In conjunction with my colleague Catherine Jones, soon to be of Portsmouth University, I am arranging a session at the coming years RGS-IBG 2010 annual conference. The session is jointly sponsored by the Geography of Health Research Group (GHRG) and the Quantitative Methods Research Group (QMRG) of the RGS. The details by way of a call for papers are:

The Spatial Dimensions of Health

Session Abstract

There is little doubt that geography and health are linked. Whether geography is considered in terms of the ‘geographies’ of individuals; communities and neighbourhoods; services and resources; or diseases- the linkage persists. In light of this, Gatrell and Elliot (2009) state ‘the subject of “health” is a rich source of material that bears study by the geographer’ (p.3). The importance of such study is highlighted by the steadfast presence of spatial disparities in health and healthcare nationally.

The intention of this session is to bring together research on the spatial dimensions of health, for the purpose of highlighting ongoing and nascent challenges within the diverse spectrum of health and health geography.

The session organisers invite proposals for papers that present empirical contributions within the spatial dimensions of health, ideally with focus on the UK. We welcome proposals that explore:

• The spatial dimensions of health inequalities and health behaviours
• Place, community and neighbourhood health and healthcare
• Spatial methods for developing health statistics
• Web 2.0 and health mapping

Reference
Gatrell, A. C. and Elliot, S. J. (2009) “Geographies of Health: An Introduction”, 2nd Edition, Wiley-Blackwell, Chicester

Key Words: Health, behaviour, inequality, quantitative, space.

Deadline for submitting abstracts is Monday 1^st February 2010

Please send abstracts up to a maximum of 250 words and proposed titles (clearly stating name, institution, and contact details) to Daniel Lewis (d.lewis@ucl.ac.uk) and/or Catherine Jones (kate-emma.jones@ucl.ac.uk).

Details of the full call for papers here.

Yesterday I attended an Infectious Disease Research Network (IDRN) course on “Use of mapping sofware and systems in health research“. The broad remit of this event was to draw attention to the use of mapping software, such as GIS, and geospatial technologies, such as GPS, in health related research. The event was chaired by Professor Graham Moon, who seemed interested in the subject matter despite the fact that his work is not strictly in infectious diseases, rather health-related behaviours.

The way in which i think about health geographies is very much related to the individual, and the condition of a person being healthy or not, the likelihood of certain groups having a certain level of morbidity etc. Thus the first few presentations were actually quite strange, coming from an infectious disease angle, the focus is not the person but the disease and how it spreads. Therefore several talks predominantly featured the preponderance not of people, but of frogs, larvae or snails. The upshot of such analysis is that mapping is really quite important, these creatures can only exist in certain conditions, temperatures, soil types, moisure levels etc. and so spatial analysis helps directly map their habitats and delineate the sites of highest risk.

This type of analysis coupled directly to the extensive Malaria Atlas Project (MAP) based in Oxford which trawls for contemporary research on malarial prevalence globally and uses the subsequent huge data source to inform stakeholders of where certain types of malaria are likely to exist. The MAP project uses an impressive set of workflows through PostgreSQL and Python to create nice maps (cairo, mapnik and reportlab) and web maps (Django (python), Java and google web toolkit). Their most interesting element is the bayesian modeling framework which takes malarial influences such as temperature, elevation and other environmental factors, creates a malarial range and is then able to say where you are likely to find certain malaria forms. All the work coming out of MAP is cross checked by a panel of experts.

In the first session there was also a talk from the guys at spatialepidemiology.net who clearly have an extensive knowledge-base set up. Most interestingly they are pushing the contribution of ‘citizen scientists’ through their Android-based software for collecting field data – called epicollect – however the extent to which they are actually engaging citizen- or ‘street-’ science is negligable. they seem to subscribe to the idea that collation of data from many sources counts, even though the ‘citizen scientists’ they envision are all fully trained epidemiological researchers, hardly ‘Joe Public’.

The other presentations came from the Health Protection Agency (HPA) who reopened the onrunning debate on patient identifiable data, dynamic and time conscious data and the rights and ownership of data ‘masehed-up’ in a google maps interface. Subsequently we learnt of the incredible work being done  by MapAction, who let us know that maps were also a form of aid like food, water and medicine.

