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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2008.11.022 Byline: Mark W. Skinner (a), Nicole M. Yantzi (b), Mark W. Rosenberg (c) Abstract: This paper contributes to the literature on the geographies of care and caregiving by examining the implications of weather for providing home and community care for children and older adults. Integrating research from two previous qualitative studies of formal and informal care provisioning in Ontario, Canada, the authors re-analyzed semi-structured interviews with 83 directors, managers, paid staff, volunteers and family members to examine the challenges they faced when providing care during the winter season. Similar to other settings where winter conditions like snow, ice and cold temperatures are commonplace, the studies were set within a health policy context in which there is not enough recognition of the difficulties of weather for coordinating, managing and providing care to disabled, injured, chronically ill and frail individuals. The re-analysis focused on how winter conditions translate into geographical, administrative, economic, operational, physical, social and psychological barriers within and across different 'scales of care'. The findings indicate that the problems posed by weather are crucial yet often underestimated aspects of home and community care provided by formal and informal caregivers. The analysis of weather-related challenges for care provisioning needs to be extended to other seasonal conditions (e.g., the challenges of delivering care in extreme heat), to the developing world and even to the burgeoning debates on the health implications of global environmental change. Author Affiliation: (a) Department of Geography, Trent University, 1600 West Bank Drive, Peterborough, Ontario Canada K9J 7B8 (b) Department of Geography, Laurentian University, Canada (c) Department of Geography, Queen's University, Canada

As people grow older in late life, their need for help with the activities of daily living increases. In Spain, those who need such help constitute about 20 per cent of the population aged 65 or more years. Support may be from formal care, informal care or both, and the type has different consequences for care receivers and their social networks. The aim of this paper is to examine the relationship between informal and formal care and the use of health services among older people in Spain. Using a sample of 1,148 respondents aged 65 or more years from the Spanish National Health Survey of 2003, we analysed the association between the sources of care (formal, informal, both, or no care) and the frequency of three types of health-care utilisation: hospitalisation, emergency services and medical consultations. After controlling for sex, age, level of difficulty in the activities of daily living, self-perceived health status, and social class, it was found that older people with disabilities who received neither informal nor formal care were more likely to consult physicians than those who received informal care, but that there were no significant relationships between the type of care and health-services utilisation. The findings provide new information about the consequences of the different types of care of older people with disabilities, and suggest specifically that informal care substitutes for some tasks usually done by health professionals. KEY WORDS--health services, informal care, formal care, disabled older people, Spain.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.07.028 Byline: Mark W. Skinner (a), Mark W. Rosenberg (b) Keywords: Canada; Long-term care; Managed competition; For-profit; Non-profit; Rural and small town Abstract: This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy. Author Affiliation: (a) Department of Geography, Trent University, 1600 West Bank Drive, Peterborough, Ont., Canada K9J 7B8 (b) Department of Geography, Queen's University, Canada

While much research has examined First Nations peoples' health in Canada, few studies have explored the role of traditional activities in enhancing health. Using data from the 1991 Aboriginal Peoples Survey (APS), this paper incorporates a set of measures of traditional activities within a determinants of health framework for understanding First Nations peoples' health. Results from the analyses undertaken show that many of the determinants of health identified in analyses of the Canadian population in general hold for First Nations peoples. While only a few statistically significant relationships between health status and traditional activities were identified, taking into account the limitations of the APS and other conceptual issues, we argue that there is the potential to move from the analysis of traditional activities to a more nuanced analysis of cultural attachment. Keywords: Aboriginal peoples; First Nations peoples; Traditional activities; Determinants of health; Canada

It is often said that women live longer than men, but suffer more illnesses throughout their lives. It has also been demonstrated in various studies of women's health that measures of health and health behaviour vary over different geographic scales. Added into this mix is the fact that historically more women than men in relative terms are found on the lower rungs of the socio-economic ladder. What has not been so well-developed is our understanding of the connections among health, gender, poverty and especially location. In 1998, Statistics Canada released the second wave of the National Population Health Survey (NPHS-2). Included with the NPHS-2 public use microdata file are measures of health status, gender, income and location which can be analyzed in the form of logistic regression models. Results are reported which provide a better understanding of the relative roles that gender, poverty and location play in the geography of inequalities.

