Curtis, Sarah. Health and Inequality: Geographical Perspectives

International Social Science Review, Spring-Summer, 2005 by Linda Q. Wang

Curtis, Sarah. Health and Inequality: Geographical Perspectives. London: Sage Publications Ltd., 2004. xiv 329 pp. Cloth, $99.95; paper, $39.95.

Around fifty percent of the world's population currently lives in cities. In the next few decades, about the same percentage of the population in today's less developed countries will have lived in cities as well. As the world becomes increasingly urbanized, the quality of urban health, health services, and access to health-care resources become pressing issues. Understanding urban health variations and developing viable strategies to ameliorate inequalities in today's highly urbanized and developed societies, therefore, will have invaluable future implications for the currently less developed but rapidly industrializing and urbanizing societies.

Health and Inequality is a valuable and timely publication in this regard. International in scope, Curtis addresses issues of urban health and urban health variations primarily in the more developed countries. Using extensive case studies from around the world, she provides a broad, yet in-depth analysis of the contributing factors to both harmful and healing spaces for health. Anchored on the central thesis that place matters, Curtis argues convincingly from a geographic perspective that the variations and inequalities of health and health services shared by various population groups in cities of the more developed countries could be best understood in places at different geographic scales. Places are investigated as an essential embodiment of the members' power in constructing the different spaces for health and their ability to control and negotiate access to various public health resources. Government policies and professional efforts delegated to ameliorate spatial health variations in cities, therefore, could be more effective by addressing issues of environmental injustice resulting in the cultural, economic, social, and political variations.

Health and Inequality opens with an introduction that highlights the impact of social and cultural variations on perceptions of health, illness, and risks for health at different geographic scales. Curtis proposes that the unique interdisciplinary nature of geographic approach to the study of health, therefore, is ideal in constructing a holistic understanding of the causes of health variations and in developing analytical strategies that address spatial health inequalities. Curtis then organizes the ensuing chapters into two sections. In Section One, she analyzes five geographic landscapes of health through an extensive literature review on health and well-being by both social and medical scientists. Upon careful valuation and assessment of the merits and limitations of the existing research, Curtis notes that each of the five geographic landscapes of health is shaped and affected by a different set of forces embedded in cultural perceptions, power relations, economic parity, consumption patterns, and social ecology. The function of these forces contextualized in specific geographic locales contributes to the variations in the spaces for healing and spaces of risks for health among the concerned populations. Curtis then constructs a set of conceptual frameworks that synthesize the relationships between the different forces and health and illustrate the intricate intertwines of spatial variations and inequalities. Each of these syntheses contributes to the advancement of a particular aspect of the geography of health; however, Curtis notes that, as an isolated body of knowledge, each has limitations in explaining and addressing the causes of health variations.

Curtis addresses the limitations of the different geographic landscape perspectives on health in Section Two. She proposes a holistic and interdisciplinary geographic perspective in analyzing health variations and inequalities in cities. Approaching the existing landscape of public health as a reality shaped in an intricate process of cultural, economic, social, and political interface, Curtis argues that an integrated geographic perspective that brings out the complementary merit of all five landscape perspectives will produce a geographic landscape of health that will better illustrate the causes and processes of health variations and inequalities in cities. Using two case studies--mental health and infectious disease such as tuberculosis--Curtis demonstrates the relevancy of all five landscape perspectives in shaping the perceptions, distributions, and treatments of these diseases, and in determining urban health variations and inequalities of service provisions as well as access to health-care resources among different population groups. Curtis, therefore, proposes that an integrated multi-perspective approach in future research on the geography of health will generate more useful knowledge that will have significant policy implications on urban public health.

Curtis concludes her argument by noting, "Geography is increasingly concerned with concepts of health which extend beyond medical definitions" (p. 282). A multidisciplinary discourse that interfaces with physical, biological, and social sciences in future research on the geography of health will lead to more valuable contributions to policy makers in policy designs that address issues of urban healing places and harmful spaces for health. Interdisciplinary geographic perspective, therefore, could be essential in the production of effective strategies that promote public health and ameliorate stark inequalities in urban public health.