomenon, e.g., 19 century Brazil, >1 000 Indian Languages; now approximately 200 languages - how/why do languages disappear? • as the influence/importance of a culture diminishes, language of that culture becomes less important • modern information technology – English is the language of the Internet • globalization – “homogenization” of culture • people/culture worldwide are becoming more Anglo-centric • as we are becoming more like each other there is less of a need to distinguish ourselves from one another, therefore you see the loss of language and the loss of nuances such as the Australian twang - Question: Is the loss/disappearance of a language/culture analogous to the extinction of a biological species? “Good friend for Jesus sake forbeare, /To dig the dust enclosed heare:/Bleste be ye man that spares these stones./And curst be he that moves my bones” Tombstone engraving on W. Shakespeare’s tomb - not the usage, the differences in spelling, and the tone of the language The Geography of Religion Norton, Ch.6, pp.241-252 Introduction Religion: a set of beliefs and associated activities designed to facilitate appreciation and understanding of our place in the world Universality: all cultures have religions - it serves a basic need - the need may be captured in the definition of religion - note the last 400 years, the juxtaposition of religion on the one hand and science on the other hand Religious laws/beliefs governing: diet, life passages, roles of men and women, dress, laws, education…. 19 Century Canada: strong ties between religion and higher education, e.g., Queen’s University – Presbyterian McMaster University – Baptist McMaster’s motto: “Ta panta en Christoi synesteken” Greek, “In Christ, all things are possible” How is religion expressed on the landscape? pg. 241 Fig. 6.18 - other examples of regions/areas defined by religious criteria - also, geographic space used for religious pu
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