Throughout the COVID-19 pandemic, maps showing spread of the virus and vaccination rates by location have become fixtures in national and international news media. These figures have sparked important debates about geographical inequalities and have made many of us think more about the relationship between health and place – a concept that has long been central to the work of health geographers.
Emerging from the field of medical geography, health geography began to gain traction in the late twentieth century, following a growing movement in health scholarship away from a biomedical model and towards a more socio-ecological one. By studying “the dynamic relationship between health and place”[1], health geography research reveals the social, cultural, and political aspects that shape health and the built environment, offering a more holistic approach to the subject. This approach also enables the coverage of a broad range of topics and methodologies, as is clear in the health geography research done across all three campuses of our department. Below we highlight just some of the recent research pursued by our faculty and graduate students, including studies on food access, exposure to air pollution, the disabling experiences of urban life, and community and policy responses to health inequalities. There is also the work of our undergraduate students who have begun to explore health geography and whose projects show the potential for significant contributions to the field. While spanning an array of subjects, these research projects and initiatives all reveal the significance of place, offering important insights and possible solutions for improved health and well-being.
Access to Food
Our food environment, including geographic access to food retailers, has important implications for food behaviours, diet, and health. Professor Michael Widener, Postdoctoral Fellow Lindsey Smith, and PhD student Bochu Liu have been using GPS and time-use data to consider access to food retail across different neighbourhoods in Toronto. In particular, they look at how time-use dynamics play out in space, noting that time and space work together to impact food and service access. For instance, as Dr. Widener notes, the suburbanization of poverty creates conditions in which people must commute longer distances across space which in turn takes time, leaving less time for food shopping, preparation, and other health-related tasks. In similar studies, exposure and health outcome measures have largely focused on the individual, however in their work, Widener, Smith, and Liu argue that social factors, including shared responsibilities for food shopping and household shores, need to be accounted for when measuring access. By using both GPS tracking and diaries in which participants document their time-use, their research reveals both the ‘unseen’ exposures or obstacles made visible by mapping and the lived experiences of their participants.
Access to Food Study GPS & Time-Use Data: Six weekly patterns of activity and location sequences for the Toronto 2019 sample
Exposure to Air Pollution
Dr. Egide Kalisa, a postdoctoral fellow working with Dr. Matthew Adams and Dr. Vincent Kuuire, is seeking to understand children’s air pollution exposure at schools in Kigali, Rwanda. Using air pollution monitors (as seen in the picture, where Dr. Kalisa is setting them up) they have observed that air pollution concentrations in the area can be worse than one might experience in Ontario Highway 401 rush-hour congestion. Their goal is to understand the sources and risks of the pollution better to provide support in reducing children’s exposure. As part of this work, Dr. Kalisa organizes workshops for students to teach them about air pollution risks, provides hands-on training with air pollution monitors, and teaches students to recognize environments where air pollution could be high and thus should be avoided.
Egide Kalisa, a postdoctoral fellow, working with Drs. Adams and Kuuire, is shown setting up air pollution monitors in Kigali, Rwanda.
Senior Social Isolation and Loneliness
When the first COVID-19 lockdown began in March 2020, PhD student Amber DeJohn realized her plans to study social isolation and loneliness among older adults was as important as ever. Working with senior centers, she recruited 24 older adults for a phone survey and interview, focusing on how their lives were changing in lockdown and how technology bolstered connection or created new isolations. As a health geographer, she was interested in their thoughts on place and how the adoption of new technologies had modified enjoyment of their homes and previously in-person activities. On the heels of this work, she collaborated with Dr. Widener and Bochu Liu to collect data about older Chinese migrants. More specifically, they were interested in their health, socializing, and time use during the pandemic, and whether there were spatial dimensions to social connectedness and health. While data collection is ongoing, they have been able to survey over 90 older Chinese migrants in the GTA with the help of Mandarin- and Cantonese-speaking research assistants from UTM. This cross-cultural research has been possible only through discussions with cultural insiders both in Toronto and abroad in Beijing, where another research team had already has already implemented their survey.
