This document discusses the importance of spatial literacy and skills in healthcare. It notes that space is integral to human experience and behavior, and that healthcare systems, epidemiology, funding and policy are all spatial in nature. However, spatial science remains underutilized in healthcare. The document argues that improving spatial literacy through concepts like geography, maps, and spatial data analysis can help address complex problems in health research and delivery. It concludes that as spatial technology advances, spatial illiteracy poses a growing challenge, and that paradigm shifts are needed to better integrate spatial science into interdisciplinary health research.

1. Spatial Literacy for the Health Sciences:
Capacity Building for the 21st Century
Presenter
Hamish Robertson
PhD Candidate
Australian Institute of Health innovation
University of NSW

2. Contents
• Background
• Why spatial skills matter in healthcare
• Spatial science considered – big, bigger,
biggest
• Space, place and health care
• Knowledge and skills issues
• Some applications and examples
• Conclusion

3. Background
• Possibly the most under-utilised interdisciplinary
scientific domain in healthcare – with the exception of
today’s session!
• Societies and human beings all exhibit spatial and
spatially patterned behaviours – health and illness are
spatial
• Scientific knowledge and society are co-productive
(Jasanoff etc) – space is included in this process
• Growth in data quantity, quality and analytical methods
are all spatial – the original ‘big data’
• Ubiquitous spatial technology – but health informatics
has been largely aspatial!

4. Why Spatial Knowledge Matters

6. More GIScience in Time Team than Health!

7. Viewing
Social
Inequalities
from
Space

8. Female Life Expectancy by LGA- Victoria

9. Complex Systems and Long-Tailed Events

10. Historical Literacy Wouldn’t Hurt Either

11. Three approaches to qualitative research
Source: Seamon and Gill, 2014

12. Tobler’s First Law
"Everything is related to everything else,
but near things are more related than
distant things.”
Tobler W., (1970) "A computer movie simulating urban
growth in the Detroit region” Economic Geography, 46(2): 234-240.

13. Why Spatial Skills and Knowledge Matter -1
• Because space is a central factor in human experience, cognition
and behaviour
• Space is intrinsic to human activities of all kinds including
healthcare systems, epidemiology, funding, policy etc
• Spatial technology is everywhere, increasingly sophisticated and
growing rapidly
• Spatial data and its analysis is the original ‘big data’
• Maps and mapping are fully digital i.e. mathematico-statistical in
nature (map-ematical – Joseph Berry)
• Healthcare patients, providers and facilities operate in spatial
ways and produce spatial patterns including health inequalities
(Dartmouth Atlas)

14. Why Spatial Knowledge and Skills Matter - 2
• Health informatics technology cannot negate space, only
incorporate it in more useful and meaningful ways
• Broader social and environmental changes all have significant
spatial implications
• All natural sub-systems can be aggregated upwards to our total
environment – interconnections matter and so does scale – poorly
addressed in much health research/policy
• Linking total health to other policy domains has value and utility in
terms of purported aims and desired outcomes – can be done
through space
• Spatial technology is almost universally pervasive but completely
under-utilised in healthcare
• Rising complexity in natural-human system interactions demand it
e.g. climate change, pollution, urban heat sinks etc

15. Medical and Health Geography
• Deep cultural notions of space, place and health interactions – healing
places, places of illness e.g. ‘Shinrinyoku’ or ‘forest bathing’,
pilgrimage, philosophers who walk e.g Immanuel Kant
• Homer – The Iliad (special places) and the Odyssey (special journeys)
• Airs, Waters, Places – Hippocrates’ environmental associations
between places and health/illness
• 18th century France – Royal Medical Society of Paris proposal for a
medical geography of France – nation-building, maps and health
• Germany – Finke’s first ever world medical atlas 1792–95
• Yellow fever maps, military medicine, medical policing etc
• Healthy ageing – often special places identified e.g. islands such as
Okinawa and Sardinia (utopian tropes)
• Recent science correlating health status in urban environments with
access to green space and blue space etc

