Medical Geography (GEOG 445) Fall 2012 Class meets: T & TR 12:30-1:45 PM 452 Hamilton Hall Instructor: Mike Emch Email: emch@unc.edu Office: 326 Saunders Hall Office hours: 2-3:30PM Tuesday and 3:30-5 Thursday or by appointment Course Objectives This course surveys medical geography, a field that focuses on geographical aspects of health and disease. Medical geography deals with human-environment interactions and the influence these interactions have on public health. What distinguishes medical geography from the discipline of geography as a whole is simply its thematic focus, not its methods or theoretical grounding. Throughout the semester we will use the concepts and techniques of the discipline of geography to investigate a variety of health-related topics. This course covers three major approaches to medical geographic research: ecological approaches, which systematically analyze relationships between people and their environments; social approaches, including political economy and socio-behavioral approaches; and spatial approaches, which employ maps and spatial statistics to identify patterns of single and associated variables. Students are encouraged to view these three approaches as complimentary. Much research in medical geography incorporates ecological, social and spatial theories and methodologies. Medical geography is integrative and multidisciplinary, incorporating contributions from a wide range of specialties. Specific course objectives include: 1. Facilitate a critical understanding of health, disease, illness, and society; 2. Introduce major contemporary issues in global health; 3. Promote an understanding of how geography as a discipline contributes to understanding health and health care; 4. Understand the impact of ecological and population change on health; 5. Explain how social and economic context impacts health; 6. Utilize maps to examine the spatial patterns of disease and risk factors that may contribute to disease The course text is Meade, M.S. and Emch, M.E. 2010. Medical Geography, 3rd ed. New York: The Guilford Press.
Grading The points available for the course are divided among the following activities. All assignments are due on time, and will be penalized 3% of your grade for each day late. Midterm 35% Final 35% Case Studies 30% (15% per case study) You will write up two case studies during the term. Directions are on the Blackboard site under Assignments. Write-ups for these case studies will consist of a 1-2 page paper (plus some other outputs). We will also have a midterm and final. Attendance to this course is mandatory. You are expected to take part in the discussions and if you are not in class then you cannot. If there is a special reason that you need to miss class such as a conference or a religious holiday then let the instructor know. Email the instructor each time you miss class before you miss class. Also, each time you miss class you must hand in a one-page typed summary/ critique of the readings for that day within one week of missing the class. If you don't hand this in then you will be penalized 5% for each class period that you miss. You need to hand in the one-page summary/ critique even if you have a good reason for missing class. Graduate students: We will meet outside of class to discuss additional activities/readings and you will write a class paper or another mutually agreed upon deliverable. Schedule Week: Dates Topics and INTRODUCTION Introduction to Medical and Health Geography, Concepts of Health and Disease, Epidemiological Terminology Week 1: Aug 21 & 23 What is medical geography? How do we define health? Some epidemiological terminology that will help you throughout the semester Meade & Emch, "Chapter 1: Questions of Medical Geography" Suggested Resource: CDC's Glossary of Epidemiology Terms: http://www.cdc.gov/reproductivehealth/epiglossary/glossary.htm
ECOLOGICAL APPROACHES Disease Ecology Week 2: Aug 28 & 30 What is disease ecology? How do we use this theoretical framework to understand the spatial distribution of disease? Why/how are specific diseases affected by population, habitat and behavior to greater or lesser extents? What is a natural nidus and how does it relate to landscape epidemiology? Meade & Emch, "Chapter 2: The Human Ecology of Disease" Emerging and Reemerging Diseases: Ecological Change, Evolution of Pathogens & People Week 3: Sep 4 & 6 What are emerging and reemerging diseases? What are the drivers that cause diseases to re(emerge)? How have environmental changes impacted disease distributions? How has evolution led to the emergence/reemergence of diseases? Meade & Emch, "Chapter 4: Landscape Epidemiology" Demographic and Epidemiological Transitions, Migration, Mobility and Globalization Week 4: Sep 11 & 13 How have mortality and fertility levels changed over time? Have these trends differed in different areas of the world? How have the major causes of death changed over time? Why have these changes occurred? What's the difference between mobility, migration and circulation? How does mobility contribute to disease transmission? How has mobility changed over time? Meade & Emch, "Chapter 5: Transitions and Development" Week 5: Meade & Emch "Chapter 10: Disease Diffusion in Space" Food and Nutrition Sep 18 & 20 How has agricultural production changed over time?
