‘That awful place was home’:1 Reflections on the Contested Meanings of craig dunain asylum

The paper explores a particular Scottish asylum geography (Craig Dunain Hospital near Inverness) as a meaningful social space. Drawing on archival evidence and combined with contemporary patient and staff voices, the contested meanings of this institution are discussed. In particular, patient narratives reveal both positive and negative assessments of internal and external asylum spaces. Changing feelings about the asylum are argued to be related to matters of geography, and are conceived in terms of distance from and proximity to the institution.     

A geographic assessment of 'total' health care supply in Ontario: complementary and alternative medicine and conventional medicine

Shortages of family physicians, specialists and other personnel working within the realm of conventional medicine (CM) concern citizens in many regions and municipalities in Canada. Complementary and alternative medicine (CAM) approaches (such as chiropractic, holistic, homeopathic, naturopathic, massage and acupuncture) are increasingly used in conjunction with, or in some cases as replacements for, conventional medicine. Thus, to get an idea of 'total' health care supply in a jurisdiction and to draw comparisons between locations, it is useful to understand the spatial tendencies of both CM and CAM offices. With the use of a sample that contains the location, employment and sales of 4,955 CAM and 8,709 CM offices, this study details the spatial patterns of health care supply in the Canadian province of Ontario. The analysis comprises three main parts. First, the geographic tendencies of CAM and CM office activity are revealed in per capita terms and while regional differences are detectable, the main contrast is that CAM displays a much more even distribution across the urban-rural continuum in comparison to CM. Second, through the use of location quotients and a local spatial autocorrelation analysis, it is shown that certain municipalities (especially in Ontario's southwest and south-central regions) specialize in CAM and the most outstanding spatial feature is an '81 municipality CAM cluster' that represents arguably the pinnacle of CAM activity in the province. CM specialization is rarer and is biased towards the more populated municipalities. Third, a Spearman's correlation analysis suggests that CAM and CM health care supply are associated with community well-being indictors and urban density measures.     

Measuring potential spatial access to primary health care physicians using a modified gravity model

Ensuring equity of access to primary health care (PHC) across Canada is a continuing challenge, especially in rural and remote regions. Despite considerable attention recently by the World Health Organization, Health Canada and other health policy bodies, there has been no nation-wide study of potential (versus realized) spatial access to PHC. This knowledge gap is partly attributable to the difficulty of conducting the analysis required to accurately measure and represent spatial access to PHC. The traditional epidemiological method uses a simple ratio of PHC physicians to the denominator population to measure geographical access. We argue, however, that this measure fails to capture relative access. For instance, a person who lives 90 minutes from the nearest PHC physician is unlikely to be as well cared for as the individual who lives more proximate and potentially has a range of choice with respect to PHC providers. In this article, we discuss spatial analytical techniques to measure potential spatial access. We consider the relative merits of kernel density estimation and a gravity model. Ultimately, a modified version of the gravity model is developed for this article and used to calculate potential spatial access to PHC physicians in the Canadian province of Nova Scotia. This model incorporates a distance decay function that better represents relative spatial access to PHC. The results of the modified gravity model demonstrate greater nuance with respect to potential access scores. While variability in access to PHC physicians across the test province of Nova Scotia is evident, the gravity model better accounts for real access by assuming that people can travel across artificial census boundaries. We argue that this is an important innovation in measuring potential spatial access to PHC physicians in Canada. It contributes more broadly to assessing the success of policy mandates to enhance the equitability of PHC provisioning in Canadian provinces.     

