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Putting chronic illness ‘in place’. Women immigrants' accounts of their health care
Abstract
This paper discusses the ways in which first generation Canadian women of Vancouver's Chinese and South Asian communities manage their chronic illness. The study reported was concerned with the women's experiences of health care encounters in hospitals and clinics, and their subsequent incorporation or modification of biomedical knowledge as they managed the day-to-day consequences of their illness. The paper presents a critique of culturalist explanations of personal health care practices, through an ethnographic account of the women's institutional and occupational emplacement and their racialized experience of place. In the study women's accounts of their illness and its management indicated a search for the alleviation of symptoms that involved a plurality of illness management strategies. The women's health care practices were mediated by local social networks and a distribution of non-medical resources rooted in the process of ‘place’, in addition to specific barriers to the use of biomedical techniques. The study suggests that inquiry into problems of health care for minority population groups needs to go beyond a narrow focus on biomedical services, and analysis must be wary of attributing primacy to untheorized concepts of culture, ethnicity or ‘race’ in explanation.
... The emerging focus on place-based dimensions of health and health care experiences is the most characteristic feature of recent developments in a 'reformed' medical geography renamed 'health geography'. Health geographers are paying increasing attention to ways in which place relates to people's experiences of health and health care (Dyck, 1995;Gesler, 1991Gesler, , 1992Jones & Moon, 1993;Kearns, 1993Kearns, , 1995. In this body of work, place is understood from a subjective viewpoint comprising experience and meanings of place as well as the power of place in shaping people's everyday lives (Dyck, 1995;Gesler, 1991;Kearns, 1993). ...
... Health geographers are paying increasing attention to ways in which place relates to people's experiences of health and health care (Dyck, 1995;Gesler, 1991Gesler, , 1992Jones & Moon, 1993;Kearns, 1993Kearns, , 1995. In this body of work, place is understood from a subjective viewpoint comprising experience and meanings of place as well as the power of place in shaping people's everyday lives (Dyck, 1995;Gesler, 1991;Kearns, 1993). The concept of therapeutic landscapes, first introduced by Gesler in 1991 is a key theoretical concept that helps to establish a more concrete link between health and place by uncovering the ways in which individual, social, cultural, environmental and structural factors interact in creating healing landscapes (Gesler, 1992). ...
... In recent years, the health concerns of immigrants and other potentially vulnerable populations have received increased attention (Dyck, 1995(Dyck, , 2006Dyck & Dossa, 2007). However, that attention has not generally moved into the therapeutic landscapes literature. ...
The aim of this paper is to elucidate the links between place and Bengali immigrant women's use of social networks in their efforts to live a healthy pregnancy. The literature on therapeutic landscapes has mostly emphasized characteristics of local places. I argue that social networks constituted in and beyond the places where people live are equally important. I draw on findings of a qualitative study conducted with Bengali immigrant women in New York City between 2004 and 2006 to understand the place-creating characteristics of social therapeutic networks. In-depth interviews with 40 women in selected neighborhoods in New York City show that such networks operated at multiple scales, ranging from the local to the transnational. A mix of tangible and virtual care and support were received through face-to face interaction and phone conversations. Advice on how to live a healthy pregnancy, cooking and bringing or sending food and therapeutic conversations emerged as important kinds of care and support provided by therapeutic networks. These networks worked in complex ways, reflecting: 1) the situational context of women's lives, shaped by the temporal (e.g. length of residence) and place-based (e.g. residential geographies) aspects of migration, 2) the importance of 'imaginative aspects' in shaping the meanings women formed of therapeutic networks and 3) the diverse ways in which women created and sustained these networks, based on class, country of origin, religion and culture.
... We have not as yet developed spatial discourses that provide insights into how societal values, practices and structures impact on lives (Soja 1989). That space has much to do with multiple marginal positioning of ethnocultural minorities with disabilities may be demonstrated by drawing cues from critical geographers, as well as cultural and feminist anthropologists (Dyck 1995;Kerns 1997;Emberley 1993;Fine/Asch 1988;Minh-ha 1989). These critiques suggest that space, and its concomitant place and also time, cannot be delineated within a unitary framework. ...
... Spaces are gendered, raced and disabling both in their representations and how they are experienced. Dyck (1995), for example, has shown how women's work evokes spaces that are not legitimated in dominant representations. A focus on everyday space(s) of home, streets, neighborhoods and work reveals complex interdependencies that challenge dichotomous representations of pubic and private, and productive and reproductive spaces. ...
... 48 This is especially notable in the case of immigrants, for whom many diverse cultural considerations go into the decision of when and where to receive health care. 49,50 Such information is best gleaned from ethnographic research, or, as Dyck puts it, "Talking to people, rather than about 'dots on maps' [referencing Parr 51 ]." 52 Because I wanted to find out how fear and other intangible, aspatial factors would be one such consideration, in-depth interviews about women's experiences was the most fitting method. This paper thus also contributes to health geography's more recent focus on the lived experiences of health and well-being, 48,53 which can contribute to the concern across various disciplines, including health policy, on factors impacting health care access and health service delivery. ...
... As is common with first-generation immigrants, the women I spoke with blended health care modalities from both their home countries and receiving communities. 49,54 Interviewees communicated with family, friends, and health professionals from their home countries to obtain health knowledge and sometimes even medicine itself (before it became unlawful to do so), which was more affordable. Anita, who had no kids and was from Mexico, explained, the case for young first-time mothers who did not know many people in the United States. ...
Drawing from 56 semi-structured interviews, this article details how undocumented Latina immigrants living in Atlanta, Georgia, in 2013 cultivated health and well-being in an insecure environment. In addition to the myriad challenges that immigrants face in accessing health care in their new communities, undocumented immigrants living in Atlanta at that time faced the legal barrier presented by Georgia’s new “show me your papers” law, which imbued public space with the risk of deportation for those who are undocumented. This law complicated health care access by making the trip to the doctor’s office risky. Immigrants’ health care decisions were thus shaped by the “geography of fear” that permeated their new communities. This fear presented itself not only in public space but also in clinics and hospitals, where many immigrants feared – and sometimes received – bad treatment. Despite the obstacles fear and immigrant policing presented, many of the women I interviewed showed boldness in their health care decisions, staking their claim to medical attention where they saw fit. Additionally, many maintained transnational networks and continued with familiar health practices from home. Combined, these strategies worked to create complex and shifting “therapeutic landscapes” in an environment permeated by insecurity and fear.
... They usually belong to lower socio-economic classes and tend not to seek information outside of their most immediate and familiar environment, thinking that outside sources are not capable of addressing their concerns and are not trustworthy or credible. A large number of publications are available that confirm in various ways this aspect of newcomers' information-seeking behaviour (Ahmad et al., 2004a;Deri, 2005;Dyck, 1995;Fisher et al., 2004b;Leduc et al., 2004;Sheikh-Mohammed et al., 2006). ...
... Most respondents reported that the main sources of information on health and healthrelated services in their countries of origin had been their doctors and other health providers, a response in line with other authors' observations acknowledged in several studies as essential sources of information for immigrants (Ahmad et al., 2004a;Deri, 2005;Dyck, 1995;Leduc et al., 2004). ...
... The challenges of access to health services, and ultimately overall health, may be greater for particular groups. For instance, it may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (Anderson et al., 1993; Dyck, 1995; MacKinnon and Howard, 2000; Oxman- Martinez et al., 2000; Weerasinghe, Mitchell, Hamilton, & Ragheb, 2000), with immigrant women preferring a health care provider with the same culture, language, and gender (Black and Zsoldos 2003). Similarly, refugees may present different health needs (i.e., mental health needs) and profiles from the broader immigrant population related to existing mental and physical health conditions as well as the trauma of resettlement and being a refugee (Lawrence and Kearns 2005). ...
... The challenges of access to health services, and ultimately overall health, may be greater for particular groups. For instance, it may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (Anderson et al., 1993;Dyck, 1995;MacKinnon and Howard, 2000;OxmanMartinez et al., 2000;Weerasinghe, Mitchell, Hamilton, & Ragheb, 2000), with immigrant women preferring a health care provider with the same culture, language, and gender (Black and Zsoldos 2003). Similarly, refugees may present different health needs (i.e., mental health needs) and profiles from the broader immigrant population related to existing mental and physical health conditions as well as the trauma of resettlement and being a refugee ( Lawrence and Kearns 2005). ...
