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Abstract

As part of the tripartite evolution, health geography emerged alongside the population health perspective and a shift from the biomedical notion of health to an increased recognition of the role of socio-ecological factors that shape health and well-being. Owing to these shifts, health geographers have made substantial contributions to global health research in the areas of theoretically informed research, methodological innovation and diversity and evidence-based research translating into health policy and practice. By establishing the reciprocal relationship between place and human health, health geographers have expanded global health scholarship by demonstrating that geography and health are inextricably linked. This review provides a background of recent developments in health geography and demonstrates how health geographers can leverage their expertise by adopting new technologies in the face of emerging global health challenges.

Keywords

Health geography global health population health space place scale theory

Introduction

Health geography adopts geographical perspectives to examine the influence of socio-environmental factors on our experiences of disease, health and healthcare across scales (Dummer, 2008; Vine et al., 2023). As a sub-discipline, health geography emerged in response to critiques against traditional medical geography, which focused on the patterns, causes, and spread of disease and health service provision shifting towards greater recognition of the importance of places and spaces in shaping health outcomes (Braimah et al., 2023; Elliott, 2018). Earlier debates within the sub-discipline (Dorn and Laws, 1994; Eyles and Litva, 1996; Kearns, 1994) resulted in a theoretically nuanced sub-discipline and methodological pluralism – the need to incorporate diverse methodological approaches in research (Andrews et al., 2012; Elliott, 2018). Following this shift, the sub-discipline has substantially contributed to global health research in various ways. Yet, such contributions have been footnoted rather than foregrounded (Herrick, 2016). Despite the distinctiveness of the sub-discipline, it is intriguing that, for over three decades, health geography has not carved out a distinct niche within the global health landscape to situate its novel contributions. Indeed, geographical contributions have been sidestepped by other disciplines, including medical anthropologists, sociologists and political scientists who have questioned the potential of the sub-discipline to contribute to the interdisciplinary making of global health (Herrick and Reubi, 2017). However, the compulsion to do global health stems from geography’s long-standing engagement in domains such as globalization, urbanization, lifestyles, culture, governance, geopolitics, political economy, risks, vulnerability, development and the environment (Herrick, 2016). Aside from being sidelined by other social science disciplines, it is also apparent that much of (potential) geographical contributions to global health debates have failed to be positioned within and outside the sub-discipline (Herrick and Reubi, 2017). Consequently, global health brings with it an innate, powerful and politicizing spatial logic, opening a compelling window for geographical enquiry into critical global health research. This potentially presents a lacuna for health geographers to situate their unique contributions.

Health geographical research has predominantly focused on core components of global health, such as population and public health (Elliott, 2018; Herrick, 2016; Riva and Mah, 2018). The population health approach focuses on the health outcomes of populations and considers the influence of multiple determinants of health, such as medical care, genetics, lifestyles, and social and physical environments (Vine et al., 2023). This research approach is unique and holistically addresses health and well-being across scales (Farrow et al., 2022). Given the renewed understanding of health (beyond biomedicine), the population health perspective underscored the need for increased attention to addressing the social determinants of health . The social determinants of health framework seek to admit the influence of multiple factors outside the healthcare system operating at different scales as significant determinants of health and well-being (Vine et al., 2023). But even more importantly, the population health approach is interdisciplinary and intersectoral and embraces complexities, which aligns with the goals of global health policy and practice (Farrow et al., 2022; Riva and Mah, 2018). While public health involves organized efforts to prevent, protect, promote and restore people’s health through policies, programmes, interventions and services across scales, global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people (Chen et al., 2020; Koplan et al., 2009; Vine et al., 2023). Global health scales up and builds on the successes of public health interventions, and the role of health geographers has become fundamental.

The goal of global health is to pursue three objectives: (1) to generate knowledge and theories about global health issues and influential factors by developing global solutions; (2) to distribute this knowledge through education, training, publication and other forms of knowledge sharing; and (3) to apply global knowledge, theories and intervention strategies in practice to solve global health problems . According to Chen et al. (2020), global health research must meet three criteria: First, the study must have a global perspective; second, targeted issues should have a global impact; and finally, the study should seek global solutions. At the intersection of global and public health lie issues of international health. International health adopts public health principles to address cross-border health challenges, particularly those that affect low and middle-income countries (Merson, 2014). Although international health issues are restricted to participating countries, they sometimes require a global health intervention to tackle them (Tulchinsky and Varavikova, 2014). For instance, the 2014 Ebola epidemic, which affected six West African countries, including Guinea, Liberia, Sierra Leone, Mali, Senegal and Nigeria, falls within the purview of international health (Bosa et al., 2024). Global health is an extension of international health in terms of its scope, scale and purpose (Koplan et al., 2009). At present, the global health landscape involves a variety of efforts aimed at reducing the global burden of disease, particularly curtailing the transfer of infectious diseases. Aside from controversies around a common definition of global health (Koplan et al., 2009), it has been criticized as not being a unified field of inquiry and lacking a coherent theoretical basis to merit the status of a discipline (Herrick, 2016). A significant number of health geographers are deeply involved in global health research and have adopted public health strategies in theorizing the intricate relationships between bodies, spaces and power dynamics (Andrews et al., 2012).

The article seeks to establish a synergy between health geography and global health and discusses the current and potential contributions of the sub-discipline to global health research, policy and practice. The rest of the article is structured into three sections. Following the introduction, section one will establish the nexus between health geography and global health research. Section two will highlight the contributions of health geographers to global health research through the lens of theoretically informed research, methodological innovation and diversity, and action-oriented research translating geographical research into global health policy and practice. The last section will make recommendations for future research and explore the potential of the sub-discipline to leverage emerging fields such as social prescribing, artificial intelligence, GIS and drone technologies to advance the course of global health research. The article concludes with a summary of key issues and advocates for interdisciplinary research among health researchers to tackle complex of global health challenges.

