       According to Oxford dictionaries, human health refers to a state free from illness or injury and can be used to describe a person’s mental or physical condition. Based on this definition, everything a person does is affected by their health and a person’s health is also a directly affected by their actions. When thinking of factors that play a role in human health, people typically think of something along the lines of genetics or availability of healthcare. Genetics can play a great role in the risk of a person to have things such as a heart attack, sickle cell anemia, brain tumors, and more. The availability of healthcare can be affected by things such as wealth. For example, wealthier people typically have access to more medication and vaccines to diseases. While these are very important on the average human's’ health, some would argue that there is one other major factor that the population over looks. This major factor is where a person has lived in their life. The differences in health trends between areas such as New York city and a rural town in Florida are very likely to be a result of that environment and not just the differences in wealth or genetics. Where a person lives affects their health and is just as important as other factors such as wealth and genetics.

       The topic of health geography is not necessarily a new idea. Humans, as a population, have had the idea of locations effect on health for centuries. Case studies as early as John Snow’s map of the 1854 Broad Street cholera outbreak are listed under the topic of health geography (Boyle #). In this study, a cholera epidemic in a community was traced back to the town's central drinking well by John Snow’s use of what would eventually be classified as health geography (Boyle #). This early example spiked interest in people as they began to see the importance of this topic. The study of health geography recently has mainly been using GIS to look at medical trends between areas. Instructor Klinkenberg says “There are three main themes in the geography of health care (or medical geography): disease ecology, health care delivery, and environment and health.  Disease ecology involves the study of infectious diseases (e.g., malaria, HIV/AIDS, infant diarrhea) including the spatial distributions of meteorological, biological and cultural phenomena associated with disease. The study of health care delivery includes spatial patterns of health care provision and patient behavior and includes issues like inequalities in health (health status and accessibility), and de-institutionalization of the mentally ill. Environment and health is environmental hazards researched together with health geography. Topics within this new tradition include environmental risk assessment, as well as the physical and psychosocial health impacts of environmental contamination” (Klinkenberg). Klinkenberg basically breaks the topic into three distinct sections and defines each. The first and third sections, disease ecology and environment and health, are what is being examined in this paper. Klinkenberg second section, health care delivery, is what this paper defines as availability of health care. In this paper, I define availability of health care as another major factor that affects health and not as a subcategory of health geography.

The most obvious examples of locations effect on health come from looking at case studies examining the differences between countries and continents. These cases are easy to visualize because when entire countries suffer from certain diseases more than the rest of the world, it is hard for an intelligent person to argue that it is not connected to location. For example, take a look at the amount of people living in China who have problems related to asthma or eyesight (Borneman). The percent of people in major cities of China that report having these problems are far larger than cities such as New York or London (Borneman). Because all of these are major cities in developed nations, it is safe to say the wealth factor can be disregarded because there is not that much of a difference in wealth here. Also since the rates differ dramatically between cities, I do not believe these problems are strictly genetic. All that is left is the difference in location. Cities in China have higher rates because not only is the environment different there compared to cities such as London or New York, but Cities in China are far more densely populated. Because of this, these cities contain large amounts of smog which in turn can lead to asthma and reduce visibility and affect eyesight (Borneman). Malaria is another disease that is primarily affected by the difference in a country's location. The transfer of malaria is usually facilitated by the movement of mosquitos. Mosquitos thrive in tropical regions that are warm and damp (Borneman). As seen in figure 1 below, the countries that suffer from large malaria problems all contain large tropical regions within the country. This shows that location can directly affect health. As most people know, different countries have different life expectancies. This meaning that where you live is also a good predictor of how long you will live. This is caused by many factors, but life expectancy trends typically correlate with geographic regions. For example, “in 2005, the life expectancy for a male living in the UK was 74.4 years. However, the life expectancy of a male living in Solihull was 78.3” (Gibson). The UK is a developed nation with a generally wealthy population, but the life expectancy was still lower than in Solihull. This helps allude to the fact that there are other very important variables tying into a human’s personal health. 

Next, going deeper into the analysis of the differences between location. The differences between countries appear obvious and are well known, but there are differences between region in the United States as well. I would consider it a fact that the northern regions are colder than southern regions and that regions in the Midwest are more dry than others. I believe most Americans would agree with that, but not all Americans know that these environmental differences can affect your health. One example of a major difference in health trends for a specific region of the United States is the ‘Stroke Belt’. “‘The ‘Stroke Belt’ is a term used to describe an area in the Southeast U.S. Where there is a higher stroke mortality rate. There have been many attempts to explain this phenomenon looking at factors such as race/ethnicity, risk factors, including obesity and the prevalence of chronic diseases, such as diabetes but there has been no consensus on why it affects this one area as significantly” (Gibson). It seems apparent that the problems in the ‘Stroke Belt’ stem from the areas geographic location. I believe that if the problems have been proved to not be tied to any of the above stated factors, then it has to have something to do with the location. Another example deals with a person's exposure to UV light. Laden’s research group has found a number of links between environmental factors and health. For example, the results of one study showed that “greater exposures to UV light correlate with a higher incidence of squamous cell carcinoma. In some regions of the U.S.—for example, the Southwest—people are more exposed to UV light and thus face a higher risk” (Feldscher). This intake of UV light happens on a daily basis, whether it be going for a run in the neighborhood, walking into a store from the parking lot, mowing the lawn, and more. These simple daily task could potentially lead to the development of cancer all because a person lives in an area that receives more exposure to UV light. Also, researchers studying an association between fine particulate levels in the air and mortality rates have found that “in regions of the U.S. where air pollution has decreased over time, there has been an improvement in public health” (Feldscher). Although correlation does not imply causation, it is fair to say that air pollution and mortality rates are proportional. This means that as air pollution increases, mortality will most likely increase as well and vice versa. This is important because there are regions in the United States, such as the metropolitan northeast, that contain a larger amount of air pollution than other regions in America. If a person does not live in a metropolitan area, but lives near a factory or a major road, such as a highway, they could be at risk for similar effects. Living near a major road would put a person at risk of consuming large amounts of pollutants from vehicle exhaust. Living near a factory would put the person at direct exposure to the factories waste that is released into the atmosphere. However, living in the city is not completely negative for women. According to Laden, “women living in densely populated areas get a protective effect against obesity—likely because they walk more and drive less than their suburban counterparts” (Feldscher). Follow up

