The Geography of Malaria Control in the Democratic Republic of Congo

Janko, Mark; & Emch, Michael E. (2017). The Geography of Malaria Control in the Democratic Republic of Congo. In Harrington, Daniel W., McLafferty, Sara, Elliott, Susan J. & Elliott, Susan J. (Eds.), Population Health Intervention Research: Geographical Perspectives (pp. 91-104). London: Routledge.

Janko, Mark; & Emch, Michael E. (2017). The Geography of Malaria Control in the Democratic Republic of Congo. In Harrington, Daniel W., McLafferty, Sara, Elliott, Susan J. & Elliott, Susan J. (Eds.), Population Health Intervention Research: Geographical Perspectives (pp. 91-104). London: Routledge.

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Melinda Meade opened her seminal work “Medical Geography as Human Ecology” by noting that “health professionals frequently wonder how medical geography differs from epidemiology, or what geographers do that health planners do not. These are not idle questions,” she wrote, “for in fact most models in medical geography have come from epidemiology or from health planners” (Meade, 1977: 379). In that paper, Meade then went on to develop her “Triangle of Human Ecology,” which posits that an individual’s health status is a result of interactions among his/her biological characteristics, behaviors, and environment. Since that time, modern medical geography has evolved into a field with its own identity, as well as one that continues to maintain a close relationship with epidemiology and other health science disciplines. This chapter is motivated by the belief that geographers have a fundamental and unique role in public health research, and intervention research in particular. Specifically, we believe that geographers’ main contribution to public health intervention research is through studies designed to understand how the effect of an intervention might vary across space. Methodologically, geographers’ contribution is motivated by fundamentally different inferential goals than those of epidemiologists. Indeed, while epidemiology traditionally focuses on attempting to estimate a mean effect, such as an average treatment effect, medical geographers have, since Meade’s writings, been encouraged to take a step back and ask whether or not such a summary measure is a reasonable one. If, for example, different habitats have varying degrees of support for a mosquito vector, why should we expect an intervention such as a bednet to have the same effect everywhere, or that the average effect would even be experienced by the majority of individuals in the majority of places? Additionally, different people have different biological characteristics as a result of living in different places, and these characteristics can act to promote or prevent disease. Furthermore, different people in different places have different behaviors, and as Meade noted, “[b]ehavior, the observable aspect of culture, usually has spatial expression” (Meade, 1977: 382). Thus, where most public health intervention research is interested in estimating an average of some sort, medical geographers’ chief inferential goal should be to understand how an effect varies from place to place and what contributes to it.




CHAP

Population Health Intervention Research: Geographical Perspectives

Geographies of Health

Janko, Mark
Emch, Michael E.

Harrington, Daniel W.
McLafferty, Sara
Elliott, Susan J.
Elliott, Susan J.

Williams, Allison

2017





91-104




Routledge

London





9790

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