The nexus between health geography and global health research

Health geography has established that the environment in which people are born, grow, live, work and retire – thus, the places we occupy directly impact our health and well-being (Gatrell and Elliott, 2015). Consequently, health geographers have increasingly recognized the significance of place in experiences of health and healthcare (Elliott, 2018; Kearns, 1993). Relph (1976) and Tuan (1977) long established the link between health and place by demonstrating how providing health services can affect a person’s experience of place. They demonstrate, for instance, how a large and impersonal hospital might exude a sense of ‘placelessness’, whereas a community clinic might act as a point of contact and model a sense of place-identity and place-belonging among rural residents (Relph, 1976). Health geography’s substantial focus on the role of place has led to increased engagement with the socio-ecological model in establishing the relationship between the social, cultural and physical environment and the admission of multiple determinants of health (Elliott, 2018). The social determinants of health framework and the socio-ecological perspective extend the biomedical notion of health to include well-being (the self-assessed quality of life) and a benchmark for examining wider socio-political and economic influences on health (Crooks et al., 2018). Following the pioneering works of health geographers like Relph, the Ottawa Charter (1986), which was anchored on health for all through health promotion, reconceptualized our understanding of health as a resource necessary for everyday living which allows individuals to cope with their environment. These developments endorsed the power of place in shaping experiences of health and well-being of populations, which is a theme pioneered within the discipline of health geography. The link between health and place consequently informed the development of other relevant place-centred concepts such as healthy cities, healthy communities (Davies and Kelly, 2014) and therapeutic landscapes (Gesler, 1992) – recognizing the psychological effects of spaces and as places for health and well-being such as beaches, parks, gardens, natural habitats and retreat centres (Bell et al., 2018).

Health geographers have increasingly utilized scale in measuring observed health differences between places. Scale has been conceptualized to connote the virtual hierarchically nested territorial unit spanning global, supranational, national, regional, metropolitan, urban, local and the body (Marston et al., 2017). Perhaps, Taylor’s (1982) groundbreaking three-step segregation of micro, meso and macro scales (urban, national and global) as distinct spatial units marked the foundational entry point of scale into critical human geography (see Dodds et al., 1997). Following that, the scalar differentiation was further expanded to incorporate sub-national and regional scales and emergent territorial divisions into the Global North-South dichotomy (Jones et al., 2017). Again, the primacy of human agency and structure in global health has been examined (King, 2010). Health geographers have utilized human agency and structure in highlighting the uniqueness of places on health (Andrews et al., 2014). Agency describes the capacity to act independently or collectively in numerous actor roles and influence health outcomes (Wyness, 2015). On the other hand, structure defines various ways in which people’s actions are dictated by society rather than the individual’s rational choice (Kalipeni and Feder, 1999). It has been demonstrated that structures (political, social, economic and cultural systems) shape people’s experiences and practices of health and place in a mutually reinforcing manner (Giddens, 1984). As espoused in Epp’s (1986) conceptualization of health – as a resource for everyday living, the structure/agency debate describes the ability of individuals to function in their environment within the wider global health space.

Health geographers’ substantive focus on population health aligns with the goal of global health research (Crooks et al., 2018; Elliott, 2018). This approach recognizes health as a positive concept beyond the absence of disease to incorporate other aspects of well-being, such as physical, mental, social and emotional well-being, that were hitherto neglected (Epp, 1986; World Health Organization (WHO), 1984). Population health emphasizes the influence of social, economic, cultural and environmental factors in shaping human health. Consistent with the Ottawa Charter (1986), Frankish (1996) succinctly defined health as the capacity for people to adapt to, control and respond to life’s challenges and changes over time. Consequently, health geographical research has seen a renewed focus on health and place and the urgency in addressing social and environmental determinants of health (Farrow et al., 2022; Konkor et al., 2023). Human health is (re)produced where genetics, lifestyle and occupation intersect with the natural, social and built environment and are influenced by social, economic and political processes (Braimah et al., 2023; Herrick and Reubi, 2017; Kuuire and Dassah, 2020). The work of health geographers is evident in empirical fields related to global health, such as ageing and health (Andrews and Duff, 2022; Elliott, 2022; Rishworth and Elliott, 2022a), health inequalities (Kangmennaang and Elliott, 2018), public health (Braimah et al., 2023; Vine et al., 2023), health services and care (Andrews and Evans, 2008; Domapielle et al., 2023; Gillespie et al., 2022;), environmental health (Cardwell and Elliott, 2019; Fox and Powell, 2023), maternal and child health (Atuoye et al., 2015; Kpienbaareh et al., 2019; Rishworth et al., 2016), climate change (Curtis and Oven, 2012; Namanya et al., 2021), water sanitation and hygiene (Bisung and Elliott, 2017; Nunbogu and Elliott, 2022), food security (Kansanga et al., 2022; Siiba et al., 2024) and social determinants of health (Marmot and Wilkinson, 2005; Shantz and Elliott, 2021).