... The challenges of access to health services, and ultimately overall health, may be greater for particular groups. For instance, it may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (Anderson et al., 1993; Dyck, 1995; MacKinnon and Howard, 2000; Oxman- Martinez et al., 2000; Weerasinghe, Mitchell, Hamilton, & Ragheb, 2000), with immigrant women preferring a health care provider with the same culture, language, and gender (Black and Zsoldos 2003). Similarly, refugees may present different health needs (i.e., mental health needs) and profiles from the broader immigrant population related to existing mental and physical health conditions as well as the trauma of resettlement and being a refugee (Lawrence and Kearns 2005). ...
... The challenges of access to health services, and ultimately overall health, may be greater for particular groups. For instance, it may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (Anderson et al., 1993; Dyck, 1995; MacKinnon and Howard, 2000; OxmanMartinez et al., 2000; Weerasinghe, Mitchell, Hamilton, & Ragheb, 2000), with immigrant women preferring a health care provider with the same culture, language, and gender (Black and Zsoldos 2003). Similarly, refugees may present different health needs (i.e., mental health needs) and profiles from the broader immigrant population related to existing mental and physical health conditions as well as the trauma of resettlement and being a refugee (Lawrence and Kearns 2005). ...
... However, our expectations about neighborhood-scale effects on lead poisoning are complicated by two counter arguments. First, lead exposure may be reduced via place-based strategies facilitated by the spatial concentration of certain groups, which can lead to the sharing of information about health risks, prevention, and screening (Dyck 1995). Second, screening activity and the dissemination of information about lead hazards may reflect local knowledge of where poisoned children have been located before. ...
... Because the composition of the Asian populations of the two counties is different, we cannot dismiss explanations that link increased lead levels in Worcester to the exposure of (Hmong) children to lead in their former places of residence or to culturally specific practices. Health practices differ, as do the ways information about health risks is processed by different communities (Dyck 1995). ...
We examine spatial variation in childhood lead poisoning within two industrial counties in New England: Worcester County, Massachusetts, and Providence County, Rhode Island. The findings suggest that lead exposure is linked to the differential patterns of urbanization and industrial activity and that a history of abatement can reduce lead exposure. Lead exposure in census tracts with minority neighborhoods varies in complex ways between the counties. We conclude that attention to local context forms an essential component of understanding how public health interventions will continue to affect the geography of childhood lead poisoning.
... 68 Their bodies are vehicles of cultural values and gender norms, used for carrying out household chores and responsibilities that require long hours of physical labor, such as cooking and cleaning for the family. 69 With scant financial resources, in India, they can use other women's bodies such as extended family and paid domestic help to decrease the burden. When this help is lost due to immigration, it is only their own bodies that carry out this tremendous workload. ...
Background
Over the past two decades, the prevalence of chronic pain has significantly increased globally, with approximately 20% of the world’s population living with pain. Although quantitative measures are useful in identifying pain prevalence and severity, qualitative methods, and especially arts-based ones, are now receiving attention as a valuable means to understand lived experiences of pain. Photovoice is one such method that utilizes individuals’ own photography to document their lived experiences.
Aims
The current study utilized an arts-based method to explore immigrant Indian women’s chronic pain experiences in Canada and aimed to enhance the understanding of those experiences by creating a visual opportunity for them to share their stories.
Methods
Twelve immigrant Indian women captured photographs and participated in one-on-one interviews exploring daily experiences of chronic pain.
Results
Women’s photographs, and description of these photographs, provided a visual entry into their lives and pain experiences. Three themes emerged from our analysis: (1) bodies in pain, (2) traversing spaces including immigration, and (3) pain management methods. Findings revealed that women’s representations of pain were shaped by a clash between culturally shaped gender role expectations and changing gender norms due to immigration processes. The use of photovoice visually contextualized and represented pain experiences, proving to be a valuable tool for self-reflection.
Conclusions
This research uncovers the multifaceted nature of chronic pain and identifies the influence of immigration, gender, and social relations on the exacerbation of pain in immigrant Indian women.
... A therapeutic landscape is where the "physical and built environments, social conditions, and human perceptions combine to produce an atmosphere which is conducive to healing" (Gesler 1996, p. 96). Within health geography, this definition recognizes place to be comprised of both the subjective meanings that are created through human experiences and the material realities that govern one's ability to act within locations (Dyck, 1995;Kearns, 1993). This paper contributes to the work on therapeutic landscapes by engaging with transnational theory to understand the global dimensions of health and health-seeking behaviours. ...
Using in-depth interviews with Guyanese immigrants in North America this paper argues their therapeutic landscapes are produced transnationally and these transnational therapeutic landscapes impact their ongoing health practices in the country of settlement. The results reveal that the historical use of traditional “bush medicine” provided a resilient response to inaccessible biomedical healthcare in Guyana. However, the continued use of bush medicine in the countries of settlement is not a result of barriers to healthcare. Instead, continued use constitutes a transnational therapeutic health practice that is tied to historical use, perceived efficacy of treatments, and participants’ perceptions of Guyana as a therapeutic landscape.
... Acknowledgement of the role of culture is important, but in the absence of any consideration of broader social processes and more systemic barriers to access, such assessments can inadvertently shift the onus of responsibility entirely onto the shoulders of the person in need of support. 38 It is evident from our findings, our previous stakeholder forum, 39 and the literature that barriers to accessing health promotion interventions and supports are to be found at each of the micro, meso and macro levels: individuals, families, health care providers, organizations, and society all play a role. This finding is captured by the candidacy framework for understanding access to health and social services for marginalized populations. ...
The Seniors Support Services for South Asian Community (S4AC) project was developed in response to a problem in the community: although South Asian seniors were especially numerous in the Newton area of Surrey, they were not using recreation and seniors’ facilities in this neighbourhood. Addressing the problem required the collaboration of the Parks, Recreation and Culture Department of the City of Surrey, and DIVERSEcity, a registered non-profit agency offering a wide range of services and programs to immigrant and refugee communities. Through creative outreach, reduction of language and cultural barriers, provision of childcare for grandchildren, and by taking programs to where seniors naturally gather (e.g., parks, temples), the project has succeeded, since 2008, in engaging 100 Punjabi seniors annually in diverse exercise activities, facilitating the development of peer networks and close friendships among participants, and empowering the seniors to utilize existing community resources (pool, seniors centre, etc.), initiate activities on their own and socialize with other communities. The project also offers educational workshops on various topics, including health and self-care, and counseling is provided as needed.
... 51,103,106-109 Acknowledgement of the role of culture is important, but in the absence of any consideration of broader social processes and more systemic barriers to access, such assessments can inadvertently shift the onus of responsibility entirely onto the shoulders of the person in need of support. 110 It is evident from our findings, our previous stakeholder forum, 69 and the literature (particularly in the areas of health promotion, health literacy and cultural responsiveness, rather than that on SM per se) that barriers to accessing SM interventions and supports are to be found at each of the micro, meso and macro levels: individuals, families, health care providers, organizations, and society all play a role. This finding is consistent with an intersectionality perspective and is captured by the candidacy framework for understanding access to health and social services for marginalized populations. ...
Older immigrants from South Asia experience higher morbidities of chronic conditions such as cardiovascular disease and diabetes mellitus. They also have lower physical activity rates and higher barriers to accessing knowledge about chronic conditions and the care they need to live well with these conditions. Current models for self-management education and interventions do not take these disadvantages into account. DIVERSEcity Community Services Society and the City of Surrey have collaborated since 2008 to deliver the Seniors Support Services for South Asian Community Project. The project has employed many creative strategies to address barriers to participation in health promoting activities and build community capacity. Our qualitative research study explored if and how the various components of this project have facilitated meaningful linkages between individual, family, community and healthcare systems so as to support the capacity of immigrant South Asian senior participants to live well with their chronic conditions. Findings suggest that the program addresses many of the components deemed central to existing SM interventions. More importantly, however, we identified elements of the program that arguably have a profound influence on the participants’ capacity to live well with chronic conditions that are typically not integral to the most widely promoted SM programs available. Only with the inclusion of these missing elements will SM interventions be accessible and meaningful to barriered populations such as the South Asian older adults in our study.
