Paul L. Knox

Medical deprivation, area deprivation and public policy

The distribution of primary care physicians in Great Britain is related to geographical patterns of social deprivation, and the National Health Services regional approach is found to be inadequate to resolve intra-urban inequities in distribution. It is concluded that the structure of primary care needs to be reorganized and that medical manpower policies need to be better integrated with comprehensive approaches to compensatory social planning.

The urban transition and the evolution of the medical care delivery system in America

This essay traces the evolution of the American urban medical care delivery system and examines the implications in terms of social and spatial variations in accessibility to medical care. It is suggested that the foundations of the present medical care delivery system were laid during the urban transformation which took place in the latter part of the nineteenth century, when changes in the division of labor, specialization, the role of the family, urban transportation technology and attitudes to social protectionism interacted with changes in science, medical technology and professional organization to produce radical changes in both the settings used to provide medical care and their relative accessibility to different sub-groups of the population. The medical care delivery system is thus interpreted largely as a product of the overall dynamic of urbanization rather than of scientific discovery, medical technology and the influence of key medical practitioners and professional organizations.

Measures of accessibility as social indicators: A note

Although accessibility to jobs, services and amenities is an important component of the quality of life, it is rarely articulated in operational definitions of the concept. This note stresses the importance of physical accessibility to social well-being in cities, and outlines and reviews several measures which could be used to reflect territorial variations in accessibility to specific ‘goods’. One measure-a modified version of the gravity model-is elaborated in detail, and its utility as a social indicator is illustrated using the example of accessibility to primary medical care in Edinburgh, Scotland.

Social well-being and North Sea Oil: An application of subjective social indicators

Knox P. L. (1976). Social well-being and North Sea Oil: an application of subjective social indicators, Reg. Studies 10, 423–432. It is suggested that attitudinal surveys and measures of satisfaction should complement conventional social indicators, especially in circumstances where the sensitivity of conventional data is open to doubt. Such circumstances obtain in relation to Highland communities in general, and in particular to those affected by North Sea oil developments. The satisfactions, expectations and attitudes of two of these communities are reported in order to demonstrate the utility, problems and potential associated with subjective social indicators. Variations in attitudes are discussed and a basic model of life-satisfaction is presented.

Level of living: A conceptual framework for monitoring regional variations in well-being

Knox P. L. (1974) Level of living: A conceptual framework for monitoring regional variations in well-being, Reg. Studies 8, 11–19. Recent interest in the development of social indicators has reflected a concern for the “quality of life” in many industrial nations, but a major problem has been the lack of a cohesive conceptual and theoretical framework. It is suggested that the well-established concept of level of living can provide such a framework. The concept is outlined in detail, with special reference to existing spatial applications. A working definition applicable to contemporary British conditions is proposed, and several important issues relating to the quantification of the concept are considered. It is concluded that within Britain there exists a sufficient range of indicators from which an index could be derived and used both as a descriptive instrument within regional and social geography and as the basis of a central, policy-oriented monitoring of regional variations in well-being.

Regional inequality and the welfare state: Convergence and divergence in levels of living in the United Kingdom, 1951–1971

Relatively little is known about the persistence or otherwise of geographical gradients in levels of living, even though the eradication of inter-and intra-regional disparities has been a major objective of the ‘welfare state’ created in the United Kingdom after the Second World War. Using a series of well-established territorial social indicators, this paper describes the relative change in levels of living in the United Kingdom by local authority areas between 1951 and 1971. A typology of change derived from the results of a linear regression analysis is presented. It is shown that the overall intensity of spatial inequality has changed very little over the period. At the same time, however, the relative position of some areas has deteriorated significantly, while that of others has significantly improved.

Locational behaviour, place preferences and the inverse care law in the distribution of primary medical care

Abstract The nature and effects of the ‘inverse care law’ are discussed, and past attempts to promote an equitable distribution of medical manpower are assessed. A cognitive-behavioural approach is adopted to examine the practitioners awareness of spatial inequalities in medical care standards and to identify the major factors underlying locational behaviour. Finally a series of space preference surfaces are constructed at both regional and intra-urban levels. It is suggested that interpretation of these surfaces in conjunction with objectively defined areas of underprovision can provide valuable guidance for future policy initiatives.

Fieldwork in urban geography: Assessing environmental quality

Abstract In this paper the idea of measuring environmental quality in urban areas is considered. The scope and limitations of field appraisal techniques are illustrated with reference to a schedule designed to provide an index of environmental quality within primary residential areas, and tested in Sheffield. It is suggested that the results of such surveys could make a valuable contribution not only to studies of urban morphology, but also to studies of urban residential structure. Furthermore, the method provides a useful addition to the stock of field study techniques available to geographers.

Convergence and divergence in regional patterns of infant mortality in the United Kingdom from 1949-51 to 1970-72

Abstract Regional and social disparities in rates of infant mortality have recently been highlighted as a major source of concern. Social class gradients in infant mortality have been shown to have been persistent over the past few decades, despite the introduction of the National Health Service. Relatively little is known, however, about the persistence or otherwise of geographical gradients in infant mortality. This paper describes the relative change in infant mortality in the United Kingdom by local authority areas between 1949–1951 and 1970–1972, using a typology of change derived from the results of a linear regression analysis. It is shown that the overall intensity of spatial inequality has changed very little over the period. At the same time, however, the relative position of some areas has deteriorated significantly, while that of others has significantly improved.

Norway: Regional policies and prosperity

Abstract Recent changes in the employment structure and the distribution of population are outlined in relation to problems of regional imbalance within Norway, and the implications for those areas suffering from the effects of such changes are discussed. The development of regional policies is described, including the District Development Fund of 1961 and the Building Act of 1965. The effectiveness of administrative units as bases for local and regional planning is outlined in the light of recently‐proposed changes in the administrative framework. A wide range of aspects of social and economic prosperity are examined at the county level in view of the importance of this unit in regional administration and planning, and results are presented to show the present extent of regional disparities in the prosperity of the country.