Emerging and re-emerging pandemics of global concerns such as HIV/AIDS, severe acute respiratory syndrome (SARS), Ebola and COVID-19 have benefitted immensely from geographical perspectives such as GIS, remote sensing and mapping (Kangmennaang et al., 2023; Konkor, 2019; Luginaah, 2009; Nunbogu and Elliott, 2023). Similarly, health geographers have investigated the health implications of climate change, such as drought, extreme precipitation and increased heat (Curtis and Oven, 2012; Namanya et al., 2021). Thus, the synergistic relationship between climate change, globalization, food security and human health is dynamic and multidimensional have received considerable attention from health geographers (Siiba et al., 2024). For example, Amoak et al. (2022) explored climate change, food security and health in marginalized populations and called for an integrated, science-based approach to bridge the gap between science, policy and practice. They assert that the impact of climate change stressors on Sustainable Development Goal 2 (SDG 2, Zero hunger) could potentially hinder the attainment of other SDGs, particularly SGD 3, which targets good health and well-being for all at all ages. Health geographers can engage in nutrition and food security research by leveraging their varied methodological expertise in participatory and spatial science. As specialists, health geographers can better make sense of contextual, meteorological and anthropological environments influencing food and nutrition security dynamics (Turner et al., 2020). Such geographical perspectives could unravel the sensitive lived experiences of people who are food and nutritional insecure to demand policy interventions. Furthermore, health geographers have expanded our understanding of disease risks through the symbiotic relationship between health and the environment (King, 2010). For instance, Konkor and Kuuire (2023) established the relationship between the environment and non-communicable diseases in Ghanaian cities and advocated for neighbourhood policy programmes that will improve overall population health.

With the world experiencing profound demographic shifts across spatial scales, health geographers have drawn on geographical perspectives to explore alternative means of addressing the quagmire of ageing (Wiles, 2017). Ageing in place mirrors the idea of having older people remain in their homes as they age, which presents a unique opportunity for health geographers to advance the science of theorizing the reciprocal and mutual relationship between health and place (Herrick and Reubi, 2017; Wiles and Allen, 2016). Indeed, it has proven to be a cost-effective housing strategy for dealing with the projected ageing populations in varied settings. Similarly, health geographers have been interested in how inequalities evolve and are distributed across space (Bambra et al., 2023). For instance, Rishworth and Elliott (2022b) examined the multidimensional health disparities among older adults in Uganda. Also, Kangmennaang and Elliott (2018) developed a conceptualized model for understanding the link between well-being and inequality in low and middle-income countries. These studies underscore the need for health geographers to engage in interdisciplinary research, utilizing theory and place in understanding context-specific health disparities.

Furthermore, health geographers have employed divergent models and techniques to examine the structure and human agency in addressing structural determinants of health as they vary across space, place and scales (Bambra et al., 2019; Davies and Kelly, 2014). Kearns (1993) earlier explained that by engaging with social theory and utilizing structure/agency questions, health geographers adopt a broader framework to situate health and place experiences. Agency and sense of place in global health are reflected following the Alma-Mata Declaration on “closing the gap in a generation” by the WHO’s Commission on Social Determinants of Health (Marmot and Wilkinson, 2005). Among other things, the report raised critical questions on the feasibility of attaining health equity, considering the stark disparities in health outcomes between places across scales (Brown and Moon, 2012). Health inequalities are inevitable between and within nations, cities, families and bodies. Even within the global health research space, researchers from high-income countries have an uneven advantage in securing research funding, dominating authorship and publishing in high-impact journals even when the research is undertaken in low-income countries (Ojiako et al., 2023). Indeed, the African continent has become an inevitable niche for much of global health research invaded by international researchers (see Dedios and Anderson, 2014; Herrick and Reubi, 2017). For instance, the incidence of HIV/AIDS in sub-Saharan Africa has received significant attention from global health researchers with huge funding from philanthropic organizations. However, despite the copious scientific evidence, HIV/AIDS remains prevalent in the sub-region, and the suffering of many remains the basis for further epistemological enquiry (Crane, 2013). While the sub-discipline is in its nascent stages in sub-Saharan Africa, a significant number of health geographers of African descent have engaged in extensive scholarship within the ambit of health inequalities in the sub-region (Braimah et al., 2023).

Similarly, global health governance recognizes the complex interlinkages between political and social actors across scales in a spatiotemporal manner (Fidler, 2010). Global health governance is negotiated by high-income countries through International Governmental Organizations (IGOs) such as the WHO, United Nations (UN), United Nations Children’s Emergency Fund (UNICEF), United Nations Programme on HIV/AIDS (UNAIDS), World Bank, International Labour Organization (ILO) and regional bodies such as the African Union, European Union and the Association of Southeast Asian Nations (ASEAN) through ministries, departments and agencies in partner countries (Harman, 2012). Global health is funded through philanthropic foundations, Including the Global Fund, the Bloomberg initiative, the Bill and Melinda Gates Foundation, the Rockefeller Foundation and the Health Fund through the World Bank (Fidler, 2010). Other international organizations such as Amnesty International, Oxfam and Doctors Without Borders have been instrumental in the fight against poverty and disease, particularly in developing countries. The WHO oversees over 194 member countries by providing technical assistance, guidelines and medical supplies. For example, the WHO provides guidelines such as the International Health Regulations 2005 (IHR, 2005), which are benchmark principles for countries against international health emergencies (Fidler, 2010).

Global health response is evident in the fight against HIV/AIDS, SARS, H1N1 COVID-19, NCDs, malaria and other diseases that have a significant burden on society and transnational health implications. Health geographers have acknowledged the significance of context in articulating the importance of the local environment in shaping our experiences of health and healthcare (Crooks et al., 2018). At the same time, global health has often adopted the geographic scale to understand context-specific diseases and to design place-based interventions. Population health compares health outcomes across a population and seeks to answer why certain diseases are particular to certain places and not others. Global health interventions are usually context-specific and target-place-based diseases (Tulchinsky and Varavikova, 2014). For example, neglected tropical diseases (NTDs) such as Biruli ulcer, trachoma, leprosy, lymphatic filariasis (Elephantiasis) and yaws, among others, are peculiar to environments with distinct socio-economic conditions. NTDs thrive in places characterized by the high incidence of poverty, marginalization and poor access to basic life-sustaining resources (George et al., 2023).

