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)
- 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.
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
- Spatial variation in fertility, mortality, natural increase (‘developed’ vs. ‘less
- 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?
- number of people
- quality of life
- 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
- 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;
- 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?
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
- 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: 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:
- nutrition: healthier population, greater births - economic: standard of living increases, fertility rates go down
- cultural: beliefs about birth control, etc
- 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
- 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
- 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
- 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.
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
- 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)
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
- 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
- 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
- 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
- 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
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:
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)
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,
- relates to ‘quality of life’; ‘liveability’
- components of well-being include necessities (food, shelter, health…) and non-
What factors make our cities/society more or less liveable?
- built environment
- 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: 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
- 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
1) Why do these inequalities exist?
2) What factors affect health status?
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
- socio-behavioural - political-economic
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
- Avg. daily mortality rate 1980-91
- Mortality on bad smog fays:
- 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:
- 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
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
- What are the main facilitators and barriers? i.e., factors which promote/hinder
- 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
- 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?
- Multiple causes/factors that determine health outcomes for individuals,
communities, entire populations
- Spatial variation in determinants of health as well as in health outcomes.
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,
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
October 3, 2008
- Perspective: what is human geography?
- Context: The Earth and ‘fragile human environment”
- Linkages: population + environment + health
- 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,
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
* There are no stupid questions.
Culture (see Norton, Ch. 6, esp. pp. 216-227)
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)
- 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.
- 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
- shared cultural traits: language, religion, technology, political beliefs
- 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
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”
• 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
- 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
- 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
- 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:
- 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
October 16, 2008
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
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
- 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
- peoples identities are attached to places and with places come names
“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
- 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
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,
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
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