In spite of this, the general sense of cartographic technique from the health mapping was weak excluding perhaps map action and the malaria maps. In general representation choices weren’t that intuitive, and there was an overreliance on points in webmapping. Further the almost ubiquitous use of binary red-green schemes is unintelligable for the colourblind. Generally cartographic design could have been improved for most projects. There were some interesting uses though, such as time-lapse tracks of women and children in Uganda who had been tracked using GPS.

Unfortunately (or perhaps fortunately) the open session provided some more interesting papers than the health-based session did. Particularly the fascinating work on the Legible London project, I was particularly taken with their treatment of neighbourhoods in London. The concurrent poster session provided some interesting comment, including excellent work on cycles and rhymes in the city from Urbantick Fabian Neuhaus, who also provides an extensive review of the talks on his blog.

Finally the keynote, Mikaela Keller involved in the Health Maps project, deserves a mention. The scope of the site, which is well worth visiting is incredible, the level of technical expertise that goes into the site in terms of natural language recognition and machine learning is enormous. Again though, the mapping seems to struggle with overpopulation of point sources, overwhelming the slippy map surface. Still, a valuable resource based upon collecting and displaying media reports of disease outbreaks from diverse news media and health agency websites – roughly 20,000 of them resulting in 200 new alerts per day.

This post details the presentations from the second day of PopFest 09 at LSE that I found most interesting.

Garret Maher – National University of Ireland, Galway – “Labour migration and migrant remittances: Brazilians in Ireland”

Commonly held knowledge on Irish migration dictates that Ireland is seen as a great exporter of people, particularly to the United States, however more recently, and in particular due to the expansion of the EU, Ireland has seen increasing levels of in migration. Garrett however doesn’t focus on the EU, his case study concerns the rather rarer, and more interesting, phenomenon of Brazilians working in a Galway town called ‘Gort’. Since the turn of the millenium, Brazilian’s have been actively recruited to work in Ireland, predominantly through social networks, initally more formal relationships persisted with companies with ties to Brazil recruiting workers, but later through Brazilian friendship networks funded by worker remittances. The growth in Irish population was notably leading to an official 4720 Brazialians in Ireland, although Garrett speculates there may be more than this in practice. Despite having done his fieldwork prior to the gloabl economic recession, Garrett was able to offer some insights into the state of play currently having maintained links to the areas in Brazil and Ireland that he studied.

Stephen Jivraj - University of Manchester – “Factors influencing low income migration between reighbourhood areas in England”

Stephen’s research is concerned with the nature of migration and whether it is possible to demonstrate increasing levels of residential inequality in poor areas. To do this he used the Pupil Level Annual School Census (PLASC)  dataset, which is longditudinal, with a fine temporal scale (yearly) and good spatial resolution (postcode), it also allowed for the use of the free school meals indicator to create an icome variable to represent low income pupils. Stephen built a multilevel model in MLwiN to accoutn for movements of individual pupils between areas with characteristics at the individual and neighbourhood levels. Interestingly the conclusion that Stephen came up with showed that areas which are poorer to begin with have a lower change in concentration of income poor pupils than areas which are less poor. This is slightly counterintuitive and there may be a bit of a small-numbers problem at work here, certainly the effect of poor moving into less poor areas is not substantial, however it is still possible to generalise and say: migration does increase the concentration of poor in poor areas. Of course the results only really holds for school pupils.

Jenna Truder – University of Brighton – “Re-theorising long-distance family migration in a global-city region”

Jenna presented some of what is clearly an extensive piece of research on processes of family migration at coastal margins, her particular study site being ‘Old Town’ a particularly affluent part of Hastings which is apparently naturally ebclaved by the physical landscape of the southern England coastline. Jenna characterises it as a “pocket of privillege” which is distinct in its gentrification and and cafe culture. In this presentation Jenna specifically focused on a demographic group called ‘DFLs’ or ‘down from Londons’ a group of people settling on the seaside  to fulfil desires and aspiration pertaining to quality of life that were unobtainable in London. This group has a lengthy history in Old Town, stemming from post-war East Londoners, but now encompassing most of London who shape Old town in terms of its community, environment and the opportunity for an alternative lifestyle. The atmosphere is described as somewhat sanitised from the influnce of the local fishing community. The most interesting discussion within this work is the ‘geography of loss and gain’, wherein inmigrants incur as economic loss in moving to Old Town in exchange for a perceived non economic (perhaps famillial or place specific) gain. This geography of loss and gain is seemingly magnified in Old Town due to the extent to which in migrants actively cut ties with London in moving, a practice not experienced in other cases such as Bristol and East Anglia.