Contributions of health geography to global health research, policy and practice

The impact of health geography on global health research is wide and diverse (Dummer, 2008; Vine et al., 2023). Health geographers have employed complex ontological, methodological and epistemological standpoints in global health research (Vine et al., 2023). Ontology reflects our beliefs about the world and what exists as knowledge (Bryman, 2016), while epistemology describes the ways of knowing the world and how knowledge is acquired (Bryman, 2016). Health geographers have often employed diverse theories to guide the research process, from conceptualizing the research problem to developing research questions, methods, data collection, analysis and conclusion (Varpio et al., 2020). Multiple epistemologies exist within health geography, spanning positivism, interpretivism and critical approaches (Bell et al., 2023). Positivist theories draw on quantitative scientific methods to establish health patterns across space and time using large sample sizes to provide the basis for generalization (Bell et al., 2023; Vine et al., 2023). As opposed to the positivist approach, interpretivism argues that the role of the researcher is to understand social reality based on the perceptions and lived experiences of the people they study (Bell et al., 2023). Alternatively, health geographers adopt critical approaches to bridge the research-policy gap by adopting more practical approaches, such as participatory action research (PAR) (Bell et al., 2023). A key feature of health geography is its connection to critical human geography – a set of ideas within human geography that seeks to promote emancipatory politics and social change by linking geographic research to policy and practice (Kearns and Moon, 2002). Critical health geographers reinforce the commitment to social justice, opposition to unequal power relations and transformative policies (Painter et al., 2008). Also, it allows for the development and application of critical theories. Drawing from critical theories, health geographers seek to influence the actions of policymakers by facilitating the provision and equitable distribution of healthcare services (Kearns and Moon, 2002).

Increasingly, health geographers have paid closer attention to the social determinants of health – the conditions outside the formal healthcare system in which people are born, grow, live, work and age, such as income, education, housing and neighbourhood conditions (Bell et al., 2023; Kind and Golden, 2018). These conditions significantly influence disease risks and susceptibility and drive population health inequities. A large body of research demonstrates that greater social disadvantage correlates with poor health outcomes (Braveman et al., 2011; Rishworth and Elliott, 2022a). For instance, residential location may create limited employment opportunities, leading to poverty and creating avenues for a poor diet, thereby exacerbating poor health conditions (Kind and Golden, 2018). Neighbourhood conditions shape health through physical and social characteristics and inform access to essential services and opportunities for healthy living. Konkor and Kuuire (2023) investigated the impact of residential neighbourhoods on non-communicable diseases in Ghanaian cities and concluded that residential neighbourhoods correlated with chronic health outcomes. Equally, health geographers have delved into emerging fields such as “social epigenetics”– how the human–environment interactions shape health trajectories (Mansfield and Guthman, 2015; Shantz and Elliott, 2021). For example, Shantz and Elliott (2021) demonstrated how social environment through gene expression at the molecular level shape health outcomes and translates into long-term health inequalities. Consequently, social determinants of health vary among populations due to social gradient (income, education, housing, health services) (Braveman et al., 2011). To further understand the underlying drivers of social determinants of health, health geographers have scaled up to investigate the role of upstream structural determinants of health, such as cultural norms, policies, institutions and practices (Bambra et al., 2023). Structural drivers of health inequalities are often rooted in the historical, cultural, social, economic and political structures and influence the distribution of scarce resources outside the control of the individuals they affect. These factors interact simultaneously at different geographical scales to influence the uneven distribution of essential services such as education, employment and healthcare to the disadvantage of socially marginalized groups (Bambra et al., 2019).

As theoretical innovations evolve and spark debates within the sub-discipline, health geographers continue to make giant strides in their quest for theoretically informed global health research (Andrews et al., 2014; Elliott, 2022). The interdisciplinary lens of health geography positions the sub-discipline to develop, borrow and reshape theories for specific applications in global health research (Kearns and Moon, 2002). Health geographers have drawn from diverse theoretical perspectives, including social constructivism, humanism, political economy, social and relational theories and political ecology frameworks. There is a growing consensus that the political ecology theoretical framework was perhaps the first theoretical entry into the sub-discipline (Kalipeni and Feder, 1999; King, 2010). The political ecology approach provides a robust platform for understanding complex phenomena within the interface of the human–environment nexus, addressing the mutual and reinforcing relationship between context, scale, human agency and structure (King and Crews, 2013). Mayer (1996) merged political ecology with human health to form the political ecology of health theoritical framework, which has been utilized extensively by health geographers to examine the relationship between economy, environment and health (King, 2010). Leveraging on the strengths of the political ecology of health framework, Richmond et al. (2005) investigated the impact of large-scale political, social and economic processes on the health of marginalized communities in British Columbia. Recently, Nunbogu and Elliott (2021) merged the feminist political ecology and the political ecology of health to form an integrated perspective of the feminist political ecology of health framework. This expanded framework provided a broader lens for understanding the link between place, gender and population health (Nunbogu and Elliott, 2021). Contemporary theoretical developments within the sub-discipline have led to increased calls for non-representational theory – a theoretical position that argues that much of what happens in the real world remains unrepresented in social constructivist research (Andrews et al., 2014; Cadman, 2009). Non-representational theory provides a broader perspective for incorporating a wide range of ideas, concepts, theories and approaches within and beyond geography to establish praxis (Andrews et al., 2014).

