Health & Place 8 (2002) 223–225

Editorial

Southern African perspectives on the geography of health

Introduction

The distinguishing feature of this special issue is its

emphasis on southern Africa. The academic community

has to date not had a comprehensive collection of papers

on the topic of southern African geography of health.

For example, a keyword search of Health and Place on

countries in southern Africa1 found three articles:

Gilbert (1998), Kalla (1995) and Phoolchund (1995).

Overall, contributions on and from Africa and in

particular, southern Africa, have not been prominent

in the journal.

Although the collection of papers are location specific,

the issues and arguments raised have global application.

The aim of this special issue is for research being

undertaken in southern Africa to contribute to global

debates on the geography of health.

The context of this special issue

The special issue presents a selection of research

undertaken in southern Africa which explores the

geography of health. Past research in southern Africa

has been aimed primarily (though not exclusively) at

quantifying and describing the burden of disease. The

health of populations has been cited for enforcing

certain policies such as forced removals and the

destruction of informal settlements. Current research

includes inter-disciplinary studies more interested in

finding practical and policy led ways to overcome health

inequalities (see for example, Genthe and Seager, 1996;

Von Shirnding and Yach, 1992). While drawing on

contributions across disciplines, the promotion of the

discipline of health geography as having a role in

overcoming these inequalities is a key theme of the

collection. Furthermore, by illuminating the inter-

disciplinary nature of the topic, it is hoped that this

special issue will stimulate future interaction between

disciplines both within southern Africa as well as

between southern Africa and other regions.

Dauskardt, writing in 1992, identified three areas in

which geographers can make a contribution to health in

South Africa. These areas highlight a shift away from

medical geography to health geography. First, research

into spatial diffusion of disease and health care facilities.

Second, to explore issues of health planning and policy

such as the relationships that exist between urbanisation

and health. Third, by the inter-disciplinary nature of

geography, geographers are well positioned to explore

existing frameworks of health and health care and

challenge the ability of these frameworks to take into

account social, political and economic factors (Daus-

kardt, 1992). Health geography in southern Africa has

witnessed substantial growth in the last 10 years and this

collection of papers draws on this expanding discipline

and also benefits from contributions from health

ecology, reproductive health, information and commu-

nication technology and development studies. It also

includes authors with backgrounds in both the natural

sciences and social sciences. The recommendations made

by Dauskardt in 1992 have been followed in many

instances. It is hoped that this special issue will not only

continue to promote the importance of a geographic

perspective on health, but will also encourage emerging

researchers to adopt and contribute to the growing

discipline of health geography.

The special issue brings together researchers from a

variety of backgrounds but with a common belief that a

geographical perspective is well placed to address health

inequalities in a way that is relevant to southern Africa.

Key issues within health geography in southern Africa

are presented. There is a particular focus on South

Africa. In South Africa, the move from medical

geography to a geography of health reflects wider

societal transformations. For example, in South Africa,

the relationship between health and housing are similar

to those identified elsewhere. Poor dwelling structure

and unsatisfactory house design leading to indoor air

pollution, overcrowding, inadequate food preparation

facilities and inadequate water and sanitation have been

associated with respiratory diseases, tuberculosis and

gastrointestinal diseases. In South Africa, the health–

housing relationship was dramatically influenced by

apartheid laws related to the formation of racially

1For the purposes of this special issue we have taken

southern Africa to include those countries in the Southern

African Development Community (Angola, Botswana, Demo-

cratic Republic of Congo, Lesotho, Malawi, Mauritius,

Mozambique, Namibia, Seychelles, South Africa, Swaziland,

Tanzania, Zambia and Zimbabwe).

1353-8292/02/$ - see front matter r 2002 Elsevier Science Ltd. All rights reserved.

PII: S 1 3 5 3 - 8 2 9 2 ( 0 2 ) 0 0 0 0 4 - 7

segregated areas and the control of migration. South

Africa provides a clear example of the extent to which

health is influenced by the social–political context.

Addressing inequalities in health requires a recognition

of this context and a holistic approach to health. The

collection of papers responds to the international move

away from medical geography to health geography and

covers main issues currently being debated within the

sub-discipline. The papers provide a readable balance of

case studies, theory and policy implications.

Key themes within the special issue

A number of common themes may be identified from

the papers. First, the need for greater ‘‘joined-up’’

working in co-ordinating health data and information is

identified. Martin et al., in their paper ‘‘The use of a

GIS-based malaria information system for malaria

research and control in South Africa’’ stress the

importance of regional co-ordination of decision sup-

port systems for the control of diseases such as malaria.

As Scott et al in their paper ‘‘Towards the creation of a

health information systems for cancer in KwaZulu-

Natal, South Africa’’ point out, co-ordinating informa-

tion management not only leads to a better under-

standing of disease patterns, but also to the location of

appropriate health care interventions. In most develop-

ing countries, the use of GIS in the mapping for

epidemiological surveillance remains the dream of a few

academics. Where it is used it is largely limited to

descriptive purposes and is not used by policy makers or

practitioners. In southern Africa we see applications in

public health that have long been advocated by agencies

such as WHO (1999).

The papers not only call for greater integration and

co-ordination, but also for more inter-disciplinary and

inter-sectoral working. Thomas et al., in their paper,

‘‘Environmental health challenges in South Africa:

policy lessons from case studies’’, emphasise the

importance of integrated, inter-sectoral working in local

development and planning. Mashamba and Robson, in

their paper ‘‘Youth reproductive health services in

Bulawayo, Zimbabwe’’ describe how participants in

the research suggested such an approachFthat a youth

consultation forum would be helpful for discussing a

range of problems facing young people, rather than

specific, issue based forums, such as reproductive health.