... Accessing health care services is not only about finding a provider, but also about finding an environment that is comfortable and understanding (Dyck 1995;Naish et al. 1994;Zanchetta and Poureslami 2006). Western health care institutions and the medical system are premised on the 'universal' patient body, with very little recognition of the social context/identity of that body. ...
Much of the existing research literature on the health of immigrant populations does not address the health care experiences of refugees, even though they likely experience unique and different health care needs relative to economic or family class immigrants. The objective of this paper is to explore the systemic barriers to health care access experienced by Canada's refugee populations. The paper focuses on understanding these challenges as expressed by health and social service providers at the local level in Hamilton, Ontario. Data from interviews illustrate the impact of these systemic barriers for both refugees and providers. The paper examines issues of interpretation/language, cultural competency, health care coverage, isolation, poverty, and transportation in terms of health care and availability of services. © The Author 2010. Published by Oxford University Press. All rights reserved.
... She suggests that rather than taking a single approach, health geography should be organized thematically. In our own reading of health geography, themes range from infectious diseases (Mayer, 2000) to mental health (Dear and Wolch, 1987;Parr, 1998), from disability (Dorn and Laws, 1994;Park et al., 1998) to chronic conditions (including disability) (Dyck, 1995;Jones and Duncan, 1995;Moss and Dyck, 2002), and from illness to well-being (Kearns, 1993;Kearns and Gesler, 1998;Richmond et al., 2005). To research and write about these themes, health geographers use both quantitative and qualitative methods. ...
Calls for a political ecology of health have recently emerged in geography. This article builds on these to suggest a practice of a political ecology of health by incorporating the insights of medical anthropology, STS, and history of medicine. Framed around three perspectives - partial and situated knowledges, Marxist-feminist approaches, more-than-human geographies of health - this article argues that incorporating the insights of political ecology and cognate disciplines into the problems we investigate and the methods we use will make for a stronger practice of a political ecology of health.
... Although these issues may not be exclusive to immigrants from a particular region of the world, it is obvious that the degree to which various sub-populations encounter these barriers varies among ethno cultural groups. Discriminatory policies and practices in health care institutions, lack of culturally competent care, lack of data and standardized data collection methods for disease conditions prevalent in specific groups and inadequate inclusion in health care research are all factors that contribute inequities in health and healthcare (Jones, 2000;Kennedy, et al., 1997;Krieger, 2000) Access to healthcare for African immigrant women is further compounded by family and work responsibilities as well as socio-cultural expectations (Dyck, 1995;Newbold & Danforth, 2003). The pressure to meet these expectations often results in limited health service utilization by immigrant women who are reluctant to navigate a foreign system, perceived as un-responsive to their needs. ...
Historically, immigration has had a significant impact on the changing demographic of the Canadian society. Each year more newcomers enter the country. There are more than 45 ethno-cultural associations and more than 100 different ethno-cultural groups residing in Nova Scotia. In the recent past, social science researchers are becoming increasingly involved in identifying ways of effectively addressing the social and health needs of this culturally diverse Canadian population. There is very limited literature on the Nova Scotian experiences of immigrant women especially those of African descent. For the government to develop public policy that ensures the inclusion of vulnerable and high-risk populations in our society such as recent immigrants and black people, their perspectives should be considered. Some steps are being taken by individual researchers to illuminate these perspectives. The paper will discuss the findings of a project that examined the health care experiences of immigrant women in a Canadian province with a goal of illuminating health care needs of recent immigrant women and facilitating community capacity building to create positive change for more accessible health care. The data collection method was primarily focused group meetings and workshops held with the individual immigrant communities. Although the project was conducted with immigrants from five regions of the world, this paper will focus on the experiences of first generation immigrant women of African descent with emphasis on their perspectives on the process mothering in a multicultural society. The paper will discuss their childrearing needs and their attempt to address these needs within the spaces of multiculturalism, the two predominant ones being the Canadian culture and that of their countries of origin. The paper will conclude with some suggestions for change at both the practitioner and policy level in order to effectively address the social and welfare needs of this population.
... There remains, however, much work to be done in examining the 'who, where, what and how' of social support. Furthermore, while a materialist approach emphasizes the marginalization of many immigrant women in Canada, women are also shown as pragmatic, knowledgeable agents in managing their lives and their health, including the 'smart consumerism' identified by Kelner and Wellman (1997) whereby traditional healing systems and biomedicine are both used (Dyck, 1995;Stephenson, 1995). ...
... At the same time, place context is closely related to social and cultural resources and networks. Immigrants often have strong place-based social ties based on ethnicity and country of origin (Dyck 1995). Dyck (2006) described the " sedimentation of place " for immigrant women through daily routines and activities that revolve around culturally familiar institutions, shops and services, and strong local social networks. ...
How do the social and material characteristics of residential contexts in the host country affect immigrant maternal and infant health? We examine this question through the lens of the ethnic density hypothesis, a hypothesis that posits beneficial effects on immigrant health of living in areas of high ethnic density; that is, among a socially and linguistically similar population. We analyze the association between infant low birth weight and ethnic density for Bangladeshi immigrant mothers in New York City during a period of rapid and sustained immigration (1990–2000). For Bangladeshi immigrant women, ethnic neighborhoods can provide an important source of social and material support during pregnancy. Geographic information systems (GIS) and spatial analysis methods are used to create a fine-grained indicator of ethnic density. Results show that the relationship between ethnic density and infant low birth weight changed over time. The lack of association in the early years (1990 and 1993) might reflect the fact that the Bangladeshi population had not yet reached a sufficient size, or spatially clustered settlement pattern, to provide dense ethnic neighborhoods and concentrations of social and material resources. In 2000, we observe a U-shaped association between low birth weight and density: Women living in ethnically isolated settings and those living in high-density enclaves are more vulnerable to adverse infant health outcomes. The results suggest the need for a more nuanced understanding of immigrant maternal and infant health and ethnic density that incorporates the dynamism of immigrant experiences and their associations with shifting spatially and socially defined residential environments.
... Access may also be impeded by language or cultural barriers, preferences for use of 'traditional' or 'Western' health care providers, and a lack of awareness of health care opportunities (Deinard and Dunnigan 1987;Elliott and Gillie 1998;Raja-Jones 1999). Access to health services, and ultimately overall health, may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (Anderson et al. 1993;Dyck 1995;MacKinnon and Howard 2000;Oxman-Martinez et al. 2000;Weerasinghe et al. 2000). Paradoxically, however, poor access and/or under-utilisation of health care services can have the effect of improving the apparent health of immigrants in so far as the failure to detect and diagnose health problems may lower the measured prevalence rates of chronic conditions and lead to better subjective assessments of health. ...
The literature suggests that the foreign-born, and especially recent arrivals, enjoy better health than their Canadian-born counterparts, as measured by a number of health outcomes including self-assessed health and chronic conditions. Using data drawn from Statistics Canada's longitudinal National Population Health Survey (NPHS), the paper evaluates the so-called ‘healthy immigrant effect' with respect to chronic conditions. Specifically, it evaluates the presence, number and type of chronic conditions (heart disease, asthma, arthritis, diabetes) within the immigrant population, with comparisons made to the native-born population. Native- and foreign-born prevalence rates for chronic conditions are also age–sex standardised to aid comparison. Evidence from both descriptive and multivariate analysis supports the healthy immigrant effect with respect to chronic conditions. Strong evidence of health disparities across arrival cohorts is also found.
... The impact of culture on the assumptions health care providers and clients bring to the negotiation encounter often goes unrecognized. Dyck (1995) suggested using a "local context", i.e.-making sense of everyday life and organized behaviour. This is a salient point for health care providers to understand and use in their every day communication with patients. ...
"MR-03795." "March, 2005." Thesis (MN)--University of Calgary, Facutly of Nursing, 2005. Includes bibliographical references. Microfiche.
... Immigrants may, in fact, experience "double" or even "triple" jeopardy with respect to access to and use of health care services. For example, access to health services, and ultimately overall health status, may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (23)(24)(25)(26)(27). Poor access and service use may lead to a worsening of health status over time, owing to the relative underuse of preventive health screening and underdiagnosis and undertreatment of health problems. ...