16. Key Spatial Concepts for Health Research
• Human beings are innately spatial – cognition, memory and
behavior => brains, languages, cultures, evolutionary
development (Keith Clarke, 2011)
• Settlement patterns, agriculture, urban processes, travel
patterns, service logistics etc are all spatially constituted
• Most social constructs involve explicit or implicit spatial
characteristics (e.g. society, population, social networks,
embodiment)
• Maps and mapping are both data analysis and visualisation
processes – back to spatial cognition
• Health policy and research use terms like ‘ageing in place’ in
largely atheoretical ways
• Often clear that health researchers don’t know what they
don’t know about space and place constructs

17. Spatial Knowledge Production
• Spatial technology is ubiquitous – IT technology
includes spatial tech by default e.g. GPS
• More and more software environments permit
spatial data capture and analysis including
qualitative methods
• Concept maps and data visualisation rely on
spatial cognition, colour awareness etc
• Kotusopoulos (2011) proposes a paradigm shift to
a fully interdisciplinary spatial domain

18. Paradigm Shift?

19. Qualitative Research is Going Spatial

20. NVivo
and
Virtual
Earth
Technology

21. Also Critical Spatial Skills
• Place is not just a proxy for location – weak
conceptualisation and analysis (absence of knowledge
and skills – see above)
• Un- or ill-defined use of spatial terminology is not
scientific e.g. environment, landscape, neighbourhood,
place etc
• Maps can be and often are propaganda – we also need to
be able to unpack spatial representations (Monmonier,
1991)
• Lines, areas, shadings etc can tell alternative stories but
often are singular, monolithic and absolute = instruments
of power
• Spatial literacy needs to cover the use and abuse of
spatial methods and technologies

22. Conclusion
• Spatial science is integral to modern health policy, health research
and delivery
• Producing digital versions of analogue maps is often weak and lazy
science – under-use of the technical capabilities already available,
failure to adapt = failure of knowledge and ethics
• Spatial technology is advancing at such a rate that spatial illiteracy is
a growing problem – if this was any other domain there’d be an
outcry (maybe)...
• Paradigm shifts are needed in health research to improve (a)
philosophical literacy (key concepts) and (b) spatial literacy because
they intersect at numerous points e.g. spatial entities, spatial
ontologies, semantic ontologies, metaontology etc
• In an era of increasingly complex and interconnected problems we
need to improve the interdisciplinary awareness and understanding
of spatial science
• If 10 year olds can produce working KML data files, why can’t most
of healthcare and what does this bode for the future?

23. Multidimensionality and Mapping
Source: http://www.espconference.org/ESP_Conference/75210/9/0/60
"Westerners maps in three dimensions: longitude,
latitude, and altitude," explained Plotkin. "Indians think
in six: longitude, latitude, altitude, historical context,
sacred sites, and spiritual or mythological sites, where
invisible creatures mark watersheds and areas of high
biodiversity as off-limits to exploitation."
A model map created by Indians in Brazil. Image courtesy
of ACT. Their maps are also meticulously detailed,
including virtually everything associated with a place.
"Indians mark where they get materials for houses,
bamboo, specific vines, places where they find honey and
wood for canoes, anything they eat in terms of palm
nuts, brazil nuts, Açaí -- rich palm fruit. For example
we're working with the Wayana, a warrior tribe. They
have marked two specific parts of the forest where they
can find wood hard enough for arrow points. They've
marked another point on the other side of the reserve
where they get hollow wood to craft the arrow shaft,"
added van Roosmalen.
The Indians also chart the distribution of medicinal
plants -- they use hundreds -- but for security reasons,
some highly coveted medicinal plants are not published.
In the past there have been problems with biopiracy
where outsiders trespass on lands to illegally collect
these plants for export. The Indians saw nothing in
return.