Robin Kearns

From medical to health geography: novelty, place and theory after a decade of change

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?

Space in its place: Developing the link in medical geography

This paper argues that a re-examination of the interrelationship between constructs of place and space is crucial to geographys 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.

Naming as Norming: ‘Race’, Gender, and the Identity Politics of Naming Places in Aotearoa/New Zealand:

The process of naming places involves a contested identity politics of people and place. Place-names are part of the social construction of space and the symbolic construction of meanings about place. Accordingly, we argue that the names applied to places in Aotearoa assist in the construction of the symbolic and material orders that legitimate the dominance of a hegemonic Pakeha masculinism. Attempts to rename (and in doing so, reclaim) places are implicated in the discursive politics of people and place. The contestation of place-names in Otago/Murihiku, one of the southernmost regions of New Zealand, is examined. We present a discursive analysis of submissions made to the New Zealand Geographic Board in 1989–90 concerning a proposed reinstatement of Maori names in the area. In interpreting objections to renaming we suggest these objections articulated with and through a number of ‘commonsense’ notions about gender, ‘race’, culture, and nation which discursively (re)produced a hegemonic Pakeha masculinism in New Zealand.

Transforming the relations of research: towards culturally safe geographies of health and healing

Abstract 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.

Restructuring health and rural communities in New Zealand

The recent restructuring of health-care provision has particularly a•ected rural communities in New Zealand, a nation characterized by an emerging biculturalism in its policies and outlook. In this article we develop a framework linking health care, the rural experience of place and the national cultural fabric. After presenting the stories of two North Island communities undergoing transition, we consider the role of health care in influencing the broader health of rural settlements as communities. We conclude that for communities as well as their residents, health and place are mutually constituted through the activities of health-care provision.

The walking school bus: extending children's geographies?

In many Western cities, the journey between home and school has become problematic, due to intensifying traffic and growing fears for childrens safety. Accordingly, many parents now chauffeur their children to and from school. This situation has compounded congestion, prompting efforts to identify safe alternatives. One recent innovation is the walking school bus (WSB). In this paper we report on the development of this initiative, and its adoption at a primary school in Auckland, New Zealand. We conclude that although WSBs extend childrens geographies they are, at best, an ambivalent response to the hegemony of motorized transport.

The societal costs and benefits of commuter bicycling: simulating the effects of specific policies using system dynamics modeling

Background: Shifting to active modes of transport in the trip to work can achieve substantial co-benefits for health, social equity, and climate change mitigation. Previous integrated modeling of transport scenarios has assumed active transport mode share and has been unable to incorporate acknowledged system feedbacks. Objectives: We compared the effects of policies to increase bicycle commuting in a car-dominated city and explored the role of participatory modeling to support transport planning in the face of complexity. Methods: We used system dynamics modeling (SDM) to compare realistic policies, incorporating feedback effects, nonlinear relationships, and time delays between variables. We developed a system dynamics model of commuter bicycling through interviews and workshops with policy, community, and academic stakeholders. We incorporated best available evidence to simulate five policy scenarios over the next 40 years in Auckland, New Zealand. Injury, physical activity, fuel costs, air pollution, and carbon emissions outcomes were simulated. Results: Using the simulation model, we demonstrated the kinds of policies that would likely be needed to change a historical pattern of decline in cycling into a pattern of growth that would meet policy goals. Our model projections suggest that transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10–25 times greater than costs. Conclusions: To our knowledge, this is the first integrated simulation model of future specific bicycling policies. Our projections provide practical evidence that may be used by health and transport policy makers to optimize the benefits of transport bicycling while minimizing negative consequences in a cost-effective manner. The modeling process enhanced understanding by a range of stakeholders of cycling as a complex system. Participatory SDM can be a helpful method for integrating health and environmental outcomes in transport and urban planning. Citation: Macmillan A, Connor J, Witten K, Kearns R, Rees D, Woodward A. 2014. The societal costs and benefits of commuter bicycling: simulating the effects of specific policies using system dynamics modeling. Environ Health Perspect 122:335–344; http://dx.doi.org/10.1289/ehp.1307250

Remoralising Landscapes of Care

The policy and theoretical discourses of deinstitutionalisation have been centred on a fundamental normative polarity that opposes the ‘dehumanising’ institution to the more humane environment of community care. We reconsider this moral polarity by drawing upon three philosophical currents that emphasise the need for inclusive and compassionate governance. We argue that there are strong political — ethical and practical reasons why inclusive governance can improve human-services planning and delivery. First, by recognising and addressing the vulnerabilities of nonservice users, an inclusive ethics is most likely to maximise the welfare of all groups with interests in community care. Following from this, an inclusive ethics is more likely to foster the broad social support that we argue is necessary for successful community care. Third, an inclusionary outlook has the potential to broaden the design of community-care services and facilities. An inclusive ethics would radically open up policy design to a range of other service options that account for the complexities of place, policy context, and the needs of key interest groups, such as service users, workers, relatives/advocates, and local communities.

The place of health in the health of place: The case of the Hokianga special medical area

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.

The impacts of a school closure on neighbourhood social cohesion: narratives from Invercargill, New Zealand.

We propose that, beyond their educational function, schools can serve as catalysts for community participation, social cohesion and the vitality of neighbourhoods. The paper explores the impacts of a school closure on families in an urban neighbourhood in Invercargill, New Zealand. The highest urban depopulation rate in the country has had implications for the viability of Invercargill schools. We present a qualitative study of narratives gathered during an interview-based study of the closure of Surrey Park School. Our analysis highlights the impact of school closure for low-income families and more generally reflects on the place of schools in contributing to social cohesion and the broadly defined health of a community.