Set within the "determinants of health" framework and drawing on Statistics Canada's longitudinal National Population Health Survey, this article explores health care utilization by Canada's immigrant population. Given the observed "healthy immigrant effect", whereby the health status of immigrants at the time of arrival is high but subsequently declines and converges toward that of the native-born population, does the incidence of use of health care facilities reflect greater need for care? Similarly, does the use of health care facilities by the native- and the foreign-born differ, and if so, are these differences explained primarily by socioeconomic, sociodemographic, or lifestyle factors, which may point to problems in the Canadian health care system? This study identifies trends in the incidence of physician and hospital use, the factors that contribute to health care use, and differences in health care use between the native- and foreign-born.
... In addition, diminished social networks, poor working conditions, and language barriers may contribute to declines in health (Anderson 1987, Lock 1991, Saldov 1991, Chen et al. 1996, Elliott and Gillie 1998, Hanna 1998, Grossi et al. 1999, Wozniak 2001. Access to health services, and ultimately overall health, may be especially limited among immigrant women whose family, job, or cultural expectations and roles may make it difficult to access and use resources (Anderson et al., 1993, Dyck 1995, MacKinnon and Howard 2000, Oxman-Martinez et al. 2000, Weerasinghe et al. 2000. Poor access and service use may lead to a worsening of health status over time owing to the relative under-use of preventative health screening and under-diagnosis and treatment of health problems. ...
The objectives of the current paper are to address the timing of declines in health after arrival in the host country, and to document differences in health status by immigrant arrival group (economic immigrants, family reunification, and refugees).
Statistics Canada's Longitudinal Survey of Immigrants to Canada captures health and other attributes of a cohort of immigrant arrivals to Canada at six months, two years, and four years after arrival. Descriptive and multivariate methods are applied to this data file in order to ascertain changes in health status in the period immediately after arrival.
Significant declines in health status are noted within as little as two years post-arrival. In addition, refugees are observed to have lower levels of health and are more likely to transition to a state of poor health, while economic immigrants report the highest levels of self-assessed health.
The health status of new arrivals, measured by self-assessed health, physical health, and mental health, declines quickly after arrival. Refugees generally experience the lowest levels of health.
The global health crisis initiated by the COVID‐19 pandemic (2020–2021) brought to the fore issues around bodily health and safety within the internationalisation of higher education. Rarely have these concerns been discussed in relation to international students, despite them being a central issue for students themselves and their family members ‘back home’. In this paper, we draw upon in‐depth interviews with UK‐based international postgraduate students to discuss how concepts of safety and bodily health are constructed geographically and transnationally, in conversation with family members ‘back home’ and, conversely, in their embedded and emplaced experiences as international students. The COVID‐19 pandemic provides a useful lens for considering these issues as it brought them into sharp relief as never before.
Medical geography and health geography have made significant contributions to studies of human health by addressing the spatial patterns of disease exposure, location of health care services, and place-specific processes producing health and wellbeing. Human geography and human-environment geography have also contributed with emerging attention to the body, uncertainty, and health and environment interactions. What remains understudied are the co-occurrence of multiple disease patterns, including the relationships between infectious disease and addiction. We review geographic research on infectious disease and addiction to advance a theoretical framework that emphasizes the centrality of complexity, uncertainty, difference, and care in shaping human health.
Human geography's varied engagement with the brain has involved considerations of the way people know and respond to their environments, and their place-based experiences with emotions, mental illnesses and disorders, intellectual disabilities and particular neurological conditions. This paper argues however that this scholarship could be augmented by, and existing expertise be directed towards, considering physical brain abnormalities and injuries. As a case in point it considers the spatial experience of living with Type 1 Chiari Malformation. Through interviews with four sufferers, the research articulates three domains that they have had to re-negotiate - home space, social space and medical space - emphasizing supportive and challenging aspects of each, as well as meaningful and affective qualities to encounters. The paper concludes with some pointers towards the future study of physical brain abnormalities and injuries and the kinds of knowledge it might create to increase awareness and inform care.
We examine spatial variation in childhood lead poisoning within two industrial counties in New England: Worcester County, Massachusetts, and Providence County, Rhode Island. The findings suggest that lead exposure is linked to the differential patterns of urbanization and industrial activity and that a history of abatement can reduce lead exposure. Lead exposure in census tracts with minority neighborhoods varies in complex ways between the counties. We conclude that attention to local context forms an essential component of understanding how public health interventions will continue to affect the geography of childhood lead poisoning.
The body as a place in itself and a place for the self ? Geographical aspects of a globalised body practice : yoga
This paper addresses the question of the circulation of knowledge and savoir-faire related to the body (particularly those regarding health such as yoga). Drawing on the conditions of its production and reproduction at different scales, the article proposes to consider the body as a space in itself and a space for the self, favouring an interpretation of the spatial dimensions of sociabilities, negociations, resistances and norms that frame this practice and its evolution in space and time.
This paper focuses on the graphic pathogeographies in David B.’s Epileptic and David Small’s Stitches: A Memoir to highlight the significance of geographic concepts in graphic novels of health and disease. Despite its importance in such works, few scholars have examined the role of geography in their narrative and structure. I examine the role of place in Epileptic and Stitches to extend the academic discussion on graphic novels of health and disease and identify how such works bring attention to the role of geography in the individual’s engagement with health, disease, and related settings.
Type 1 diabetes is one of the most common chronic conditions of adolescence and young adulthood. It is characterized by a demanding and complex management regime. Individuals with diabetes must engage in continual self-care actions if they are to minimize their risks of developing long-term diabetes' complications. Research has demonstrated, however, that many young adults experience difficulties engaging in these types of practice, and indeed often engage in practices that are risky for their diabetes control. Narrative approaches could provide important insights into the reasons why young people engage in risky activities. In this article, the narratives of a particular group of young adults with Type 1 diabetes (university students) are examined to see what social and spatial factors underlie their risky alcohol consumption practices. This paper contributes to geographical research on risk and chronic illness, and to understandings of the interactions between bodies, spaces and risk.
This research analyzes differences between immigrant and native-born Black women in the relationship between racial residential segregation and low birthweight risk. Differences in nativity are investigated because sociocultural diversity may affect women's exposure to environmental and psychosocial stressors associated with living in highly segregated neighborhoods and in the presence of protective "ethnic density" effects. Using vital statistics data for New York City on all births to "Black" mothers in 2000, we analyze the associations between segregation and the risk of having a low birthweight infant for immigrant and native-born mothers. Multilevel models are estimated that include maternal characteristics, census tract poverty, and a spatial measure of local segregation. For U.S.-born Black women, living in racially segregated areas—areas with high racial isolation—is associated with a higher low birthweight risk. Similar findings are uncovered for immigrant Black women; however, the association between segregation and low birthweight disappears when differences in country/region of origin are controlled. For immigrant Black women, the health impacts of segregation are much more muted and complex than those for the native-born. [Key words: Racial residential segregation; low birthweight; immigrants; ethnic density; New York City.]
The term ‘landscapes of care’ has increasingly taken hold in the lexicon of health geography. As the complex social, embodied and organizational spatialities that emerge from and through relationships of care, landscapes of care open up spaces that enable us to unpack how differing bodies of geographical work might be thought of in relationship to each other. Specifically, we explore the relation between ‘proximity’ and ‘distance’ and caring for and about. In doing so, we seek to disrupt notions of proximity as straightforward geographical closeness, maintaining that even at a physical distance care can be socially and emotionally proximate.
Emerging research within health geography and related fields is attending to the social dimensions of human health. Notwithstanding these contributions, health geography has provided less rigorous attention to the role of political economy in producing disease and shaping health decision-making. Additionally, the reciprocal relationships between health and environment have been underexplored. This paper asserts that political ecology would contribute by examining the political economy of disease, interrogating health discourses, and understanding the interactions between social and environmental systems. The benefits of a political ecology of health are demonstrated through an examination of the HIV/AIDS epidemic in South Africa.
In this paper, we reflect on the positioning of health geography within the wider academic landscapes of geography and health-related research. Drawing on examples from a number of countries, we consider the extent to which a ‘new geography of health’ has emerged in recent years. We structure our discussion around the themes of place, theoretical engagement and critical relevancy. Changes within the subdiscipline are placed in the context of a central question: what is new about the new geography of health?