Health geographers have further contributed to methodological plurality relevant to global health research in diverse ways, including the adoption of innovative qualitative approaches (ethnographic work, photovoice, autobiographical analysis, narrative analysis and oral histories), quantitative methods (spatial analysis, multilevel modelling, cluster analysis and GIS) and mixed methodological approach (quantitative and qualitative methods). They have applied these methods to examine geographies of disease, health and healthcare(Vine et al., 2023). Quantitative techniques such as multilevel modelling and spatial analysis have been used to study the geographies of disease and utilization of healthcare services at various geographic scales. For instance, GIS has been used for mapping, monitoring and modelling infectious and chronic diseases, disease surveillance and outbreak detection, and targeting interventions for health promotion (Dummer, 2008). GIS has also been used to visualize health outcome disparities on maps (Kim et al., 2022; Luginaah, 2009). Again, photovoice techniques are being used to elicit relevant and culturally sensitive health information, as well as autobiographical analysis for assessing “storied knowledge” in life course analysis, which provide fertile grounds for health geographers to unravel complex and hidden lifestyle and behavioural patterns in culturally sensitive places (Bisung and Elliott, 2017; Hay and Cope, 2021; Kim et al., 2022). Other qualitative approaches (sharing circles, structured interviews, focus group discussions) have been used by health geographers to understand the lived experiences and the socio-ecological factors driving health inequalities (Kangmennaang and Elliott, 2018; Rishworth and Elliott, 2022a). Health geographers have adopted a mixed methodologies to explore the relationship between the physical environment and health. Qualitative methods provide the basis and context for more in-depth qualitative inquiry. Indigenous health geographers have increasingly advocated for a more holistic approach to research through the “two-eyed seeing” methodology. The two-eyed seeing approach aims to foster equity in global health research by embracing the complementarity of indigenous methodologies and Western approaches towards advancing the health and well-being of indigenous communities (Wright et al., 2019). Indeed, the methodological diversity and transition from positivist approaches to more nuanced and pragmatic means of inquiry is one of sophistication that allows for an in-depth interrogation of the complex and multifaceted contemporary global health challenges.

Indeed, health geographers are instrumental in bridging the knowledge-action gap in the areas of Evidence-Based Research (EBR), integrated Knowledge Translation (IKT) and Deliberative Dialogues (DD) to the advancement of global health research (Andrews et al., 2012; Elliott, 2022; Plamondon and Bisung, 2019). The Canadian Institute of Health Research (CIHR) (2016) define Knowledge Translation as ‘a dynamic and iterative process active process that includes synthesis, dissemination, exchange and ethically-sound implementation of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system’. Luginaah (2009) has long long-challenged health geographers to highlight the implications of their research on health policy and practice and the need for evidence-based research. Health geographers have increasingly recognized evidence-based research and iKT approaches as scientific methods helping to translate knowledge into practice and effecting change in communities (Andrews et al., 2012). IKT adopts innovative approaches to close the gap between knowledge and practice by adopting appropriate channels to disseminate research findings to solve real-life problems (Andrews et al., 2012). For example, Cardwell et al. (2020) adopted the use of Hackathons as a means of translating knowledge among women with Lupus nephritis in Canada. As contained in the Canadian Coalition of Global Health Research (CCGHR) Principles for Global Health Research, Canadian Federation Funding Agencies now require researchers to include in their proposals a roadmap for knowledge translation (CIHR, 2016; Plamondon and Bisung, 2019). To further foster health equity, health geographers have increasingly emphasized the central role of deliberative dialogues – the need to recognize knowledge users as equal partners in knowledge production and engage them throughout the research process (Elliott, 2022; Plamondon and Bisung, 2019). While the impact of health geography is evident in global health research, recent years have witnessed the visibility of health geographers in mainstream global health practice, working alongside policymakers and providing expert advice on policy direction (Crooks et al., 2018). Health geographical scholarship has shaped global health policies in ways that transcend beyond the geographic spaces they occupy (Andrews et al., 2012). Consequently, Rishworth and Elliott (2022a) underscored the need for health geographers to engage broadly with integrated knowledge translation (IKT) approaches in finding solutions to the determinants of health inequalities, particularly as they relate to older adults in lower and middle-income countries.

Recommendations and future research directions

Global health issues are complex and integrative; thus, they require a multidisciplinary approach among global health researchers to develop informed research, policies and programmes that translate into innovative and sustained solutions. However, despite the vital contributions of the sub-discipline to global health research, health geographers have been criticized for excessively focusing their research on the developed world to the disadvantage of the underrepresented Global South. One important question remains: how can health geographers respond to the call for decolonizing global health? Despite significant challenges, health geographers in the Global South must scale up, break institutional barriers and build partnerships with their peers in the Global North on pillars that rest on mutual, reciprocal and equitable collaborations. Leveraging diverse geographic perspectives and expanding research into new territorial domains could produce robust evidence necessary for a global health geography agenda. Although the COVID-19 pandemic exposed widespread inequalities in global health systems and led to the adoption of GIS and drone technologies in delivering essential medical services, it also presents another opportunity for health geographers to collaborate with other researchers across other disciplines leveraging geospatial technologies at different scales to address the complex and myriad contemporary global health challenges. Health geographers are well placed to explore deeper into emerging fields such as mental health geographies, pandemic geographies, emerging NCDs, social prescribing, telehealth, migration, one health, drone surveillance and delivery services, artificial intelligence, and remote monitoring and intervention technologies to advance population health intervention research. Within the purview of health geographers, the long-standing argument that health and place are recursively entwined lies a huge potential for health geographers to mitigate geographic disparities in healthcare accessibility and utilization. Health geographers can further harness their theoretical and methodological expertise by highlighting location-specific challenges and making place-based policy recommendations influencing the development of interventions and improving health outcomes in communities. By the unique positionality of health geographers, they wield the power to take up the leadership role and advance the science of climate action research by engaging in transdisciplinary inquiry across multiple scales to address the current and impending health threats of global environmental change.