The Disabling Experiences of Urban Life
“Disability” is not a health condition or a clinical issue, but similar to the above mentioned aspects of health, it is produced by societal and environmental barriers and limitations. Teaching and research about the varied geographies of disability receives considerable attention in the department’s graduate program. Along with his graduate students, Graduate Chair, Professor Ron Buliung’s research program focuses on the disabling experiences of urban life. Recent examples form his research group include a study about the extra time disabled children spend traveling by bus, and how this extra time spent on the move erodes opportunities for social and curricular contact. While a student in our Doctoral program in Human Geography, Dr. Naomi Schwartz undertook research into the relationship between disability and food access and insecurity. Dr Schwartz’ work was conducted in close partnership with the Centre for Independent Living Toronto (CILT), and demonstrated how and why disabled persons are at greater risk of experiencing food insecurity. While this work was completed prior to the pandemic, there can be little doubt that the current context has exacerbated the problems identified in Dr. Schwartz’ research.
Responding to Health Inequalities
Over the last few decades, inequalities – including health inequalities – between neighbourhoods have increased significantly, while pressures on low-income residents (such as gentrification) have also increased. With a team of undergraduate and graduate student researchers, as well as partners from the City of Hamilton, the Hamilton Community Foundation, and local community organizations, Dr. Sarah Wakefield has spent almost a decade researching how municipalities can best support community-led health interventions. This research shows the potential of residents to intervene to improve their neighbourhoods. However, it also demonstrates that significant barriers to resident organizing exist, from limited access to meeting space to challenges in engaging and representing the diversity of residents in low-income and racialized neighbourhoods.
COVID-19 has further exacerbated such inequalities – creating new and revealing existing, complex and inequitable challenges to communities over the past year and a half. PhD Candidate and Course Instructor Ray Jewett has been a part of a network of Canadian and international health geographers responding to these issues by providing expertise in several aspects of spatial epidemiology and health services research. This includes location-based opportunities for the transmission of COVID-19, inequitable neighbourhood risk factors, regionalized non-pharmaceutical interventions and policies, and ensuring a fair vaccine rollout across diverse and dynamic urban, suburban, rural and remote places. A uniquely geographic and place-based challenge is the complex nature of organization, collaboration and cohesion within and between organizations and communities to respond to the crisis, organize resources, promote resilience and ultimately protect peoples health and wellbeing. Ray Jewett’s work over the last year has focused on the Canadian and International regionalization of activities and policies that facilitate social cohesion, productive relationships between local communities and government, and promote community resilience with the common goal of improving community-led health priorities. This work included contributions to 1) the United Nations Research Roadmap for the COVID-19 Recovery, led by Canadian Institutes of Health Research, Institute of Population and Public Health, published in the Intl Journal of Health Services; 2) Strategy for Patient Oriented Research (SPOR) Evidence Alliance report to Health Canada on COVID-19 testing protocols and organizations across different communities; 3) and two publications on the regionalized public health sector response to COVID-19 in Ontario and Canada.
Undergraduate Research in Health Geography
The department offers several undergraduate courses relevant to health, including GGR340 Health Geography, taught by Professor Sarah Wakefield and GGR372 GIS and Public Health taught by Professor Michael Widener. The former encourages students to think about the processes in space that influence health outcomes and to question whether we can modify built environments for better health and equitable access. In the latter, students explore how spatial technologies and methods can be used to understand spatial distributions of health and to help with identified challenges. In GG273, another GIS-focused course taught by Lindsey Smith this past winter term, students created Esri StoryMaps, with many considering neighbourhood amenities in the context of the pandemic. Students reflected on their personal experiences, mapped safe routes for active travel, and identified access (and barriers) to local health-promoting environments including supermarkets and greenspaces. Utilizing such skills learned in her GIS courses, undergraduate student Kathy Yang developed an app to examine COVID-19 resiliency in Toronto communities at the start of the pandemic. Her project won first place in the Esri Canada Centres for Excellence (ECCE) App Challenge, an opportunity made possible from a recent partnership between the university and Esri Canada.
Through such collaborations, education opportunities, and the excellent research of our faculty and students, the department continues to foster health geography research that addresses some of the most pressing social and health issues of our time.
[1] Kearns, R. A. (1993). Place and Health: Towards a Reformed Medical Geography. The Professional Geographer, 45(2), 139–147. https://doi.org/10.1111/j.0033-0124.1993.00139.x