Birch and Abelson [1] argue that non-income based barriers might explain differences in utilization of health services within and between income groups. Databases which contain utilization data rarely allow for the modelling of geographic variation. In the Ontario Health Survey (OHS), individual observations are georeferenced at the Public Health Unit (PHU) scale, but PHUs cannot easily be used because of the large coefficients of variation. To overcome this problem, a cluster analysis is performed to create a service environment variable, which reflects differences in service availability, population size and rurality. Utilization of health services is then modelled as a logistic regression equation where the independent variables are age, sex, service environment and income to test the Birch and Abelson argument. This argument is then extended by controlling for age, health and income status. Based on the modelling results, the importance of geography to access and utilization is assessed. Key words - access, utilization, health services

Breast cancer screening facilities operated by the Ontario Breast Screening Program (OBSP) have recently been added to the existing geography of diagnostic mammography facilities in hospitals and private clinics in Eastern Ontario. While diagnostic facilities require a physician's referral for access, the new centres offer mammograms by self-referral. Other work has shown the utilization of mammography screening services to be quite low despite widespread acceptance of early diagnosis through mammographic screening as the best method to lower breast cancer mortality. Major findings are that spatial variation does exist in attendance rates in the townships and census tracts surrounding the screening centre. At the regional level, physician referral patterns and the presence of local diagnostic mammography units appear to affect the uptake of screening at the Kingston facility. The individual level analysis confirms the importance of the primary care physician's referral with two-thirds of the client sample indicating that they were referred for screening by their family physician. The sample of clients are also very mobile women who have comparatively greater access to financial resources than other women of screening age. The results of ecological and individual level analyses of attendance at OBSP's Kingston Centre reveal contradictions in the provision of this service. Spatially, the centres follow a location pattern of a much higher order health facility yet women are expected to include screening as part of their routine care. Attenders at the Centre were found to be of higher socioeconomic status, married and have access to a private automobile. The finding that the primary care physician's referral is an important prerequisite for attendance raises questions about the feasibility of providing health care for women which encourages individual responsibility for health within the existing paternalistic health care system. Key words - mammography, women's health, utilization, mobility, Kingston, Ontario

In Canada, there has been an increasingly, vociferous debate over the future of a health care system which is based on 5 principles: comprehensiveness; public administration; universality; portability; and accessibility. In part, this debate is a policy tug-of-war among provincial governments, special interest groups and the public who on one side want to maintain the principles of the health care system and on the other want to control costs within the system. Th outcome of this policy tug-of-war is demonstrated through an analysis of the funding of health care in the province of Ontario, Canada in general, and the closure of hospital beds specifically. The analysis shows that in attempting to restructure the system, rationalization and growing spatial inequality are occurring simultaneously. The analysis calls into question the whole strategy o bed closures as a method of controlling health care costs. These conclusions have implications for other national health care systems where hospital bed closures have also been used as a strategy in controlling health care costs.

In this paper, we put forward a proposal for a critical geography of physical activity that attunes to experience while centring on the socio‐spatial processes and power structures enabling and constraining physical activity participation. Drawing on our research that explored women's and men's emotional geographies of an everyday exercise environment – the gym – in a Canadian city, we show how this approach can identify otherwise invisible environmental influences on physical activity participation. Our thematic analysis reveals that the gym environment is generative of three place‐based emotive processes of dislocation, evaluation, and sexualisation that collectively configure an unevenly gendered emotional architecture of place. Through this interstitial structure, the boundaries of localised hierarchies of masculinities and femininities become felt in ways that create tensions and anxieties, which in turn reinforce gendered boundaries on physical activity participation. Two additional themes reveal how gendered motivation and individual factors mediate negative emotional experiences. Our findings indicate that emotional geographies are one way in which gender disparities in physical activity are naturalised at the scale of the everyday exercise environment. Interventions for gender equity in physical activity would benefit from being empathetically attuned to the subtleties of place‐based experiences. More widely, bringing emotions into geographies of physical activity sheds light on the larger question of the role of place in (re)producing gendered health inequities, with implications for geographical research on health and social justice. Future critical geographical inquiry is necessary to ensure that public health interventions are grounded in the experiential realities of practising physical activity in particular places. [ABSTRACT FROM AUTHOR]

Children with chronic conditions and their families face many similar challenges that can be stressful for the family including, daily caregiving activities, financial difficulties caused by unexpected expenses, and increased use of health services to treat and help manage the condition. Many of these families, in addition to facing daily caregiving responsibilities, must travel substantial distances to access some of the necessary aspects of their child's health care. In this study, the Burke et al. (1994-1996) data of repeatedly hospitalized children and their families are used to explore a geographical dimension of family impact, distance. Outcome measures from the Feetham Family Functioning Survey and the Questionnaire on Resources and Stress are analyzed using exploratory and multivariate analysis. Results show that distance to hospital plays a role in the two areas of family life regarding relationships within the immediate family, and issues surrounding the ability to maintain the child in the family home. The implications of the results for family, health care intervention, and government policies and guidelines are discussed. Keywords: Children; Chronic conditions; Caregiving