Conclusion

The scope and breadth of health geography are dynamic and evolving, incorporating diverse methods, ideas and concepts that address contemporary global health challenges. Indeed, the theoretical and methodological innovation and diversity inherent in health geography have been acknowledged as the greatest strength of the sub-discipline. As we inch towards the achievement of SDG 3, which emphasizes health and well-being for all, we reflect on the contributions of health geographers to the Alma-Mata call for “closing the gap in a generation” by the WHO Commission on Social Determinants of Health. Notwithstanding significant gains in promoting global health equity, disparities are still visible and, in many cases, are widening. To address this gap, a holistic view, backed by a synergistic approach among health geographers, policymakers, civil society and other global health researchers across the global divide, is strongly advocated. Health geographical research is evident in the face of emerging global health challenges such as a rapidly ageing population, increasing demand for health services, transnational movements, widening health inequalities, the prevalence of NCDs, emerging and re-emerging infectious diseases, limited health resources and the use of new technologies in health care delivery. Health geographers are well positioned to leverage their theoretical and methodological resourcefulness and proffer solutions to effect change.

Footnotes

Acknowledgements

The perspective piece was inspired by Susan J. Elliott. I am thankful to Konkor Irenius and the three anonymous reviewers for their instructive comments and reviews. Their thoughtful suggestions shaped the manuscript and gave it a clear sense of direction. I am grateful to the editors, Noel Castree and Agnieszka Leszczynski, for their patience throughout the review process.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Cornelius Dassah

Cornelius Dassah is a graduate student at the Department of Geography and Environmental Management, University of Waterloo. Cornelius holds a master’s degree in Development Policy and Planning and a bachelor’s degree in Geography and Rural Development from the Kwame Nkrumah University of Science and Technology, Ghana. His research interests fall under the broader ambit of environment and population health.

References

Amoak

Luginaah

McBean

(2022) Climate change, food security, and health: Harnessing agroecology to build climate-resilient communities. Sustainability 14(21): 13954.

Andrews

Duff

(2022) Opening out ageing: On the entropy of all things. Transactions of the Institute of British Geographers 47(3): 666–681.

Andrews

Evans

(2008) Understanding the reproduction of health care: Towards geographies in health care work. Progress in Human Geography 32(6): 759–780.

Andrews

Chen

Myers

(2014) The ‘taking place’ of health and wellbeing: Towards non-representational theory. Social Science & Medicine 108: 210–222.

Andrews

Evans

Dunn

, et al. (2012) Arguments in health geography: On sub-disciplinary progress, observation, translation. Geography Compass 6(6): 351–383.

Atuoye

Dixon

Rishworth

, et al. (2015) Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana. BMC Health Services Research 15: 1–10.

Bambra

Munford

Khavandi

, et al. (2023) Northern Exposure: COVID-19 and Regional Inequalities in Health and Wealth. Bristol: Policy Press, pp.157.

Bambra

Smith

Pearce

(2019) Scaling up: The politics of health and place. Social Science & Medicine 232: 36–42.

Bell

Bryman

Kleinknecht

(2023) Social Research Methods. Oxford: Oxford University Press.

10.

Bell

Foley

Houghton

, et al. (2018) From therapeutic landscapes to healthy spaces, places and practices: A scoping review. Social Science & Medicine 196: 123–130.

11.

Bisung

Elliott

(2017) Psychosocial impacts of the lack of access to water and sanitation in low-and middle-income countries: A scoping review. Journal of Water and Health 15(1): 17–30.

12.

Bosa

Kamara

Aragaw

, et al. (2024) The west Africa Ebola virus disease outbreak: 10 years on. The Lancet Global Health 12(7): e1081–e1083.

13.

Braimah

Bisung

Kuuire

(2023) Health geography in Sub-Saharan Africa. In: Braimah

Bisung

Kuuire

(eds) Health Geography in Sub-Saharan Africa: Development-health Nexus. Cham: Springer, pp.1–10.

14.

Braveman

Egerter

Williams

(2011) The social determinants of health: Coming of age. Annual Review of Public Health 32: 381–398.

15.

Brown

TIM

Moon

(2012) Geography and global health. The Geographical Journal 178(1): 13–17.

16.

Bryman

(2016) Social Research Methods. Oxford: Oxford University Press.

17.

Cadman

(2009) Nonrepresentational Theory/Nonrepresentational Geographies. In: Kitchen

Thrift

(eds) International Encyclopedia of Human Geography, 1st edn. Oxford: Elsevier, pp.456–463.

18.

Canadian Institute of Health Research (CIHR) (2016) Knowledge translation. Available at: https://cihr-irsc.gc.ca/e/29529.html (accessed 15 November 2024).

19.

Cardwell

Elliott

(2019) Understanding an environmental health risk: Investigating asthma risk perception in Ontario youth sport. International Journal of Environmental Research and Public Health 16(11): 2033.

20.

Cardwell

Bisung

Clarke

, et al. (2020) Original qualitative research systemic lupus erythematosus (SLE): Outcomes of the Waterlupus hackathon. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice 40(7–8): 235.

21.

Charter

(1986) Ottawa charter for health promotion. Available at: www.who.int/publications/i/item/ottawa-charter-for-health-promotion (accessed 25 June 2025).

22.

Chen

Lucero-Prisno

, et al. (2020) What is global health? Key concepts and clarification of misperceptions. Global Health Research and Policy 5(1): 1–8.

23.

Crane

(2013) Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science. Ithaca, NY: Cornell University Press.

24.

Crooks

Andrews

Pearce

, et al. (2018) Introducing the Routledge handbook of health geography. In: Crooks

Andrews

Pearce

(eds) Routledge Handbook of Health Geography. London: Routledge, pp.1–8.

25.

Curtis

Oven

(2012) Geographies of health and climate change. Progress in Human Geography 36(5): 654–666.

26.

Davies

Kelly

(2014) Healthy Cities: Research and Practice. London: Routledge.

27.

Dedios

Anderson

(2014) Treating the sick continent, top of the heap with Warwick Anderson. Available at: http://somatosphere.net/2014/10/treating-the-sickcontinent-top-of-the-heap-with-warwick-anderson.html (accessed 29 June 2025).