Geographers are bringing together narrative approaches and insights from cultural and feminist geography in building a body of work that examines the links between health, place and culture. This paper follows this direction in examining accounts of health and illness of South Asian migrant women living in British Columbia, Canada, using data from semi-structured interviews and a set of in-depth group interviews. The intent of the study was to explore how traditional medicine and indigenous medicine, as subjugated knowledges, were in tension or integrated with western medicine in the women's approaches to keeping healthy and managing illness. Analysis of the accounts shows intricate relationships among the body, food, place and identity. It is argued that these relationships are integral to the ongoing constitution of subjectivities and place in the context of the rapidly growing urban centres of the study. The paper concludes with comment on how this type of analysis of health and illness 'talk' de-medicalizes immigrants' health behaviour, instead placing it within wider issues of integration and inclusion confronting racialized immigrant groups.
This paper concerns the negotiation of cultural categories embedded in and informing the ongoing nation formation of Canada. It discusses the construction of cultural identities by health care professional students as they participated in a qualitative study concerned with health care practice in an increasingly culturally diverse society. The study methodology, embedded in layers of narrative about «difference», fostered a negotiation of «self» and «other» on the part of the students and provided an intense site for reflection on cultural identities and social categories in a period of rapid demographic change in Canada. As the students defined and interpreted cultural issues during their fieldwork placements they interrogated and contested various dimensions of difference, including their own sense of Canadian-ness as this played out in «lived» multiculturalism in a specific Canadian city. It is argued that the students» negotiations of boundaries of the cultural «self» were closely linked to a changing place narrative and identity of Canada, expressed in discourses and material practices around difference at local and national scales.
Feminist geographies of health and illness have emerged over the last 10 years, marking an increased interest in the highly gendered nature of health, health care and caregiving. Yet work in this area remains relatively sparse. This article examines parallels and divergences between feminist and health geography, which frame the context of feminist geographers doing health work. Interconnections between the two subfields where there is most exchange relate to the admission of experiential knowledge in a ‘reformed’ medical/health geography, and work engaging critical theory—particularly that of the body. The positioning of health geography in the shadow of medicine brings ambiguity to the issue of transformative politics; institutional conservatism vies with an opportunity to bring feminist work to the interstitial space of social science and critical medicine.
This paper overviews the emergence of medical/health geography in Canada. The paper discusses the key questions that Canadian health geographers have explored in the past two decades, how these enquiries have featured in the field and how they contribute to the wider discourse of human geography. It also addresses questions on emerging themes and where Canadian health geography will go in the years ahead. With shifting health landscapes in terms of changes in social, political and physical environments, and changes in health care restructuring, Canadian health geographers are entering a new phase of research, teaching and policy. The complexity of the questions that health geographers seek to address means it is necessary to continue to highlight the policy implications of their findings. Health geographers need to emphasize the public agenda through interdisciplinary research and by continuing to work with geographers in other subfields.
La géographie politique et la géopolitique
Ce texte présente les principaux apports des géographes politiques canadiens à la croissance spectaculaire de cette sous discipline au cours des deux dernières décennies. L'accent est mis sur deux volets de travail en plein essor. Le premier aborde la mutation du pouvoir de l'état et le second s'intéresse à la période actuelle caractérisée par la guerre, la militarisation et les mesures de surveillance à l'échelle planétaire. Le but n'est pas de dresser un bilan du domaine de la géographie politique. Il est plutôt question de définir à travers ces deux thèmes certains travaux récents et de délimiter un certain nombre de champs d'enquête qui méritent plus d'attention et qui devraient prendre plus d'importance. Ce texte montre, plus spécifiquement, à quel point le rôle des acteurs doit être pris en compte, c'est-à-dire sa capacité d'agir, en matière de géographie politique et de géopolitique.
This dissertation explores the spatial patterns and place-based characteristics of colorectal cancer (CRC) late stage incidence and CRC-specific mortality in Miami-Dade County. Because CRC is the second leading cause of death among all cancers and is almost 90 percent preventable through medical screenings, investigations of CRC disparities across groups and communities are extremely relevant in the fight against cancer. This paper analyzes the geographic distribution of CRC cases in Miami-Dade County between two periods, 1988-1992 and 1998-2002 to: a) identify significant "hot spots" or clusters of disease; b) investigate associations of CRC patterns with neighborhood level characteristics such as socio-economic status, race/ethnicity, and poverty; and c) explore the policy implications of the spatial trends identified for the disease, with particular reference to the Welfare Reform Act of 1996. This dissertation analyzes data from the Florida Cancer Data Registry and tract level U.S. Census data, to identify the spatial distribution of CRC and study its relation to place-based variables using Geographic Information Systems (GIS) and spatial statistical modeling. Identifying spatial clusters of disease can assist in targeting public health interventions and improving social service delivery, particularly for uninsured populations. Identifying communities facing greater obstacles to screenings and quality medical care through the use of spatial analysis is an effort to mitigate these barriers while simultaneously providing empirically based evidence linking neighborhood-level social and economic conditions to health disparities.
Nancy Krieger has been one of the leading voices in documenting how social ‘axes of difference’, including race, ethnicity
and class make people vulnerable to poor health and limit their access to effective health care. We discuss the importance
of ‘locating’ diversity in health inequalities research. This includes critically dissecting racial and ethnic axes into more
nuanced social categories that incorporate differences based on immigration and other factors. It also involves considering
how diverse population groups vary in their perception and use of space for health-related activities and exposures. Examples
relating to immigrant populations’ health and access to health care are discussed.
This article uses accessibility as an analytical tool to examine health care access among immigrants in a multicultural urban setting. It applies and improves on two widely used accessibility models—the gravity model and the two-step floating catchment area model—in measuring spatial accessibility by Mainland Chinese immigrants in the Toronto Census Metropolitan Area. Empirical data on physician-seeking behaviors are collected through two rounds of questionnaire surveys. Attention is focused on journey to physician location and utilization of linguistically matched family physicians. Based on the survey data, a two-zone accessibility model is developed by relaxing the travel threshold and distance impedance parameters that are traditionally treated as a constant in the accessibility models. General linear models are used to identify relationships among spatial accessibility, geography, and socioeconomic characteristics of Mainland Chinese immigrants. The results suggest a spatial mismatch in the supply of and demand for culturally sensitive care, and residential location is the primary factor that determines spatial accessibility to family physicians. The article yields important policy implications.
This paper contributes to the body of research on the relationship between language, health (behaviour), and place. Drawing on data from a qualitative study of taxi drivers in Ontario, Canada, it illustrates how talk, a dimension of language, might (re)make and maintain an unconventional, precarious workplace through ameliorating its inherent risks and hazards. It shows how a group of taxi drivers, who work in a large, metropolitan city, and whose workplace comprises physical places such as streets, highways, and taxicabs, and social places characterised by disadvantaged social and economic location, enact different kinds of talk in an effort to protect their health. This finding suggest the need for a broader conceptualisation of health behaviour, and for further research into other occupational groups and/or unconventional workplaces in order to further develop or theorise the concept of talk.
Abstract The aim of this research is to examine use of prenatal care by South Asian immigrant women in New York City, focusing not only on barriers to care but also women’s reliance on multi-scalar, place-based social networks and resources. Recently, public health analysts have raised concern about low utilization of prenatal care by South Asian women who are much less likely than US-born women to receive early and adequate prenatal care. I use a mix of quantitative and qualitative methods to examine spatial variation in use of prenatal care for South Asian women in New York City and to understand experiences of pregnancy care for a specific sub-group of South Asian immigrant women. In the quantitative section, GIS and statistical methods are employed to identify risk factors and areas where use of prenatal care is especially low. The qualitative section comprises in-depth interviews with women from Bangladesh and Bengali women from India to understand their formal as well as informal pregnancy care experiences. I seek to examine the social, cultural and geographical barriers these women face in gaining access to prenatal care and explore how women create and draw upon resources at different geographical scales to maintain health and well-being during pregnancy. Results from the quantitative section show that Bangladeshi and Pakistani women are at higher risk of receiving less than adequate prenatal care especially in specific areas such as in South Central Brooklyn. Education and employment emerges as significant risk factor for Pakistani and Bangladeshi women’s low use of prenatal care. Results from the qualitative section highlight South Asian women’s situatedness in local and transnational networks and the role of such networks in enabling women to use both formal and informal pregnancy care. Situated within the theoretical framework of a ‘new’ medical geography this research makes several contributions to the emerging body of work untying the linkages between health and place. Home emerged as important as a space for care as well as strenuous labor for pregnant South Asian women. Everyday places such as neighborhood parks, temples emerged as important spaces with physical as well as social therapeutic qualities. ‘Social therapeutic networks’, operating at multiple geographical scales were important in shaping women’s place-based experiences of pregnancy care. As these networks unfolded, places were recreated and/or transformed making them therapeutic and healthy places. Therapeutic qualities of informal conversations and of sights and sounds surfaced in women’s narratives, further enriching the notion of therapeutic landscapes. Identifications of everyday locales as therapeutic as well as use of social therapeutic networks differed based on differences in class, religion and country of origin. The research has several policy implications. Issues raised by the women, such as long waiting times and too many tests, need to be addressed. By highlighting within group diversity amongst South Asian women, this research emphasizes the need to fine-tune prenatal care policies to cater to the needs of diverse sub-groups of women masked under a broad label. By highlighting the importance of place in South Asian women’s use of pregnancy care, this research emphasizes the need to focus not only on barriers to care but also on women’s reliance on multi-scalar, place-based social networks and resources.