Celia Fernandez Carro – Centre d’Estudis Demographics, Barcelona – “Residential context of the Spanish elderly in the early 21st century”

In her presentation Celia outlined the pressures on Spain due to the aging popualtion – with an additional 10 million elderly people to support by 2060, and the strain this puts on family and housing stock. In Spain there is a tendancy for the elderly to want to ‘stay in place’, rather than live in a care home in their old age, instead relying on their family as their main care provider. Celia attempted to model the likelihood of elderly people remaining in their residences using a logistic regression, the dependent variable being the binary of whether the home is rented or owned and characteristics regarding the home explaining this choice. Independent variables included household size, years of occupancy, number of rooms etc. All data was derived from the Spanish Living Conditions Survey, which was a sample of c.65,000 of which the sample of elderly people totals c.3870. Celia demonstrated that the the size of the house and the number of years of occupancy suggested a higher chance of being a homeowner, and linked this to the Spanish tendency of investing by buying property.

Jo Sage – University of Brighton – “The complexities of studentification”

In one of my favourite presentations from the conference, Jo elaborated on her findings regarding ‘studentification’ : the socio-economic changes caused by very large numbers of students living in particular areas of towns or cities. Jo was investigating the economic, social, cultural and environmental dimensions of a transition of an area from owner occupied family housign to having a transient student popualtion. Her main argument is that the geographies of studentification have diversified massively and the current theoretical construction is unsuitable to represent the diversity of the situation, in particularly she stresses the recent shift from a student housing market driven by landlords to the increasing agency of student in decision making , noting the link between studentication and later gentrification.

The remaining sessions dipped quite substantially out of my area of perceived expertise into something I know comparatively little about – HIV/AIDS and reproductive/sexual behaviour in developing countries. Needless to say the research presented was interesting (who knew, for instance, that contraceptives could be injectable?!) and it took be back to the development modules I studies during my undergraduate in Geography at LSE.

Lucia Knight – London School of Hygenie and Tropical Medicine – “Changing Rural Livelihoods HIV and AIDS-related illness and death in KwaZulu-Natal, South Africa.”

An interesting insight into the effect of the gap insocial welfare caused by no umemployment benefit on AIDS-related illness in South Africa. Incredibly the Umkhanyakade area of KwaZulu Natal has over a 50% rate of AIDS related deaths and accounts for 3,500 individuals using anti-retroviral drugs. This study used a household survey to capture people’s experiences of illness and its effect on the livelihood of the family. The loss of economic contrivution to a household due to illness, coupled with the increased burden the illness puts on other members of the houshold and dependents economically, and in terms of care is huge. Lucia elaborated on this, and the success of anti-retro virl drugs in restoring household order.

Sarah Keogh – London School of Hygenie and Tropical Medicine – “Reproductive behaviour and HIV status in pregnant women in Mwanza region, Tanzania”

Sarah focused on the issue of high HIV prevalance in women of reproductive age, an incredible 97% of whom attend Tanzanian ante-natal clinics. She used a regression model to assess the uptake of different contraceptive methods amongst women with different characteristics, such as number of children and HIV status, as well as the likelihood that they would have another child. She found that women with HIV were less likely to want another child than those without, and that likelihood of being HIV positive was affected by engagement in family planning, longer birth intervals and remarriage. Sarahs main point was the need to have tighter links between anti-natal clinics and family planning.

Billie de Haas – University of Gronigen – “Sex and relationships in Uganda – Adolescents’ views embedded within their cultural and socio-economic context”

A case study of school students in Kampala, Uganda, set in a day (i.e. non-boarding) mixed secondary school. The students were aged 15-19 and Billie researched the decisions made by these student in choosing sex or abstinence. One notable outcome was the inflated perception of risk caused by HIV/AIDS and pregnancy likelihood.

Dewi Ismajani Puradiredja – London School of Economics – “Contextualising Condom (non-) use by rural and urban female sex workers in Indonesia – A mixed methods study”

Jani was investigating the low condom uptake amongst sex workers in indonesia which occurs in spite of overwhelming evidence of their effectiveness in preventing infection, both HIV/AIDS and STIs. What is more, the sex-workers themselves were found to possess the knowledge of the condom’s effectiveness and still often not use them. Jani’s interesting and creative research methodology used mixed-methods, taking samples from 310 sex workers that she identified. One interesting finding was the extent to which rural sex workers are less informed about condom use than urban sex workers.