28.

Dodds

Smith

Taylor

(1997) Classics in human geography revisited Progress. Human Geography 21: 555–562.

29.

Domapielle

Dassah

Dordaa

, et al. (2023) Barriers to health care access and utilization among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP): The perspective of users and service providers in north-western Ghana. Primary Health Care Research & Development 24: e48.

30.

Dorn

Laws

(1994) Social theory, body politics, and medical geography: Extending Kearns’s invitation. The Professional Geographer 46(1): 106–110.

31.

Dummer

(2008) Public health: Health geography: Supporting public health policy and planning. CMAJ: Canadian Medical Association Journal 178(9): 1177–1180.

32.

Elliott

(2018) Fifty years of medical health geography (ies) of health and wellbeing. Social Science & Medicine 196: 206–208.

33.

Elliott

(2022) Changing geographies of aging on a global scale: The knowledge to action gap. The Canadian Geographer/le Géographe Canadien 66(1): 60–64.

34.

Epp

(1986) Achieving Health for All: A Framework for Health Promotion. Ottawa, ON, Canada: Health and Welfare Canada.

35.

Eyles

Litva

(1996) Theory calming you can only get there from here. Health & Place 2(1): 41–43.

36.

Farrow

von Kaufmann

Aguilar Perez

, et al. (2022) Why population health approaches remain so critical for public health. Perspectives in Public Health 142(5): 244–245.

37.

Fidler

(2010) The challenges of global health governance. Council on Foreign Relations, May. Available at: https://www.cfr.org/report/challenges-global-health-governance

38.

Fox

Powell

(2023) Place, health and dis/advantage: A socio-material analysis. Health 27(2): 226–243.

39.

Frankish

(1996) Health Impact Assessment as a Tool for Population Health Promotion and Public Policy: A Report. University of British Columbia, Institute of Health Promotion Research.

40.

Gatrell

Elliott

(2015) Explaining Geographies of Health. In: Gatrell

Elliott

(eds) Geographies of Health: An Introduction, 3rd edn. Sussex: John Wiley & Sons, pp.25–49.

41.

George

David

Nabiryo

, et al. (2023) Addressing neglected tropical diseases in Africa: A health equity perspective. Global Health Research and Policy 8(1): 30.

42.

Gesler

(1992) Therapeutic landscapes: medical issues in light of the new cultural geography. Social Science & Medicine 34(7): 735–746.

43.

Giddens

(1984) The Constitution of Society. Berkeley: University of California Press.

44.

Gillespie

Cosgrave

Malatzky

, et al. (2022) Sense of place, place attachment, and belonging-in-place in empirical research: A scoping review for rural health workforce research. Health & Place 74: 102756.

45.

Harman

(2012) Global Health Governance. London: Routledge.

46.

Hay

Cope

(2021) Qualitative Research Methods in Human Geography. Oxford: Oxford University Press.

47.

Herrick

(2016) Global health, geographical contingency, and contingent geographies. Annals of the American Association of Geographers 106(3): 672–687.

48.

Herrick

Reubi

(Eds) (2017) Global Health and Geographical Imaginaries. London: Routledge.

49.

Jones

III Leitner

Marston

, et al. (2017) Neil Smith’s scale. Antipode 49: 138–152.

50.

Kalipeni

Feder

(1999) A political ecology perspective on environmental change in Malawi with the Blantyre Fuelwood Project Area as a case study. Politics and the Life Sciences 18(1): 37–54.

51.

Kangmennaang

Elliott

(2018) Towards an integrated framework for understanding the links between inequalities and well-being of places in low and middle-income countries. Social Science & Medicine 213: 45–53.

52.

Kangmennaang

Kuyateh

Luginaah

(2023) Participation in Social Activities After Ebola Virus Disease Outbreak in Sierra Leone: Does Where You Live Matter? Health Geography in Sub-Saharan Africa: Development-health Nexus 12: 161–175.

53.

Kansanga

Sano

Bayor

, et al. (2022) Determinants of food insecurity among elderly people: findings from the Canadian Community Health Survey. Ageing & Society 42(9): 2067–2081.

54.

Kearns

(1994) To reform is not to discard: a reply to Paul. Professional Geographer 46(4): 505–507.

55.

Kearns

Moon

(2002) From medical to health geography: novelty, place and theory after a decade of change. Progress in Human Geography 26(5): 605–625.

56.

Kearns

(1993) Place and health: towards a reformed medical geography. The Professional Geographer 45(2): 139–147.

57.

Kim

Lee

, et al. (2022) A scoping review of qualitative geographic information systems in studies addressing health issues. Social Science & Medicine 314: 115472.

58.

Kind

Golden

(2018) Social determinants of health: Fundamental drivers of health inequity. Wisconsin Medical Journal 117(5): 231–232.

59.

King

(2010) Political ecologies of health. Progress in Human Geography 34(1): 38–55.

60.

King

Crews

(2013) 15 Challenges and opportunities for future ecologies and politics of health. Ecologies and Politics of Health 41: 280.

61.

Konkor

(2019) HIV vulnerabilities among heterosexual African, Caribbean and Other Black Men in London. Available at: https://ir.lib.uwo.ca/etd/6243/

62.

Konkor

Kuuire

(2023) The impact of residential and non-residential environments on non-communicable disease in Ghanaian cities: The role of gender. Cities 143: 104568.

63.

Konkor

Kuuire

Bisung

(2023) Understanding perceptions of neighborhood health and non-communicable disease risk in urban contexts in Ghana. Social Science & Medicine 317: 115574.

64.

Koplan

Bond

Merson

, et al. (2009) Towards a common definition of global health. The Lancet 373(9679): 1993–1995.

65.

Kpienbaareh

Atuoye

Ngabonzima

, et al. (2019) Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs? Social Science & Medicine 226: 164–175.

