William Tsang Geog 280 AE

Medical Geography in the context of Political Ecology

In Mayers article, The political ecology of disease as a new focus for medical geography within the journal Progress In Human Geography published in 1996, the definition and approach of political ecology in public health issues are explored in great depth. He defines political ecology as an integration of two theories, political economy and cultural economy, in the context of human health. Mayer argues that the controversy in approaching the political ecology of disease lies within its lack of an encompassing framework that should include, but is not limited to, humanenvironmental, political, social and economic perspectives. Throughout the article, he emphasizes that to understand health and disease as a complete entity on all scales, one must apply all the complexities of human nature in their interactions with themselves and the physical world. Thus, one thesis that is apparent in Mayers article is that the addition of political ecology as a new focus for medical geography will provide a more integrative and systemic understanding of health and disease (Mayer 1996). While some researches on this approach are cited in Mayers article, he criticizes that the two parts of political ecology, cultural ecology and political economy, were often not integrated in a way that provided a lucid analysis of political ecology as a whole or when in an attempt to do so, fail to recognize the implications of disease and human mortality. The elementary concepts of space, scale and context as perspectives in medical geography are important to understand when explaining public health

issues of any kind. The accessibility of health care and resources, population density, global to local to biological scales, cultural practices, and political systems, are all factors one should consider when analyzing the complexity of the geographic perspective. Mayers article reminds us that while medical geography is a complex and multi-faceted topic, the effective application of it in addressing the prevalence of disease and other health issues requires one to think integratively of all the perspectives. The political ecology perspective is one more valuable approach in which an epidemiologist, doctor or even a student can critically analyze public health and disease. Mayers analysis of political ecology on a global and local scale parallels with the themes in Tracy Kidders Mountains Beyond Mountains, an astonishing book that explores global health issues in places like Haiti and Peru through the eyes of Dr. Paul Farmer. In the second part of the book, Paul Farmers visits Peru to help Jim Kim, a close friend and fellow doctor at Partners In Health, an organization aimed at providing developing countries with low-cost medical care and resources, and his project in a small town called Carabayllo to provide medicine and care for the impoverished during Perus civil war. The two discover an unusually high prevalence of multi-drug resistant tuberculosis among the towns TB-infected patients, despite the implementing of WHOs highly successful and inexpensive DOTS (Directly observed treatment short-course chemotherapy) program which Paul describes as the most significant advance in TB control since the advent of antibiotics (p.138). While TB rarely acquires resistance to more than one drug at a time, Paul Farmer suggested that through improper and repeated therapy of first-

line antibiotics, patients can develop strains resistant to four or five TB drugs, otherwise known as amplification. The political ecology described in Mayers article as well as social, environmental, and economic factors resonate with Paul Farmer and Jim Kims investigation of the potentially dangerous faults of a seemingly seamless international TB treatment program. In the poor urban slums of Carabayllo, the prevalence of infectious disease like tuberculosis is undoubtedly high because of poor sanitation, crowded living space, and poor funding for medical resourcesall major factors of societal, environmental and economic influences. However, even with official policies given by the WHO and authorities overseeing Perus DOTS program, the ever increasing accounts of patients contracting MDR-TB through amplification are shrouded by successful accounts of normal TB being treated, which poses a serious health risk on a global scale. In the context with political ecology, the interactions of politics especially that of power, authority and wealth with the social and economic patterns of resource use in the case of MDR-TB in Carabayllo results in a controversial global health issue. Leaders and authorities that worked hard in convincing the government to fund DOTS feared a refunding and re-standardizing of a program they can already barely afford. In addition, the second-line TB drugs used in the case of severe MDR-TB were not up for debate as they were extremely expensive and hard to obtain. In light of this serious health issue, Jim Kim succeeded in lowering the cost of second-line TB drugs by an astounding 97% percent (from $21 a vial to 98 cents) through advocating for generic manufacturers and an

international drug distribution control committee in the production and distribution of the drugs. This remarkable feat encouraged me to look deeper into the encompassing framework of medical geography and within it, the perspective of political ecology. While Mayer addresses that large-scale social and economic changes, trends and structures are realized at the local scale, he does not mention that local scale, in turn, can be realized at an individual scale. As Jim Kim states in Tracy Kidders book, Never underestimate the ability of a small group of committee individuals to change the world. Indeed, they are the only ones who ever have (p.164). In the context of this quote, I believe that the root of political ecology, in addition to all other approaches to medical geography as explained in Mayers article, ultimately lies within human-to-human interaction. While this concept could be seen as a subset of the social aspect of geography, its important to note it can be also the underlying catalyst of all geographical perspectives. The question I leave in response to Mayers article and Mountains Beyond Mountains is a two-part one. How much of a role do humans physically play in respect to each other as opposed to man-made theories like political ecology when approaching medical geography? And knowing this, how can we further integrate this into medical geography to understand complex issues like multi-drug resistant tuberculosis prevalence in Peru? Mayer concludes in a way that both mystifies and elucidates the future of human geography in the context of health. The challengeis there. It is time to integrate and synthesize further (Mayer 1996).