Paul Mathews – London School of Economics – “Family and Fertility: The influence of social network composition on the probability of childlessness”

Coming at his research from the somewhat questionable angle of evolutionary psychology (that it is our genes that are governing our more basic, primal, behaviours not rationality) Paul looked at the kin-effect of childbirth. The basic position being that family members will want other members of their family to have children because genes are shared, thus you don’t necessarily have to reproduce yourself in order to pass on some of your genes to the next generation. This is the evolutionary imperative of lineage extended to the social network. Using event history analysis, a form of regression, on the longitudinal British Household Panel Survey (BHPS) dataset Paul showed that mothers and partners had a large effect on the likelihood of first birth. This finding seems somewhat tenuous to put down to a genetic predisposition however, I certainly think it will be very difficult to unpick the specific attitudes and behaviours at play in a question such as this within a social science context.

Here are a selection of the presentation from Day 1 of Popfest 09 that I have enjoyed, or have interested me so far:

Thomas Clemens – University of St. Andrews – “Unemployment, mortality and overcoming the problem of health-related selection: Evidence from the Scottish Longitudinal Study”

Tom gave a really interesting talk, based on a paper he has written that challenges commonly held assumptions in the construction of a robust methodology for longitudinal research. Starting with the idea that there is a correlation between unemployment and health, namely that there is a strong relationship between not having a job and being more prone to illness and inevitably death, Tom enlightened us of the issue of reverse causality in longitudinal research. This issue is this: the researcher has a window within which the status of employment, and health characteristics of a person are evident, within this window there is the possibility of observing a relationship between poor health and unemployment, however it is impossible to say whether this is causal, i.e. that poor health derived from not having a job, or reverse causal, i.e. poor health was the cause of the unemployment. The net result of this reserve causality is the idea that you therefore overestimate the correlation between unemployment and mortality/morbidity. The common tactics here is to enforce a ‘wear-off period’, commonly 5 years, in which observed deaths are ignored in order to account for  the likely effects of short-term health problems (i.e. death or recovery and readmission to the labour force). In his analysis Tom found that the data from the Scottish Longitudinal Study didn’t support the need for a wear off period in the assessment of unemployed status leading to poor health, and that instead adjusting for limiting longterm illness may be a crude but useful way of accounting for the effect of the ‘wear-off period’ in other contexts.

Michael Grayer – QMUL – “Estimation of life expectancy for small areas”

Michael, in a delightfully geographical study, showed how he was able to compute the likely life expectancy for London wards. Life expectancy is a good summary indicator of population mortality, however its appropriateness for small area studies has been, upto this point, challenge by the inherent small numbers problem of small areas, that in a small area with few people a single person can have a large effect on the result. Michael demonstrated this with some examples, showing that small variations in the numbers of elderly people created an uncharacteristic ‘long-tail’ in the survivorship curve for a ward when compared to the expected shape, this artificially raised the estiamted life expectancy for the area. In order to adjust for this Michael introduced ‘Silcock’s Bias correction method’ a mathematical function which seems to have the effect of smoothing the tail of the survivorship curve and creating a survivorship curve of the expected shape. The next set for Michael is to look at applying confience intervals and doing some ward-by-ward comparisons.

Ignacio Pardo Rodriguez – Universidad Complutense de Madrid – “Mixed methods and demography: why, when and how”

I wanted to flag this talk, not because I particularly agreed with the message per se, there seemed to be an advocation of ‘all mixed method, all the time’, but because I think it is an important and fascinating discussion. No one can claim to be unaware of the increasing buzz surrounding mixed-methods, certainly in the world of GIS we have increasing seen it. I particularly like Pavlovskaya (2006) on this very issue, as well as the myriad examples in Public Participation GIS (PPGIS) and Critical GIS (CGIS) and am personally quite interested in the emerging world of ‘critical quantitative geography’ as posited by Mei-Po Kwan and Tim Schwanen (2009 and forthcoming) which elaborate on and break down the quant-qual divide that has been seen to persist since perhaps the cultural turn. Personally I favour an approach which uses the most appropriate tool for the job, be in quant, qual or a bit of both informing the other, certainly I favour the inter/intra – disciplinary working approach which engages the expertise of others, with differing skills to yourself, in order to formulate an approach to methodology. This kind of discussion reminds me of a paper by Bell and Reed (2004) entitled “adapting to the machine” in which the possibilities of mixed-methodologies are expounded in essentially a kind of socratic dialogue.