How have changes to agriculture impacted human nutrition and, ultimately, human health? What is the nutritional transition? How is it related to changes in agriculture? How has it influenced the emergence of chronic disease? Review Meade & Emch, "Chapter 5: Transitions and Development" section on "Nutrition in Transition" Environmental Exposure Week 6: Sep 25 & 27 What do we mean by environmental exposure? What are the different types of environmental exposures? How are they connected? What is an "exposure pathway"? How might climate change affect the distribution of disease? Meade & Emch, "Chapter 6: Climate and Weather: Influences on Health" Week 7: Oct 2 & 4 First case study write-up due Thursday of this week in class! Catch-up and Review Midterm Exam Oct 4 Environmental Exposure Week 8: Oct 9 & 11 What do we mean by environmental exposure? What are the different types of environmental exposures? How are they connected? What is an "exposure pathway"? How might climate change affect the distribution of disease? Week 9: Oct 16 (18 th is Fall break) Meade & Emch, "Chapter 7: The Pollution Syndrome" SPATIAL APPROACHES Spatial Analysis and Health What spatial techniques, in addition to mapping, are useful for studying health?
: Meade & Emch, "Chapter 12: Scale, Spatial Analysis and Geographic Visualization". GIS and Public Health Week 10: Oct 23 & 25 : What goes into the mapping and visualization of health information? How can I tell a good map from a bad map? What can I learn from maps? Meade & Emch, "Chapter 3: Maps and Geographic Information Systems in Medical Geography" SOCIAL APPROACHES Week 12 - The Social Context of Disease Week 11: Oct 30 & Nov 1 What health inequalities exist today? How does health vary around the world? What are the origins of these inequalities? How is socioeconomic status related to health outcomes? What can be done to alleviate these inequalities? : Meade & Emch, "Chapter 8: Political Ecology of Noncommunicable Diseases" The Political Ecology of Health & Healthcare Week 12: Nov 6 & 8 Week 13: Nov 13 & 15 : What is political ecology? How is it related to political economy? How do political interests lead to ecological change? How do politics influence the spatial distribution of both communicable and noncommunicable diseases? Meade & Emch, "Chapter 8: Political Ecology of Noncommunicable Diseases" Poverty, Neighborhoods & Health How do we define poverty? How does poverty influence health and/or lead to health disparities? How do we define "neighborhood"? How do neighborhood environments act to influence health behaviors
and outcomes? : Meade & Emch, "Chapter 9: Neighborhoods and Health" Second case study write-up due Tuesday of this week in class! Poverty, Neighborhoods & Health Week 14: Nov 20 (22 th is Thanksgiving) : How do we define poverty? How does poverty influence health and/or lead to health disparities? How do we define "neighborhood"? How do neighborhood environments act to influence health behaviors and outcomes? Meade & Emch, "Chapter 9: Neighborhoods and Health" Health Services Planning Week 15: Nov 27 & 29 : How are health resources distributed? What inequalities exist? What does "access" mean? What can be done to promote equitable access to health care? Why are hospitals located where they are? Meade & Emch, "Chapter 11: Health Care and Promotion" Week 16: Dec 4 Exam Time: Take Home Final Exam Essay Questions Handed out today Catch up and study session for objective part of final exam Take Home Final Exam Essay Questions Due today December 11 noon-3pm (for objective part of exam) Special Needs: If you feel that you may need an accommodation for a disability or have any other special need, please discuss this with me. I will best be able to address special circumstances if I know about them. My office hours and contact information are listed at the beginning of this syllabus.