Although rates of tuberculosis (TB) in much of the western world have steadily declined since the Second World War, this infectious disease remains a leading cause of death among those living in impoverished circumstances. Social science perspectives have argued that TB is as much a reflection of socio-economic inequality and the uneven distribution of power and resources as it is about biological processes. In this thesis I explore the lived experience of TB within the Somali refugee community in Auckland, New Zealand. While migrants and refugees are frequently blamed for the resurgence in TB in Western countries, very little is known about the determinants that underlie this manifestation of the disease. The present research addresses this gap in the literature by employing a transdisciplinary social science approach that considers the determinants of health and illness that range across the social, cultural economic and political domains of human experience. The geographical underpinnings of the work are borne out in the fundamental goal: to (literally and metaphorically) place the lived experience of health, disease (and particularly TB) within the Somali refugee community in the wider context of migration and resettlement. Employing qualitative methods I draw upon participants’ narratives to highlight the different ways in which Somali health beliefs and experiences have been shaped by wider structural forces. I demonstrate that within Auckland, Somalis encounter multiple and overlapping layers of disadvantage. The combined impacts of this disadvantage have a profound influence on their health and illness experience, particularly in terms of the development and ongoing occurrence of TB. Respondents with TB recounted widespread stigma that exacerbated the harm incurred by the illness itself. Although Somalis are highly marginalised, the thesis acknowledges the agency and creativity exerted by people in fashioning the course of their life within the context of considerable structural constraints.
This thesis examines the meanings of naturopathy through the experiences of twelve women with refugee backgrounds involved in naturopathic treatment at the Victorian Foundation for Survivors of Torture (Foundation House), a refugee torture and trauma rehabilitation service in Melbourne, Australia. The findings of this research show that the naturopathic encounter provided a transformative and meaningful meeting place for healing, a place in which the women felt at ease and in place.At Foundation House naturopathy has been practised alongside counselling since 1989, two years after the organisation’s inception. The women I interviewed for this project came from diverse sociocultural backgrounds and a wide range of countries including Iraq, Iran, Yemen, Afghanistan, Somalia, Burma and Serbia.The thesis brings together two contemporary fields of practice: Western models of refugee health care and traditional medicine. It argues for the place of non-biomedical approaches in refugee health care in a Western setting. The thesis takes an interdisciplinary approach to theorise the naturopathic encounter. The distinction between holistic and reductionist perspectives on health, illness and the body is underpinned by the theoretical work of medical anthropologists Nancy Scheper-Hughes and Margaret Lock and that of medical sociologist Aaron Antonovsky. A cultural studies perspective, influenced by the work of embodiment scholar Elspeth Probyn is employed to theorise these women’s experiences of the naturopathic encounter.This qualitative study is based on in-depth interviews and draws on grounded theory as an approach to data analysis. Descriptions of respite, renewal, and healing in the naturopathic encounter are cited as the most observable themes emerging from the women’s stories. These themes represent a health-oriented, as opposed to a disease-focused, perspective. Importantly, a health-orientated approach is congruent with the core tenets of naturopathic philosophy. Listening to the body is a crucial therapeutic tool in the naturopathic encounter, where primacy is given to supporting and strengthening health-creating strategies. I argue that this orientation disrupts the existing dominant biomedical approach to refugee health care. I draw on the work of Probyn to theorise the movement from the naturopathic encounter (NE) to the naturopathic meeting place (NMP). Central to this transposition is Probyn’s articulation of the body’s awareness of being in and out of place. This awareness lends itself to an understanding of the connectedness between past and present in the bridge-making that these particular refugee women have engaged in across cultures in the NMP.The thesis addresses an important but often neglected focus in refugee research: the resilience and agency of refugees. This positive aspect of refugee recovery is revealed in the research by theorising the women’s stories through Probyn’s embodiment analysis and cognisance of the ‘everyday’ as a productive and creative process. The research interrupts the ubiquitous image of the ‘disempowered refugee victim’. It highlights the practical wisdom and agency of these particular women that is often overshadowed in the complex resettlement process. It makes a call for further health-orientated research to broaden and deepen our understanding of the refugee experience.
This paper seeks to examine how immigrants in a multicultural society access and utilize culturally- and linguistically-diverse family physicians. It focuses on Mainland Chinese (MLC) immigrants - the most important source of immigrants to Canada since 1996 - in the Toronto Census Metropolitan Area (CMA), Canada. Specifically, the paper aims to explore the choice between Chinese-speaking and non-Chinese-speaking family physicians by MLC immigrants and to determine the underlying reasons for MLC immigrants use of ethnically- and linguistically-matched family physicians. A wide range of data are analyzed including survey and focus group data, physician data from the College of Physicians and Surgeons of Ontario (CPSO) and geo-referenced 2001 Canadian Census data. A mixed-method approach is employed combining quantitative analysis of survey data and Census data, spatial analysis of patient travel behaviour based on the survey and qualitative analysis based on focus groups. The paper reveals an overwhelming preference among MLC survey respondents for Chinese-speaking family physicians regardless of study areas and socioeconomic and demographic status. The focus groups suggest that language, culture and ethnicity are intertwined in a complex way to influence the choice of health care providers and health management strategies in the host society. The paper yields important policy implications for identifying health professional shortage areas for culturally-diverse populations, addressing issues related to foreign-trained physicians and enhancing primary care delivery relevant for immigrant populations.
Within a wider discussion of health service provision for black and minority ethnic (BME) groups, this paper considers how socio-cultural factors affect the provision of HIV and sexual health services to South Asians in London. It argues that communally held concepts of honour and shame within South Asian communities create a framework of social control with significant implications for HIV/AIDS transmission. It examines the provision of culturally sensitive services to BME communities by ethnically specific and generic service providers through a case study of the Naz Project London. Finally, it proposes an agenda for future research into BME sexual health service provision.
This review explores the theme of "the local' in medical geography, beginning with a discussion of the role of "locality' in health planning. The empirical focus of medical geography has been instrumental in enabling a significant contribution in this field. The theoretical underpinning of such work has been limited, relying on policy to provide the motivation for research; frequently this has resulted in the relegation of location to a role as the mere container of measurable events. The authors consider the limited literature in medical geography which has taken a more overtly theoretical perspective on the role of locality. -from Authors
Los inmigrantes originarios de Bangladesh en Londres : Las concentración residencial, desafio a los politicos en materia de salud y de ayuda social.
S. E. CURTIS. P. E. OGDEN
Los inmigrantes originarios de Bangladesh establecidos en Gran Bretaña son una proporción relativamente limitada de la populación procedente del Nuevo Commonwealth. Sin embargo, constituyen un grupo extremamente distintivo, particularmente por su concentración geográfica en ciertos barrios de Londres. Esta ponencia tiene dos propósitos : primero, apoyándose en los datos del censo de 1981, de trazar la distribución de estos inmigrantes en el contexto national y dentro de la región de Londres ; segundamente, de examinar algunas de las consecuencias de dicha concentración para el suministro de servicios sociales, especialmente de servicios médicos, en uno de los distritos más pobres de Londres.