James Cheshire – UCL – “Surnames as Indicators of cultural regions in the UK”

I work with James, so perhaps it is unfair to expound the virtues of his work too greatly, but I am fascinated by the methods he has used to manipulate and transform surname data and create something actually very interesting and perhaps culturally significant. James uses several different techniques, cluster analysis and Multi-dimensional scaling (MDS) in order to represent the existence of distinct ethno-linguistic regions in the UK. What really fascinates is the time frame, James has data for the 1881 census and the 2001 electoral register, basically millions of names. He seems to demonstrate with this that actually, we don’t move around all that much. In an interesting case study of Corby, James showed how his 1881 data suggested the town of Corby to be ‘English’ and yet in 2001 it was consistently clustered with Scotland, qualitative research on the matter demonstrated that this wasn’t an error, but that a factory had moved into town employing only Scottish workers which had had a long-lasting impact on the town as shown by his analysis. The map visualisation throughout this presentation were excellent.

See James’ blog here.

Fabian Neuhaus – UCL – “Urban Diary – The spatial extension of everyday life”

Fabian’s presentation was perhaps the richest of all in the first two sessions, dealing with the many-fold overlays of people and place, and their activities within the city as a way of understanding and documenting urban rhythms and behaviours. Fabian used the space-time cube, or space-time ‘aquarium’ technique very well to visualise his participants activities and is able to draw on a strong graphic design background to really elicit the maximum aesthetic from his experiments. I was also particularly take by his considertion of different transport modes and the urban experience, as well as his use of mental maps in conjunction with GPS traces. Fabian also keeps a rather good blog, access here.

The references from the brief discussion of mixed methods were:

Bell, S., and Reed, M. (2004) “Adapting to the machine: Integrating GIS into qualitative research” Cartographica, 39(1), 55-66.

Kwan, M-P and Schwanen, T. (2009) “Quantitative revolution 2: the critical turn”, The Professional Geographer, forthcoming

Kwan, M-P and Schwanen, T. (2009) “Critical Quantitative Geographies”, Environment and Planning A, Vol. 41(2), 261-264

Pavlovskaya, M. E. (2006) “Theorizing with GIS: A tool for critical geographies?”  Environment and Planning A, Vol. 38(11), 2003-2020

I have had an abstract accepted for an oral presentation at PopFest 2009. The title of my talk is “Demographic Change in General Practice Patient Populations: a Study of Southwark, London.”

PopFest is a population studies conference that is specifically aimed at and organised by postgraduates. I hope it will be a good opportunity to discuss issues concerned with measuring and analysising changing populations with researchers outside of the arena of geography. I will be a great opportunity to engage with social policy and demography and draw out their opinions and assess how they interact with and relate to geographic study.

My abstract for the presentation is as follows:

The predominant literature in geographies of healthcare point to health as being subject to a ‘postcode lottery’- that is your access to, and quality of, care is primarily related to where you live- this has led to a greater reliance on geographic indicators of deprivation of patients by postcode than perhaps it ought to. Recent targeting techniques in health proved to be more effective when also accounting for wider contextual information including: the ethnicity composition, neighbourhood characteristics, patient demographics and a range of other social and economic population attributes shown to be linked to health.

This study focuses on General Practices and an analysis of registered patients, collected through a national but locally managed information system, ‘Exeter’, which records new patient registration in real time. The study integrates patient demographics from ‘Exeter’, a derived ethnicity classification from ONOMAP based on the registered patient data, as well as neighbourhood characteristics from the ONS Output Area Classification and CACI’s Health Acorn with health prevalence data reported at the GP level via the NHS Quality and Outcomes framework (QoF).

The research asserts that the patients themselves, particularly in Southwark where geographic access to healthcare is less of an issue, at times make specific choices related to which General Practice to use based on preferences for a certain type of doctor, service, or community. Thus healthcare service provision at the GP level should be understood both in terms of who and where, moving away from the strict imposition of a ‘postcode lottery’ to a more patient focused understanding.