1. PLACE AND HEALTH Kristin Eccles February 9 th, 2015 University of Ottawa: EPI 6181

2. Introduction Difference between space and place Space (where): the location Place (what): the interpretation of space, subject to interpretation How can place affect health? Physically Eg. Living near busy roads Socially E.g. social networks, sense of community, perceptions Structurally Eg. How health care is structured, rural vs. urban JECH 58(1), 6-10.

3. Space Physical aspects- “the built environment” contextual factors (the nature of the place itself) Easy to measure Eg. distance to point source pollutant emitters https://trigirlck.wordpress.com/2012/06/22/cycling-in-the-hammer/

4. Place Compositional factors (the nature of the people who assemble in particular places) How do people interact with their environment (social and physical)? Structure vs. agency debate How do they feel about where they live? Some environment can be therapeutic Eg. green space, park, access to the outdoors, therapeutic landscape, Other environments can have a negative effect Eg. living in an environment that does not promote healthy living Much harder to measure Berkman, Kawachi, Glymour, (2014)

5. Relationship Between Place and Health Space and place are highly intertwined Cultural embodiment of place First Nations and Inuit Traditional/ country food Relationship between place and health Place and social class Varying health is caused by varying socioeconomic statuses Place and capital Social capital and materialistic capital Berkman, Kawachi, Glymour, (2014) JECH 58(1), 6-10. http://www.turtleisland.org/healing/healing-wellness.htm

6. Conventional vs. Relational Social science & medicine, 65(9), 1825-1838.

7. Health Inequality vs. Health Inequity “Health inequality is the generic term used to designate differences, variations, and disparities in the health achievements of individuals and groups.” How disease is distributed in a population “Health inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice.” Most health inequities are seen across social groups (eg. class and race) Unjust because they reflect an unfair distribution of the underlying social determinants of health (eg. access to educational opportunities, safe jobs, health care) JECH, 56(9), 647-652

8. Brief Intro to Spatial Analysis Spatial Indicators Moran’s I Getis and Ord’s G* Nearest Neighbour Perfect dispersion =-1Perfect clustering = 1 http://edndoc.esri.com/arcobjects/9.2/net/shared/geoprocessing/spatial_statistics_tools/spatial_autocorrelation_morans_i_spatial_statistics_.htm

9. Inequity Case Study: Code RED http://thespec-codered.com

10. http://media.metroland.com/thespec.com/statistics_flash/ SDOH in the City of Hamilton

11. http://thespec-codered.com/map/cancer/lungMortalityZoom.html

12. http://thespec-codered.com/map/cancer/breastMortalityZoom.html

13. Challenges of Geographic Analysis The place is “bigger than the sum of it’s parts” Research is mostly cross-sectional Hard to incorporate this: social capital, history, life course Much of this effect ends up in the model residuals Ecological Fallacy The ecological fallacy occurs when you make conclusions about individuals based only on analyses of group data. Scale of Analysis What is the correct level and unit of analysis? Modifiable Area Unit Problem (MAUP) Changing the level of analysis of boundary delineations can change the results! Spatial Autocorrelation People who live close together are more likely to have similar traits Pose problems when modeling because we want the independent variables to be statically independent Solution: Spatial Autoregressive model, and geographically weighted regressions JECH 58(1), 6-10.

14. http://geog214-7.wikispaces.com/Modifiable+areal+unit+problem+(MAUP)

15. MMR Immunization Uptake Rates How the Measles, Mumps, Rubella (MMR) immunization rate uptake change over space, and time? Eccles, K.M., Bertazzon S. (2015)

17. Alberta Trends in MMR Uptake Low immunization rate clusters in the North Health Zone and in the South Health Zone Limiting factors in the North Rurality limits access facilities Limiting factors in the South High Mormons, Mennonites, Hutterites, and Netherlands Reformed Congregations population Refuse immunizations for cultural reasons These groups experience regular outbreaks: Mumps outbreak in 2005 Pertussis outbreaks every three to five years Previous Measles outbreak in 1997 Eccles, K.M., Bertazzon S. (2015)

18. New Trends in Place and Health Public health problems- diseases of the environment Building or redesigning where we live so it create health people Interdisciplinary Collaborations between doctors, public health practitioners, urban planners, city officials makeCalgary: Healthy Symposium (http://makecalgary.com/?page_id=8101) Redesigning urban core Bike lanes Make it more pedestrian friendly

19. References Berkman, L. F., Kawachi, I., & Glymour, M. (Eds.). (2014). Social epidemiology. Oxford University Press. Cummins, S., Curtis, S., Diez-Roux, A. V., & Macintyre, S. (2007). Understanding and representing ‘place’in health research: a relational approach. Social science & medicine, 65(9), 1825-1838. Eccles, K.M., Bertazzon S. (2015). A Spatio-Temporal Analysis of Regional Differences of MMR Immunization Uptake in Alberta, Canada. Manuscript submitted for publication. Kawachi, I., Subramanian, S. V., & Almeida-Filho, N. (2002). A glossary for health inequalities. Journal of epidemiology and community health, 56(9), 647-652. Macintyre, S., & Ellaway, A. (2000). Ecological approaches: rediscovering the role of the physical and social environment. Social epidemiology, 332-348. Tunstall, H. V. Z., Shaw, M., & Dorling, D. (2004). Places and health. Journal of epidemiology and community health, 58(1), 6-10.

20. Discussion How do you define place? Sociological Perspective How do sociological perspectives tie into place and health? What side of the structure/ agency debate are you on? Structure: our actions are influenced/limit the choices and opportunities available (Top-down) Agency: is the capacity of individuals to act independently and to make their own free choices (Bottom- up) What do you think shapes place the most? Why? How practical a value does this research have? What intervention possibilities arise?