Placing health inequalities

Where you live can kill you

Authored by: Clare Bambra

Routledge Handbook of Health Geography

Print publication date:  June  2018
Online publication date:  June  2018

Print ISBN: 9781138098046
eBook ISBN: 9781315104584
Adobe ISBN:


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Today, Americans live three years shorter than their counterparts in France or Sweden. Scottish men live more than two years shorter than English men, and there is a 25-year gap in life expectancy across the suburbs of New Orleans (Bambra, 2016). Why are there such inequalities in health across all geographical scales – between neighborhoods, cities, regions, and countries? Health geographers have traditionally explained these health divides in terms of the effects of compositional (Who lives here?) and contextual (What is this place like?) factors. The compositional explanation asserts that the health of a given area, such as a town, region or country, is a result of the characteristics of the people who live there (individual-level demographic, behavioral and socioeconomic factors); whereas the contextual explanation argues that area-level health is also in part determined by the nature of the place itself in terms of its economic, social and physical environment. More recently, it has been acknowledged that these two approaches are not mutually exclusive and that the health of places results from the interaction of people with the wider environment (Cummins et al., 2007). This chapter will therefore also examine the relational approach (which tries to accommodate this interaction) as well as the political economy approach (which reconceptualizes context, looking beyond the local to the influence of national and international political and economic factors) (Bambra, 2016).

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