66.

Kuuire

Dassah

(2020) Place and health. New York: Elsevier.

67.

Luginaah

(2009) Health geography in Canada: where are we headed? The Canadian Geographer/le Géographe Canadien 53(1): 91–99.

68.

Mansfield

Guthman

(2015) Epigenetic life: Biological plasticity, abnormality, and new configurations of race and reproduction. Cultural Geographies 22(1): 3–20.

69.

Marmot

Wilkinson

(Eds) (2005) Social Determinants of Health. Oxford: Oxford University Press.

70.

Marston

Jones

Woodward

(2017) Human geography without scale. In: Philo

(ed.) Theory and Methods. London: Routledge, pp.337–354.

71.

Mayer

(1996) The political ecology of disease is one new focus for medical geography. Progress in Human Geography 20(4): 441–456.

72.

Merson

(2014) University engagement in global health. New England Journal of Medicine 370(18): 1676–1678.

73.

Namanya

Berrang-Ford

Harper

, et al. (2021) Geography, climate change and health adaptation planning in Uganda. In: Makanga

(ed.) Practicing Health Geography: The African Context. Cham: Springer, pp.175–190.

74.

Nunbogu

Elliott

(2021) Towards an integrated theoretical framework for understanding water insecurity and gender-based violence in low-and middle-income countries (LMICs). Health & Place 71: 102651.

75.

Nunbogu

Elliott

(2022) Characterizing gender-based violence in the context of water, sanitation, and hygiene: A scoping review of evidence in low-and middle-income countries. Water Security 15: 100113.

76.

Ojiako

Weekes-Richemond

Dubula-Majola

, et al. (2023) Who is a global health expert? PLOS Global Public Health 3(8): e0002269.

77.

Painter

Borba

Hynes

, et al. (2008) The use of theory in health behavior research from 2000 to 2005: a systematic review. Annals of Behavioral Medicine 35(3): 358–362.

78.

Plamondon

Bisung

(2019) The CCGHR principles for global health research: Centering equity in research, knowledge translation, and practice. Social Science & Medicine 239: 112530.

79.

Relph

(1976) Place and Placelessness, Vol. 67. London: Pion, p.45.

80.

Richmond

Elliott

Matthews

, et al. (2005) The political ecology of health: perceptions of environment, economy, health and well-being among ‘Namgis FirstNation. Health & Place 11(4): 349–365.

81.

Rishworth

Elliott

(2022a) Global discourses and local disconnects: Gender, aging, health, and well-being in Uganda. Annals of the American Association of Geographers 112(6): 1519–1536.

82.

Rishworth

Elliott

(2022b) Multidimensional disparities, resisting inequities: A political ecology of aging in Uganda. Geoforum 135: 25–36.

83.

Rishworth

Dixon

Luginaah

, et al. (2016) ‘I was on the way to the hospital but delivered in the bush’: Maternal health in Ghana’s Upper West Region in the context of a traditional birth attendants’ ban. Social Science & Medicine 148: 8–17.

84.

Riva

Mah

(2018) Practicing health geography in public health: A focus on population-health-intervention research. In: Crooks

Andrews

Pearce

(eds) Routledge Handbook of Health Geography. London: Routledge, pp.354–360.

85.

Shantz

Elliott

(2021) From social determinants to social epigenetics: Health geographies of chronic disease. Health & Place 69: 102561.

86.

Siiba

Kangmennaang

Baatiema

, et al. (2024) The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review. PLoS One 19(2): e0297393.

87.

Taylor

(1982) A materialist framework for political geography. Transactions of the Institute of British Geographers NS 7(1): 15–34.

88.

Tuan

(1977) Space and Place: The Perspective of Experience. Minneapolis, MN: University of Minnesota Press.

89.

Tulchinsky

Varavikova

(2014) Expanding the concept of public health. The New Public Health 10: 43–90.

90.

Turner

Kalamatianou

Drewnowski

, et al. (2020) Food environment research in low-and middle-income countries: A systematic scoping review. Advances in Nutrition 11(2): 387–397.

91.

Varpio

Paradis

Uijtdehaage

, et al. (2020) The distinctions between theory, theoretical framework, and conceptual framework. Academic Medicine 95(7): 989–994.

92.

Vine

Mulligan

Harris

, et al. (2023) The impact of health geography on public health research, policy, and practice in Canada. International Journal of Environmental Research and Public Health 20(18): 6735.

93.

Wiles

(2017) Health geographies of ageing. In: Feng

Phillips

(eds) Geographical Gerontology. London: Routledge, pp.31–42.

94.

Wiles

Allen

(2016) Embodied ageing in place: What does it mean to grow old? In: Hall

Chouinard

(eds) Towards Enabling Geographies: ‘Disabled’ Bodies and Minds in Society and Space. London: Routledge, pp.217–235.

95.

World Health Organization (WHO) (1984) Health Promotion: A Discussion Document on the Concept and Principles: Summary Report of the Working Group on Concept and Principles of Health Promotion, Copenhagen, 9-13 July 1984 (No. ICP/HSR 602 (m01)). Copenhagen: WHO Regional Office for Europe.

96.

Wright

Gabel

Ballantyne

, et al. (2019) Using two-eyed seeing in research with indigenous people: An integrative review. International Journal of Qualitative Methods 18: 1609406919869695.

97.

Wyness

(2015) Conceptualizing Agency. In: Wyness

(ed.) Childhood. Bristol: Policy Press, pp.7–33.

Towards global health equity: The contributions of health geography to global health research,policy and practice

Abstract

Keywords

Introduction

The nexus between health geography and global health research

Contributions of health geography to global health research, policy and practice

Recommendations and future research directions

Conclusion

Footnotes

Acknowledgements

Declaration of conflicting interests

Funding

ORCID iD

References