This chapter explores the potential contribution of a social and contextual approach to the investigation of health and health care experiences of immigrant, visible minority women living in Western society. The issues here are broadly framed by a contemporary health promotion mandate, which adopts an holistic concept of health. The chapter focuses specifically on the notion of culture, as this concerns health-related knowledge about visible minorities, as a vehicle to explicate this argument. Culture needs to be recognized as a complex and dynamic concept, closely linked to the processes and structures embedded in society that shape individual and group behavior. The first section focuses on "immigrant women' as it relates to the health promotion mandate. The next discusses links between culture and health ideas and practices, and proves the conceptual framework of the argument presented in the chapter. The major section considers ways in which perceived links between culture and health and health care experiences have been approached at different contextural scales in research, and draws upon models in traditional medical anthropology and critical perspectives spanning recent work in geography, anthropology and sociology. Implications of a theoretical orientation for guiding health promotion related research are discussed in the final section. -from Author
The paper presents findings from an investigation into individual perceptions of health and health care. The investigation employed an ethnographic or qualitative approach and was located in a theoretical framework deriving from Schutz and Heller. While Heller's study of everyday life is used to note how people make sense through constructing 'stories', Schutz's notions on scientific constructs are employed to demonstrate the need for, and problems with, social scientific interpretation. In the conclusion, however, other Schutzian ideas are found wanting, and reference is made to hegemony as a representation of the context of many experiences and perceptions.
The title of this book is encouraging. It captures a concern about patient care acknowledged decades ago that persists into the present?the nature of physician-patient encounters. "by technically helping patients adjust in some way, physicians actually may be reinforcing 'the big social problems that keep people distressed and unhappy.'" Quality patient care focuses attention on a host of empathetic and egalitarian social psychological variables beyond normal medical models based on the symptomology and etiology of the patient's illness. Physician/biologist Howard Waitzkin alerts us to the prevalence of social problems within clinical settings and encounters. Waitzkin's intellectual diversity makes him uniquely capable of inspiring integrative efforts to knit together, empirically and conceptually, the seemingly disparate parts of the medical encounter. Waitzkin demonstrates that when patients approach a physician for help, they re-present a social context along with their physical problem(s). When social issues arise in the intimacy of the patient-doctor relationship
The author surveys ways in which the idea of difference is reshaping the scope of medical geography. While the corpus of work by self-proclaimed medical geographers is modest, there is a more daunting range of scholarship which, at various times, is presented at conferences and elsewhere under the banner of medical geography. This latter work must be consulted to discern progress and future directions in the field. The author surveys work which has taken map as metaphor and examined the otherwise hidden lives of health "consumers'. The author traces the modernist idea of "progress' through models of health and medicine; and surveys the introduction of gender concerns into medical geography and a further section considers, in light of new concerns for difference, the issue of naming the changed field of study. The concluding section identifies concerns with body politics as one way in which the field is being challenged to rethink the subject of its inquiry. -from Author
This paper discusses the Asian Mother and Baby Campaign, an initiative in health promotion which aims to promote better maternity services for Asian women. The Campaign has been sponsored by the DHSS and the Save the Children Fund since in launch in September 1984. What is under consideration here is the medical, social and political background to the Campaign. How the Campaign relates to such issues as the interpretation of perinatal mortality rates, women's rights in obstetric care and racism in the NHS will be examined. The overall argument is that the Campaign, in its initial conception and objectives, represents an attempt by health authorities, to create a consensus among health professionals on how to meet the health needs of Asian mothers. Its reformist intentions tend to col lude, at the ideological level, with an image of a 'Black pathology' although they represent a genuine attempt to challenge personal racism. It is this core tension in the Campaign which will be discussed.
The health needs of black families have not been substantively addressed in the intellectual tradition of nursing in the United States. This tradition is permeated by white middle‐class and female ideological perspectives, a bias unrecognized by the majority of nurses, including those in academia. It is an ideology that labels, stigmatizes, and blames victims of racial, sexual, and class discrimination. Approaches that explicate health concerns from the viewpoint of the client, illuminate the experience of discrimination, and expose its influences on health have been excluded from the discipline. The dominant perspective driving research conducted by health providers, of which nursing is but one example, is marked by approaches to problems that maximize the importance of the role of the individual provider and propose solutions for people without consideration of the social context and group membership. As a result, socioeconomic, cultural, and environmental factors that contribute to the chasm between the health of black and white Americans have been ignored.
Conformity to white middle‐class standards for feminine thought and behavior in the training of nurses entrenches the covert ideological underpinnings of the culture of nursing and maintains the dominant research perspective derived from it. This article argues that the conformity required of both students and faculty in nursing has systematically excluded black people, thus preventing their insights from challenging covert ideology and from shaping the core paradigm of nursing. The conformity is maintained through self‐regulation by faculty members and students, a self‐correcting process described here and labeled “whiting‐out difference.”
Using anthropological methods and a theoretical perspective derived from the sociology of Erving Goffman, Robert B. Edgerton's The Cloak of Competence: stigma in the lives of the mentally retarded (1967) brought an unusual degree of empathy to attempts to understand the lives of those labeled ‘mentally retarded’. Yet the book was conceived prior to the time when mental retardation began to be widely formulated as a social construction rather than a clinical syndrome. This essay analyzes the consequences for Edgerton's understanding of the lives of recently deinstitutionalized people of this uneasy combination of empathy and acceptance of mental retardation as an unalterable condition. Particular attention is paid to the ways in which Edgerton's conceptualization of mental retardation served to deny to members of his sample a voice with which to speak authoritatively about their own situation. Edgerton's revisionist follow-up research, which called into question some aspects of his earlier conceptualization of mental retardation, is also discussed.
The first part of text adresses the various notions of "difference" that have emerged in the recent controversy about the category "black" as a common sign for the experience of African-Caribbean and South Asian groups in post-war Britain. The aim is to signal how "black" has operated as a contingent sign under different political circumstances. The second section is concerned with the ways in which issues of "difference" were framed within feminist theory and practice during the 1970s and 1980s. The primary focus is on the British debate. The author concludes with a brief examination of some conceptual categories used in the theorisation of "difference", and suggests a new analytical framework.
This paper is based on a comparative study examining how Chinese and white families manage the care of a chronically ill child. The circumstances of their lives that shape their experience of illness are explored. It is argued that the ideologies which underpin Western health care practices, in this case, the ‘ideology of normalisation’, often differ from the perspectives held by non-Western immigrants, and others who do not have access to the ideology. The discrepancies in viewpoints between patients and practitioners can lead to a different set of goals in the treatment encounter, with the possibility of misunderstandings in the clinical context.
The ‘ideology of normalisation’ is used to show how professional ideologies serve as a means of separating out families into those who comply and those who do not. In other words, the ideology, and the moral discourse on normalisation, permit professionals to evaluate families and to categorise them. This categorisation has consequences for patient care, they might be refused treatment. Yet, this ideology is not based merely on ‘value-free professional theories’, but is located within the moral order. The socio-political, economic and historical factors that underpin the ideology are discussed.
An engagement with public health concerns and aspects of social theory such as the structure/agency debate is crucial to medical geography. The imperatives underlying this engagement center on place, a geographical concept which is prominent in both social theory and recent health philosophy. Without detracting from its distinguished heritage, this reformed medical geography will analyze issues such as the consequences of illness and health service provision for both personal well-being and the collective experience of place by communities.
This paper looks at the issue of private health care from the perspective of black (Afro-Caribbean) women in Britain. The research on which it is based (Thorogood 1988) indicates that these women have a particular relationship to health care, one aspect of which is their use of private consultations with General Practitioners. This is, I suggest, a consequence of their historical and contemporary experiences.
We need a feminist theory of disability, both because 16 percent of women are disabled, and because the oppression of disabled people is closely linked to the cultural oppression of the body. Disability is not a biological given; like gender, it is socially constructed from biological reality. Our culture idealizes the body and demands that we control it. Thus, although most people will be disabled at some time in their lives, the disabled are made “the other,” who symbolize failure of control and the threat of pain, limitation, dependency, and death. If disabled people and their knowledge were fully integrated into society, everyone's relation to her/his real body would be liberated.
