The current issue of the American Journal of Public Health has many articles that speak directly to issues of direct relevance to areas of current concern in geography and in population health. “Global Health and the Global Economic Crisis” by Benatar, Gill, and Bakker (pp. 646-653) pursues several arguments, and among them are that 1)global inequities in health reflect inequities in power; 2) the profit driven global economic system is a driver of inequities in health, and of collective poor health; and 3) a new paradigm is needed, versed in ethics, and culturally sensitive, creative, and innovative long term policy.
“The Social Determinants of Tuberculosis” by Hargreaves and colleagues (pp. 654-662) is very close to what I do in Ghana, and brings the understanding of tuberculosis into the realm of social epidemiology, social science, and the movement that has been termed “the social determinants of health” for the past 30 years or so. It is a label that I do not like since it is too—deterministic. I would much rather see “social influences on health.” It does not help to have a biologic determinism and a social determinism competing with one another–the whole problem is that health is not the result of determinism and the underlying causes of either ill-health or good health are not deterministic in nature. Be that as it may….this interesting article reviews the social factors that underlie contemporary TB epidemiology, including mobility and urbanization. In the US, for example, the main driver of TB is the influx of foreign-born individuals, for the simple reason that some are originating from areas that have high rates of TB; thus, percent foreign born, in any area in the US gives that area a high relative risk of having a TB prevalence rate well above the median. One of my recent doctoral graduates in the Department of Epidemiology, Eyal Oren, PhD, discovered a great deal of spatial clustering of incident TB cases in this state, and, based upon chart reviews and medical records, in King County.
The final article that I will mention is a spatial analysis of major trauma and injury in the North America. The article, titled “Trauma in the Neighborhood: A Geospatial Analysis and Assessment of Social Determinants of Major Injury in North America” (pp. 669-677) examines the spatial patterns and clustering of major trauma using GIS and a commonly used clustering algorithm, SatSCan. It is another example of examining health phenomena using the “social determinants” approach. In this case, I would call it the “social correlations” approach. Even if the relationships were deterministic, and they were not, there was no causation established here.
This issue of AJPH is unusually full of interesting articles that will interest geographers in many specialties.