Slides from a seminar series I presented at my university.

1. Infectious and Communicable Disease:
A Health Geography Perspective
Seminar 2
Hamish Robertson, PhD
30th June 2021

2. Contents
• Introduction
• Infectious and communicable disease considered
• Geographies of Communicable Disease – historical and contemporary
• Covid-19 as a Spatial Phenomenon
• Antimicrobial Resistance – OUTBREAK and related matters
• Some sociopolitical and sociotechnical considerations
• Discussion
• Conclusion

3. Introduction
• This is the second in a group of four seminars of some of my thinking about
health geography and some contemporary/emerging health issues and
concerns
• Not especially systematic and aimed at a broad audience for the purposes
of engagement and discussion
• Key aim is to promote an understanding of the role(s) of geography in
current and emerging healthcare provision
• Scope is likewise broad and covers theory to practice, including some
projects I have been involved in with other colleagues
• NB most GIS work by my colleague Nick e.g. Outbreak mapping
• Usual caveats apply – I am not an epidemiologist, microbiologist, medical
etc.

4. Infectious and Communicable Disease
• Infectious diseases (also known as communicable diseases) are
caused by infectious agents and can be passed from one person or
animal to another. Transmission can occur directly (through contact
with bodily discharge), indirectly (for example, by sharing a drinking
glass) or by means of vectors (such as mosquitoes). They are caused
by bacteria, viruses, parasites or fungi or their toxic products.
Examples of these communicable diseases include coronavirus,
malaria, influenza and chickenpox.
• https://www.aihw.gov.au/reports/australias-health/infectious-and-
communicable-diseases (2020)

5. Communicable Disease Concept
• Refining the model – infectious diseases are not all communicable but
communicable ones are contagious
• Many diseases are infectious but the host does not necessarily spread
them to others e.g. toxoplasmosis (Toxoplasma gondii->cats->human
host)
• Science a product of a wider interdisciplinary perspective e.g. not just
medicine and public health
• Health geography has a role at the intersection of the spatial, social
and natural sciences

6. Noncommunicable Disease (NCD)
• The major issue for more affluent countries – especially chronic
conditions -> up to 50% of USA, Canada etc. living with one or more
chronic diseases – what is ‘health’ in this context?
• Age-related conditions a major concern and a challenge to
established systems and practices - problem of treatment focused not
prevention focused
• Epidemiological transition theory (Omran, 1971 etc.) complicated by
Covid19 – non-linear and not progressive – can have communicable
and NCDs concurrently
• Teleology is fine and good in philosophy but a real problem when it
guides social and political responses

7. Basic Model Extended and Developed Since
Omran but…also critical analysis

8. Problem of Science Being
Socialised
• Dubos (1959/1989 Rutgers University Press) discussed the
adaptive nature of viruses, bacteria fungi etc. as live/living entities
– some debate ongoing with viruses but see microphages
• Risk of teleological thinking being transferred from sociocultural
and sociopolitical environments to scientific knowledge e.g.
progress, linear development theory, ideal states etc.
• Retreat from/avoidance of the innate complexity of a dynamic
biological environment ands the role of microbial life
• Fleming warned against overuse/irresponsible use of antibiotics
and yet here we are –> sepsis rates rising, antibiotic resistance
and AMR research growing at pace
• Also, the model of mass-scale, cheap and highly profitable pharma
industry – policy, politics, industrial models and the quick fix
mentality
• Downstream consequences…

9. Parasites and
Associated
Issues

10. And on to a Health Geography Perspective

11. Contemporary Geography and Infectious Disease

12. The Supramap project:
linking pathogen genomes
with geography to fight
emergent infectious
diseases.
Source: Gemini Genomics 2020

13. Microbiology and Geography
• Microbial life, including infectious agents, is often spatially patterned in
ways that can be mapped and analysed using contemporary technologies
• Concept of space, and geography, useful in exploring a range of
microbiological questions
• Biological sciences and geography interface growing at pace, especially in
key/emergent areas of complex questions e.g. GIS, GeoAI etc.
• Extensibility of the geographic concept – e.g. internal geographies (see
neuroscience and brain mapping), intimate environments, personal spatial
trajectories and exposures, wider ecological environmental interactions
(e.g. environmental disturbances and destruction and viral/bacterial risks)

14. Mapping Disease – It Was Ever Thus
• Mapping infectious, communicable disease has a long history
• The connection between disease and people, and the politics of such
connections is also enduring
• The modern state formation made the embodiment of sickness and
disease a site for the application of both social stigma and social force
e.g. TB, STI’s (think Lock Hospitals in Australia), mental illness and so
on
• Eugenics was closely allied to this including the role of the middle
classes in ‘regulating’ society and the social order