One first hand example was found in a Ted Talk by Bill Davenhall. Davenhall explained his experience with a major heart attack. Davenhall had no previous problems with his cardiovascular system. He was not a smoker and no one in his family had a heart attack in their life that he knew of. Davenhall says he ate well and was very health, but he still experienced a major heart attack (Davenhall). When his doctor asked him about his family's history with heart trouble and his personal health, Davenhall says his doctor was confused as to what caused his heart attack. So Davenhall did some research himself. What he found was that where he had lived throughout his life was the most likely root of his heart problems. Davenhall noted that he had lived 19 years in Scranton, PA; 25 years in (Rubbertown) Louisville, KY; and 12+ years in Los Angeles, CA. Scranton contains large concentrations of Sulphur dioxide, carbon dioxide, and methane gas. Rubbertown contains large concentrations of chloroprene and benzene. LA contains large concentrations of particulate matter and ozone (Davenhall). All three of these areas have large concentrations of chemicals that contribute to the development of a heart attack. This is significant because it is a firsthand example of an American who had never been advised by a doctor that he lived in the best places to have a massive heart attack. However, according to Davenhall, his doctors did ask him many times about his genetic background, yet he still had a massive heart attack. A link to the Bill Davenhall ted talk is provided below figure 1.

Next, one can look at a specific difference in region types, such as trends between rural and nonrural areas. As discussed earlier, women living in nonrural areas are less likely to suffer from obesity, but that is a small specific example. Continuing with the idea of obesity, a study by researchers from the United Kingdom concludes that “adolescents in rural areas ate fast food more often when fast-food outlets were easily accessible, whereas the opposite was true for adolescents living in urban areas” (Garbutt). This means that the youth living in rural areas are more prone to facing obesity problems than those of non-rural areas because of the higher rate of fast food consumption. There are many other key differences between rural and nonrural areas. For example, a study titled "Spatial Classification of Youth Physical Activity Patterns" shows “that while rural youth get the largest proportion of their physical activity while at school, urban and suburban youth are most active when commuting. Not only does this finding suggest that the walk to school might be just as important to some children's health as is the physical education they receive as part of the school curriculum” (Garbutt). This is saying that non rural youth typically receive more physical activity daily because many more commute to school by walking that rural students. This is partly because most rural youth live too far away from school to walk. However, I do not believe this study took into account the amount of physical activities performed outside of school besides commuting. Both of these studies were a part of geographic information system (GIS) based research to determine how location affects physical health. 

While many people agree with the idea of location having an effect on your health, some will still argue that it is not as important compared to genetics, availability of health care, and wealth (Determinates of Health). Considering genetics, Bill Davenhall’s Ted Talk is a prime example that shows certain health risk that are usually associated with genetics can actually be caused by something else. Davenhall had a nearly clean slate concerning his cardiovascular genetics, but where he spent the majority of his life caused major problems for him (Davenhall). Alaska’s chief medical officer even says “In many ways, your zip code is more important than your genetic code when it comes to health” (Ollove). In John Snow’s case study with the cholera outbreak, almost every possibility known at the time had been examined by professionals. The doctors near the town examined all the patients background, all the patients had similar health care availability, and all were of similar wealth. Luckily Snow was clever enough to examine features regarding the physical location of the patients who contracted cholera. The importance of locations effect on health is also evident in the University of Wisconsin Population Health Institute’s health rankings of counties in every state. Another example is the collaboration between the University of Southern California and PolicyLink, a nonprofit focused on issues of equity, that compares the health of 150 metropolitan areas using several indicators, including rates of asthma, diabetes, and obesity (Ollove). Follow up

As many people agree, human health is extremely important when it comes to daily lifestyle. Most people are concerned with their health and how they can improve it over time. There is plenty of evidence mentioned throughout this paper to support this argument. This is most evident when looking at health trends between different countries, health trends between different regions of the United States, and health trends between rural and nonrural areas. However, not everyone knows that their geographic location plays a major role in their personal health. Where a person lives is just as important as their genetics, wealth, and availability of health care. Because of this, it is extraordinarily important that the awareness of this factor is raised to the general public. If more people knew about the degree to which where they live affected their health, they would be able to better plan life choices like which towns to buy a house in or where to raise their children.