Trans lives in the ‘gay capital of the UK’

Recent geographical interventions have begun to question the power relations among lesbian, gay, bisexual and trans people, challenging assumptions that LGBT communities have homogeneous needs or are not characterised by hierarchies of power. Such interventions have included examinations of LGBT scenes as sites of exclusion for trans people. This article augments academic explorations of trans lives by focusing on ‘the gay capital’ of the UK, Brighton & Hove, a city that is notably absent from academic discussions of gay urbanities in the UK, despite its wider acclaim. The article draws upon Count Me In Too (CMIT), a participatory action research project that seeks to progress social change for LGBT people in Brighton & Hove. Rather than focusing on LGBT scenes, the article addresses broader experiences of the city, including those relating to the city as a political entity that seeks to be ‘LGBT inclusive’ and those relating to the geographies of medical ‘treatment’ that relocate trans people outside the boundaries of the city, specifically to the gender identity clinic at Charing Cross Hospital in London. It argues that trans lives are both excluded from and inextricably linked to geographical imaginings of the ‘gay capital’, including LGBT spaces, scenes and activism, such that complex sexual and gender solidarities are simultaneously created and contested. In this way, the article recognises the paradoxes of the hopes and solidarities that co-exist – and should be held in tension – with experiences of marginalisation.     

Culture,emotional transnationalism and mental distress: family relations and well-being among Taiwanese immigrant women

Immigrant women's vulnerability to mental distress has been recognized in the literature and yet the socio-cultural causes of their distress have rarely been explored. On the basis of a case study of Taiwanese immigrants residing in Chicago, this article illustrates the dynamic contexts within which Taiwanese immigrant women's distress is produced at home and explains the social and cultural factors that engender the women's distress. In this article I argue that Taiwanese immigrant women frequently shift back and forth between Taiwanese and American cultural norms in an effort to apply effective behavioral guidance and justifications to interactions with their spouses, children and in-laws. The term ‘emotional transnationalism’ is used to describe the psychological experience associated with transnational cultural practices. Distress is often generated as these women struggle with feelings of ambivalence and contradictions that confront them in their search for cultural identities. The severity of distress is largely determined by the power hierarchies between women and those with whom they interact. Married women's status as subordinate to their in-laws creates more negative experiences than any other status.     

The end of slavery: Disease patterns and cultural behaviours of African Americans in Suriname

There have been few bioanthropological studies related to African Americans, either slaves or free people. The results of an analysis of eight skeletons of African ancestry (five males and three females) acquired in Suriname at the end of the 19th century by Dr J. Spilzley and currently housed in the Duckworth Collection (University of Cambridge) are presented. Dental abrasion related to habitual pipe smoking was observed in four individuals, confirming the widespread use of pipe to smoke tobacco among slaves observed in other related sites. Our results indicate a very poor state of oral health for these individuals, with females presenting a higher frequency of dental carious lesions and antemortem tooth loss in comparison with males. The presence of cribra orbitalia in some individuals suggests, as observed in other diaspora skeletal series, individuals suffering from severe stress, caused by poor nutrition, infectious diseases, or both. Such appalling life conditions agree with many written records, which describe very harsh work conditions and very deprived diets. Our results, although based in a small sample, contribute to a better understanding of the cultural behaviours as well as the patterns of disease that afflicted the African Americans in Suriname in the 19th century. Copyright © 2010 John Wiley & Sons, Ltd.     

Effects of U.S. States' Social Welfare Systems on Population Health

Social scientists have studied the welfare state extensively. Many studies seek to understand the determinants of the welfare state; however, a few have explored the social consequences of social welfare systems, especially on health outcomes of the population. Even though cross-national comparative studies support the thesis that the welfare state regime type, which represents different levels of commitment on social welfare, is closely linked to population health, there is little research to support this argument at a sub-national level. To fill the gap, this study explores the effects of the U.S. states' social welfare systems on health using age-adjusted mortality rates as a proxy for population health. By operationalizing social welfare systems as three dimensions—public expenditures, tax structures, and welfare program rules—we find that more generous education spending, progressive tax systems, and more lenient welfare program rules help to improve population health. The model corrects for first-order serial correlation using Prais-Winsten regression methods and is estimated with state and year-fixed effects.     