China's rapid socioeconomic growth in recent years and the simultaneous increase in many forms of pollution are generating contradictory pictures of residents' well-being. This paper applies multilevel analysis to the 2013 China General Social Survey data on social development and health to understand this twofold phenomenon. Multilevel models are developed to investigate the impact of socioeconomic development and environmental degradation on self-reported health (SRH) and selfreported happiness (SRHP), differentiating among lower, middle, and higher income groups. The results of the logit multilevel analysis demonstrate that income, jobs, and education increased the likelihood of rating SRH and SRHP positively for the lower and middle groups but had little or no effect on the higher income group. Having basic health insurance had an insignificant effect on health but increased the likelihood of happiness among the lower income group. Provincial-level pollutants were associated with a higher likelihood of good health for all income groups, and community-level industrial pollutants increased the likelihood of good health for the lower and middle income groups. Measures of community-level pollution were robust predictors of the likelihood of unhappiness among the lower and middle income groups. Environmental hazards had a mediating effect on the relationship between socioeconomic development and health, and socioeconomic development strengthened the association between environmental hazards and happiness. These outcomes indicate that the complex interconnections among socioeconomic development and environmental degradation have differential effects on well-being among different income groups in China. [ABSTRACT FROM AUTHOR]

Globally, boys and men are more physically active than girls and women. Despite geographical variation in physical activity participation and gender differences across types of physical activities, physical activity is frequently assessed at national scales using only select indicators. Using 2012 Canadian Community Health Survey data, we undertake a gender-based analysis using cross tabulations, chi-square tests, and binary logistic regression models to investigate whether gender differences in physical activity vary across geographical scales and physical activity types in Canada. We examine: (1) whether gender gaps in physical activity change across geographical scale (national, provincial, city); (2) if any geographical variation in gender differences varies by activity type (active leisure time, weight-training, home exercises); (3) whether age and/or income help to explain geographical variation in gender differences in physical activity; and (4) if gender, age, marital status, education, and income level predict variation in differences in physical activity at different geographical scales. Results demonstrate that both scale and activity type matter for how gender differences in physical activity are observed. By zooming in or out, or by changing the activity lens, gender gaps emerged or disappeared. We conclude that physical activity interventions need to be gender-sensitive in ways that are place-specific. L'entraînement physique au Canada : existe-t-il un écart entre les genres? Les garçons et les hommes sont généralement plus actifs que les filles et les femmes. Malgré l'existence de disparités géographiques dans la participation à l'activité physique et de différences entre les genres en fonction des types d'activité physique, des évaluations de l'activité physique prenant appui sur quelques indicateurs prédéterminés sont souvent réalisées à l'échelle nationale. Une analyse différenciée selon le genre a été effectuée à partir des données tirées de l'Enquête sur la santé dans les collectivités canadiennes de 2012 à l'aide de tableaux croisés, de tests de khi-deux et de modèles de régression logistique binaire, afin de déterminer si les différences entre les genres en matière d'activité physique varient selon les échelles géographiques et les types d'activité physique au Canada. Il s'agit de déterminer : (1) s'il existe des écarts liés au genre dans la variation de l'activité physique en fonction de l'échelle géographique (nationale, provinciale, urbaine); (2) si certaines disparités géographiques des écarts entre les genres varient en fonction du type d'activité (temps consacré aux loisirs actifs, musculation, exercices pratiqués à la maison); (3) si l'âge ou le revenu sont des facteurs qui contribuent aux disparités géographiques des écarts entre les genres; et (4) s'il est possible de prédire les effets du genre, de l'âge, de l'état civil, de la scolarité et du revenu sur la variation de l'écart de l'activité physique aux différentes échelles géographiques. Les résultats confirment que l'échelle et le type d'activité exercent une influence sur la manière de voir les écarts entre les genres en matière d'activité physique. En modifiant l'échelle d'observation ou la forme que prend l'activité physique, des écarts entre les genres surgissent ou disparaissent. En conclusion, il importe de s'assurer que les efforts de promotion de l'activité physique tiennent compte des spécificités de genre tout en considérant les caractéristiques propres à chaque milieu. [ABSTRACT FROM AUTHOR]

Home as a place of caring is theorized using the literature from geography, sociology, housing and feminist studies. To support our theorization, grounded theory is used to capture and interpret the experiences of women caring for children with long-term care needs in the home. Eleven semi-structured interviews conducted with women in Ontario, Canada uncovered differences in the way the women perceived their homes and highlighted their multiple and complex experiences. The findings revealed three key issues. First, women do not want their homes to be completely defined by long-term care activities as many other types of activities are situated in their homes. Second, long-term care activities and schedules are not segregated but become deeply embedded and enmeshed within the spatial and temporal practices and processes of family life. Third, the meanings, characteristics and ideal of 'home' portrayed in popular culture and the academic literature often clashed with what the women experienced on a daily basis. Analysis revealed the tensions surrounding 'reconstructing spaces in the home' and 'the home as a private and public place' which are indicative of the women's struggles with the disjuncture between the ideal and lived home. The women's experiences challenge us to consider new ways of theorizing the home, and the home when it is a place where long-term care is provided. [ABSTRACT FROM AUTHOR]