15. Lazzoretti – Plague and Leprosy

16. The Venice Ghetto –
Social
Contamination and
Control via Space

17. Controlling the geographical spread of infectious disease:
plague in Italy, 1347-1851.
Andrew D. Cliff, Matthew R Smallman-Raynor, Peta M. Stevens

18. John Snow and the Broad Street Cholera Map of 1854
• Many early medical
geographers were doctors
with an interest in
mapping – more supply
than paying jobs e.g. navy,
army, empire, slave trade
• Origin myth for
epidemiology, medical
geography etc.
• Was NOT decisive in
intervention, was useful
for analysis
• Part of a growing wave of
19th century data viz

19. 1831: the map that launched the idea of global health
Tom Koch (2014) – The Lancet

20. Perry's 1844 map of a fever epidemic in Glasgow

21. Social Mapping and Social Taxonomy

22. Locational Disadvantage Can Persist Over Time

23. Historical Disease Mapping – The Economist

24. Disease and the Environment
• This is key in terms of microbial life since many bacteria and viruses
are contained within specific environments , under stable (or slow
changing conditions)
• We have a problem now with this stability and rates of change are
speeding up – Canada’s current heatwave!
• Containment is an issue (e.g. Covid19) as is the issue of changing
conditions (e.g. warming and shift in existing/new vectors such as
mosquitos etc.)
• Scope of the problem was always an issue i.e. some pathogens travel
fast, others more slowly but we act on the environment too

25. Connecting
Changes in
Geography and
Disease Patterns

26. Covid Data Mapping – Johns Hopkins

27. WHO
Joins
the
Game

28. Localisation

29. Visualising Coronavirus’ Global Spread
• https://www.youtube.com/watch?v=vB13SItWgGE

30. The OUTBREAK Project –
Antimicrobial Resistance in
the 21st Century

31. From Virtual Earth Visualisation
to GIS Analysis and Mapping

32. Space and Scale in a Virtual Earth – Google
Earth

33. Examples for Illawarra
Shoalhaven LHD

34. Explicit Geographies for Our Two Case Study Partners

35. Demography and Epidemiology:
National Health Survey Data 2018 for UTI’s

36. UTI Prevalence Estimates for ISLHD SA1 and SA2
Data Source: National Health Survey 2018

37. LHD Geography (SA2) – Epidemiology, Infrastructure and Mobility

38. Some Sociopolitical and Sociotechnical Issues

39. The State as a Healthy Body: Infectious Agents
and Embodiment
• Dorothy Porter’s concept of the healthy state and its consequences
for those deemed unhealthy elements or infectious agents – the real
social epidemiology?
• Racism, eugenics, sexism, ableism etc…selective bodies and minds
and the consequences of a reification of the ‘normal’
• Surveillance has therefore always been problematic and not ‘simply’ a
neutral exercise of state and professional power
• Risks exist with expanded development and application of
surveillance technologies - we have a history of this – more in
Seminars 3 and 4

40. Health Has Never Been Neutral…

42. The Reliance on Martial Metaphors – Then and
Now
• A long-standing cultural metaphor – doctor as
soldier in the war on disease etc.
• Reinforced at various turns – the war on (add
your disease/condition/anxiety)
• Servicing a fundamentally middle-class view of
the world – virtue posturing by people paid to
do jobs and paid rather well
• Similar lack of accountability as in war – rules
established and then avoided where possible
• Intersection of bourgeois mythologies of
professions and technological expansion – all
benefits, no downside, no ethical concerns etc.

43. Spatial Technologies and Infectious Elements
• If groups of people are perceived as
infectious agents for minds, bodies
and states, these technologies will
be (are being) used to target them
• These technologies have a military
origin, the risk is an intensification
and diversification of established
uses
• Social policy and practice risks exist
too – targeting ‘risk’ groups

44. Conclusion
• Ideas of infection were and are social as much as they are a product of
‘science’
• Genuine applications exist for health geography and associated
technologies but parallel risk scenarios also exist
• A singular scientific approach is not possible because various disciplines
take a different view and some are more politicised than others e.g.
medicine’s self-advocacy is substantial
• Technological integration is possible BUT ethical concerns and potential
harms are substantial
• Discourse needs to be critically engaged – see what we have done using
the same sort of language and applications in the past!
• Opportunities clearly exist for application of health geography in
improvements – again, not simple case of technology ‘stripping’ but the
whole package of application and critique