The ‘cultural safety’ debate in New Zealand concerns the power-ladenness of health care interactions and the (controversial) need for health professionals to be fully conversant with the historical and contemporary circumstances of Maori people. We take this debate as a prompt to survey the implications of different ‘ways of seeing’ for how we define and investigate issues of health and illness in geography. The paper reflects on the issue of representation and the attendant question of how to include the researched in the construction of knowledge about health and healing. Given that knowledge and experience of health issues are social and cultural constructions, we suggest that geographical studies of health and place need to be centred in ‘culturally safe’ research practice.
Employing an expanded meaning of the concept of landscape taken from the 'new' cultural geography, this paper explores why certain places or situations are perceived to be therapeutic. Themes from both traditional and recent work in cultural geography are illustrated with examples from the literature of the social science of health care. The themes include man-environment relationships; humanist concepts such as sense of place and symbolic landscapes; structuralist concepts such as hegemony and territoriality; and blends of humanist concerns, structuralist concerns, and time geography. The intention of this broad overview is to bring some particularly useful concepts developed in cultural geography to the attention of social scientists interested in matters of health and to stimulate research along new lines.
This inquiry into the lives of women living with a chronic illness brings to attention the complex processes that frame the existential meanings of illness. Data from immigrant Chinese and Anglo-Canadian women with diabetes are used to show that illness is constructed in a complex social, political and economic nexus. When the circumstances of women's lives are examined, styles of managing illness that could be attributed to ethnicity, become recognizable as pragmatic ways of dealing with the harsh realities of material existence. It is argued that the trends toward individualizing social problems, and shifting the responsibility for caretaking from the state to the individual, obfuscate the social context of illness, and exclude the socially disadvantaged from adequate health care.
In New Zealand until the 1920s, most births occurred at home or in small maternity hospitals under the care of a midwife. Births subsequently came under the control of the medical profession and the prevalent medical ideology continues to support hospitalised birth in the interests of safety for mother and child. Despite resistance from the medical profession, recent (1990) legislation has reinstated the autonomy of midwives and this has come at a time when the demand for home births is increasing. This paper locates these changes within the geographical context of home as a primary place within human experience. It is argued that the medical profession has been an agent of an essentially patriarchal society in engendering particular experiences of time and place for women in labour. Narrative data indicate that the choice of home as a birth place is related to three dimensions of experience unavailable in a hospital context: control, continuity and the familiarity of home.
Contemporary models of health have broadened the concept so that health includes, but is not exclusively, biomedical wellness. One concern arising from this widened perspective is the degree to which health service provision promotes healthier, more convivial communities. This paper examines the contribution of health services to the experience of place in the Hokianga, an isolated and predominantly Maori area of New Zealand. While other public services are being increasingly privatised, charged to users and restructured to central nodes of provision, health care in the Hokianga remains free and delivered within a network of community clinics. It is argued that the taking of health care into communities both enhances the wellness of the population and positively enhances the experience of place for local residents.
This article critiques two major theoretical perspectives concerning the doctor-patient interaction in medical anthropology represented by the work of Howard Waitzkin and Arthur Kleinman. In his work on the doctor-patient interaction Waitzkin has tended to draw on structural explanations which subordinate the role of agency. Kleinman's work emphasizes agency without satisfactorily integrating structural or social causality in his work on the doctor-patient interaction. The work of Anthony Giddens and others has clarified the structure/agency dichotomy in social science to which the nature of power is central.
This paper analyses the experiences of Anglo-Canadian and immigrant Chinese families with a chronically ill child by using the idea that the social organization and ideology of health care services generate particular illness experiences. Immigrant families find the ideology dissonant with their customs for managing illness. The disjuncture between practices often leads to non-compliance and ineffective treatment. Health professionals explain non-compliance by the obvious facts of cultural differences, but I argue that it should be understood by institutional practices that exclude families from participating in caretaking. I maintain that patients and families should be included in decisions that affect their lives. Pressures from government to economize by increasing home care services, and the increasing number of immigrants may force practitioners to negotiate culturally acceptable care with them.
This paper discusses the microgeographies of unemployed women with multiple sclerosis, as they manage the physical, social and economic consequences of their illness. Recent directions in the geography of health and health care draw attention to the relationships between space, place and health experience, and in this paper a focus on the everyday lives of women with Multiple Sclerosis reveals the complex interweaving of space, physical impairment and gender in how they experience place. In-depth interviews were used in the study to investigate how women occupied and used home and neighbourhood space after leaving the paid labour force. The majority of women were found to experience shrinking social and geographical worlds which rendered their lives increasingly hidden from view as patterns of social interaction changed and use of public space diminished. The paper discusses the women's residential and household changes, mediated by marital and socio-economic status, and presents two brief case studies to illustrate the remapping of the meanings of work and place as women renegotiate their lifeworlds. The focus of the study on the spatio-temporal settings of the women's everyday lives revealed an interplay of biomedical discourse, policy structures, sociocultural norms and local sets of social relations that shaped the strategies the women used in reconstructing their lives. The women showed a diversity of responses, but these were all characterized by a restructuring of home and neighbourhood space, a reordering of personal relationships and increasing interpenetration of the public sphere in their private lives. The findings suggest that attention to the body in its geographical as well as social context provides an avenue for investigating the links between subjective experience and the broader social relations and processes which shape the illness experience.
This paper reports the results of a systematic critical appraisal of the research literature designed to determine the balance of evidence for the role of psychosocial stress as a risk factor in women's coronary disease. The study is placed within a larger research programme which addresses geographic variation in heart disease among women. The scope of the research is based on the burden of illness that coronary disease represents, existing geographic variation in morbidity and mortality, the role of psychosocial stress as a potential risk factor for women given changing gender roles, and the relative lack of attention paid to both the etiology and epidemiology of women's coronary disease in the research literature. In fact, there is very little original research, the balance of which provides equivocal evidence of a link between psychosocial stress and coronary disease in women but enough to suggest a need for further etiologic research. This need is substantiated by the appearance of a perception among the general population that 'stress' 'causes' heart disease. In addition, it would seem that 'stress' and 'heart disease' are major health concerns for women. Given the dichotomy between actual and perceived etiologic links, there perhaps needs to be an adjustment made with respect to research focus which addresses the role of perceived environmental stress as well as the individual in defining health and well-being. That is, the relationship between psychosocial stress and heart disease may depend upon the meaning of the situation to the individual and the way she perceives her life situation. Medical geographers are well-placed to address these research issues using a combination of qualitative and quantitative approaches.
This paper argues that a re-examination of the interrelationship between constructs of place and space is crucial to geography's involvement in the broader endeavour of health research. Place has re-emerged as nexus of ascribed meaning within contemporary social theory. Places, however, are related in space, by distance or proximity. The distinction needs to be made between this orthodox (geometric) view of space and two types of social space: the (experienced) space described by humanist geographers; and the more recent (socio-spatial) conceptualization which is both experienced and (re)produced by societal structures and advocated by social theorists in geography. We argue that advancing a recursive understanding of space and place is an appropriate direction in medical geography. This direction will include both an understanding of the ways in which space shapes the character of places and how the particularities of places resist or set in motion (orthodox) spatial processes. Illustrations are drawn from studies of mental illness and mental health care and primary health care in a remote area of New Zealand.
Principles of occupational therapy practice make the profession an important potential partner in health promotion initiatives for immigrant groups. Health promotion embodies the principles of self-definition of health needs by target groups, and working with a community in initiating and supporting programmes. This paper discusses the implications of an exploratory study of the daily activities of immigrant Indo-Canadian mothers for translating health promotion principles into practice. The research process and an analysis of interviews conducted with the women suggest factors to consider in using a health promotion framework with immigrants who have experienced social and economic dislocation through the immigration process. Discussion of household structure, divisions of labour, childcare strategies, and parenting concerns raises issues requiring particular attention in sharing occupational therapy skills and knowledge with ethnocultural communities.
Do we really have a dependent variable in our study of the sex differences in illness and sex differences in the explanations for illness? The purpose of this paper, which reviews the literature in this area over the past decade, is to argue that because of both conceptual and methodological difficulties in the definition of health/illness, there are serious problems in the available analyses to date. Confusions between medical and lay definitions, mental and physical illness, illness per se and illness behavior are among the issues raised with respect to the first issue: conceptual and definitional incommensurability. Proxy respondents, distinctions between males and females in illness experience, and improper rate calculation are among the issues discussed in the section concerning methodology.
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Awareness and Use of Well Woman Services in Liverpool
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