Testing the ‘Laacher See hypothesis’: a health hazard perspective

It has recently been suggested that the Laacher See volcanic eruption, which occurred around 13,000 years ago, initiated significant demographic fluctuations along the northern periphery of Late Glacial human settlement and that these led to a number of material culture transformations. The origins of the Southern Scandinavian Bromme culture and the northeastern European Perstunian culture as well as the temporary abandonment of Central European regions have been linked to this eruption. However, it remains unclear precisely which aspects of the eruption stimulated Late Glacial foragers to abandon their traditional ways of life. Paradoxically, the culture–historical impact of the eruption appears greater further away from the eruptive centre. Here, we investigate one potential middle-range link between the Laacher See eruption and Late Glacial fauna and foragers: tephra as a health hazard. We use laser-diffraction particle-size analysis to quantitatively investigate tephra from one site with a secure Late Glacial archaeological deposit. In addition, we use values previously reported in the literature and a predictive model to calculate the hazard potential along a transect of two of the three major Laacher See tephra fans. Our results show that the Laacher See tephra may have posed a potential health hazard and that its hazard potential may have increased with distance from the vent. To our knowledge this is the only study that attempts to quantify the changing grain-size composition of tephra fall-out longitudinally in this way, at least with regard to a prehistoric eruption. We close by discussing, more speculatively, other possible health-pertinent effects of the Laacher See eruption and suggest ways in which future work can further evaluate the impact of this eruption on Late Glacial populations.     

Gender and place influences on health risk perspectives in northern Canadian Aboriginal communities

Developing a better understanding of the factors underlying health and environmental risk perspectives has been the focus of significant research in recent years. Although many previous studies have shown that perspectives of risk are often associated with gender, sociocultural variables and place, our understanding of the relationship between these factors and risk remains equivocal. A research study was undertaken to develop better insights into the understanding and perspectives of various types of health risks in two sets of northern Canadian Aboriginal communities – the Yellowknives Dene First Nation communities of N'Dilo and Dettah in the Northwest Territories and the Inuit communities of Nain and Hopedale in Nunatsiavut. Gender was found to have a limited overall effect on risk perspectives, consistent with other studies that found no gender differences in communities stressed by multiple and concurrent risks. Nonetheless, subtle gender differences were seen in the qualitative responses, with women focusing more on community impacts and mitigating actions. Threats to ‘place-identity’ associated with changes in traditional lifestyle and connection to the land were strongly associated with risk perspectives. These results reinforce the need to be cautious in making assumptions about the complex effects of community and personal attributes, such as gender and gender relations, in assessing the factors underlying risk views and concerns. They also suggest the importance of gathering multiple types of data (both quantitative and qualitative) in order to fully assess the effects of both gender and place. Ultimately, understanding risk in a northern context requires recognizing the unique circumstances and identities of northern Aboriginal peoples.     

Trends in adult stature of peoples who inhabited the modern Portuguese territory from the Mesolithic to the late 20th century

This study documents long‐term changes in stature from the Mesolithic to the late 20^th century in the territory of modern Portugal. Data utilised originated from published sources and from a sample of the Lisbon identified skeletal collection, where long bone lengths were collected. Mean long bone lengths were obtained from 20 population samples and compiled into nine periods. Pooled long bone lengths for each period were then converted to stature estimates. Results show three major trends: (1) a slow increase in stature from prehistory to the Middle Ages; (2) a negative trend from the Middle Ages to the late 19^th century; and (3) a very rapid increase in mean stature during the second half of the 20^th century. The political and territorial stability of the Kingdom of Portugal may have contributed to the greater heights of the medieval Portuguese, compared with the Roman and Modern periods. The negative secular trend was rooted in poor and unsanitary living conditions and the spread of infectious disease, brought about by increased population growth and urbanisation. Although the end of the Middle Ages coincided with the age of discoveries, the population may not have benefited from the overall prosperity of this period. The 20^th century witnessed minor and slow changes in the health status of the Portuguese, but it was not until major improvements in social and economic conditions that were initiated in the 1960s, and further progress in the 1970s, that the Portuguese grew taller than ever before. Since the Middle Ages other European countries have experienced similar oscillations, but showed an earlier recovery in stature after the industrial period. Copyright © 2008 John Wiley & Sons, Ltd.