Experience suggests that inter-sectoral thinking and

action is easiest at the community level where profes-

sional, sectoral divisions are not so greatly perceived.

However, considering the above two papers together,

one can see real moves to inter-sectoral analysis at both

grass-roots and institutional levels.

A common backdrop to the paper by Collins, ‘‘Health

ecology and environmental management in Mozambi-

que’’ and to the paper by Mashamba and Robson, is the

impact of structural adjustment on health. This is in

contrast to the other three papers which are based in

South Africa, a country where structural adjustment has

not been adopted. Most research which has attempted to

link structural adjustment with (adverse) health out-

comes have been done in sub-Saharan Africa (see for

example, Hanmer and White, 1999, in Zambia and

Zimbabwe). The methodological challenge of control-

ling for potential confounding factors in cross-sectional

studies remains and only longitudinal studies will be able

to begin to tell the full ‘‘health story’’ of structural

adjustment.

In all the papers, place is a common theme. Authors

draw on a range of backgrounds to explore the

geography of health–epidemiology, health ecology and

health geography. Visualising and mapping data is used

as way of illuminating and analysing health inequalities

in order to find solutions that will feed into policy and

practice. Martin et al., explore the use of GIS at a

microlevel in malaria control while Scott et al., employ a

more macrolevel analysis for the provision of health care

services. Martin et al., demonstrate the benefits of

illustrating within-district differences in malaria inci-

dence for the first time and the implications of this on

strategies for malaria control. Limitations in using

information and communication technologies (ICTs)

are discussed and Martin et al., Scott et al., Thomas

et al., and Collins all refer to the problems of data

shortage in the developing country context. The data

problems reported by Scott et al. illuminate the

challenges faced by users of spatial data and information

in a developing country context. The potential users of

ICTs are not only the researchers, but also the people

from whom the data has been collected. Collins

describes the need for developing appropriate technol-

ogy that is applicable to the contextFsuch as incorpor-

ating participatory evaluation into GIS. There are many

examples of where the technology has been implemented

in a way which has not taken cognisance of the

particular local context (for example, considerations

ranging from whether the necessary skills were available

to the availability of an affordable and reliable

electricity supply). Choices on implementing ICTs need

to consider resource constraints and will include choices

of allocation where resources are scarce. At the same

time however, we should not take a paternalistic

approach. Dunn et al. (1997) outline the possibilities

and challenges for the development of GIS in a

developing country context. They argue that by taking

account of technical issues, data, organisational issues

and training and expertise, it is possible to develop

appropriate GIS.

In South Africa, the use of GIS and ICTs more

generally, have frequently been implemented in such a

way that these decisions have been inclusive and

Editorial / Health & Place 8 (2002) 223–225224

rational. In South Africa, where historically, there has

been greater access to resources for at least some of the

population, researchers need to do more regionally in

terms of capacity building and collaboration with

regional partners to share expertise. The same argument

can be applied to a number of other aspects of health.

This collection enables a view of various issues which

need to be considered in future health planning and

policy in southern Africa. While there is not a paper

explicitly on HIV/AIDS we see a need to take a rounded

view of such issues which are equally applicable to a

number of health problemsFfrom arguably over-

researched malaria to neglected mental health. More-

over, we would like to see a greater engagement among

those conducting research on health in southern Africa

with the (re-)emerging debates on critical geographies.

In a themed issue of the Royal Geographical Society

(with the Institute of British Geographers) journal,

Area, Kitchen and Hubbard introduce papers from

authors/activists who, it seems, see that their research ‘‘is

as much about changing the world through their own

actions as it is about studying the world’’ (Kitchen and

Hubbard, 1999, p. 198). Part of this might be to engage

in ‘‘on-the-ground’’ practical politics and to also engage

in research that adopts a partnership approach in which

power is devolved so that the researched become co-

researchers (Kitchen and Hubbard, 1999). We would

welcome a debate among those exploring the geography

of health in southern Africa, as to the extent practical

action needs to be taken by researchers both at a local

and regional level. From documenting health inequal-

ities in health across places, through demonstrating the

practical use of geographical information systems to

policy makers, to monitoring and evaluating the ‘‘holy

grail’’ of inter-sectoral action, geographers of health can

play a vital role in the future development of southern

Africa. It is hoped that this collection of papers

celebrates the progress in the geography of health in

southern Africa over the past 10 years, as well as

stimulating debate and opening up challenges for future

research.

Acknowledgements

The guest editors would like to thank the referees who

reviewed and commented on the papers as well as

colleagues who have encouraged and shaped this project

since its inception in 1998.

References

Dauskardt, R., 1992. Of sickness and health: prospects for

south african medical geography. In: Rogerson, C.,

McCarthy, J. (Eds.), Geography in a Changing South

Africa: Progress and Prospects, Oxford University Press,

Oxford, pp. 201–214.

Dunn, C., Atkins, P., Townsend, J.G., 1997. GIS for

development: a contradiction in terms? Area 29 (2),

151–159.

Genthe, B., Seager, J., 1996. The effect of water supply,

handling and usage on water quality in relation to health

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Gilbert, L., 1998. Community pharmacy in South Africa: a

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Hanmer, L., White, H., 1999. Human development in sub-

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Maria Allison

School of Health and Social Studies,

University of Warwick,

Coventry CV4 7AL, UK

E-mail address: maria.allison@warwick.ac.uk

Trudy Harpham

School of Urban Development and Policy,

South Bank University, 202 Wandsworth Road,

London SW8 2JZ, UK

E-mail address: t.harpham@sbu.ac.uk

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