A landscape is an ecological research unit of analysis which defines a region containing some spatial differentiation in habitat quality or characteristics: often described as spatial heterogeneity (Turner, 1989; Picket and Cadenasso, 1995). Studies of environmental relationships to human, vector-borne, zoonotic, and animal diseases through the lens of spatial and/or landscape epidemiology (so-called “landscape approaches”) have led to new frameworks, methodologies, and thousands of empirical studies linking disease and disease risks to features of the environment (Robertson, 2017). Ten key propositions of landscape approaches to health (based on a review of several studies) are outlined in Table 8.1 (Lambin et al„ 2010). We have examined these propositions to consider how they can inform the characteristics of a healthy settings approach (Table 8.1).

Almost all the strictly “spatial” dimensions of these propositions focus on static aspects of habitats: the presence or absence of landscape features; how they are configured in the landscape; and how their configuration influences connections and movement between patches. Other characteristics of the propositions relate to human-mediated processes within landscapes: how aspects of land use change, land ownership, and human movement and behaviour define and shape key aspects of infection risk.

The propositions identified by Lambin et al. (2010), while important for identifying many spatial components of disease emergence and distribution processes, are inadequate for defining the Eco-Healthscape. Landscape approaches typically focus on associations between environmental features and disease incidence to isolate areas of special concern (e.g. clusters or high-risk areas). Analyses frequently stop there, rather than identifying what actions should follow in these demarcated areas (e.g. see Rothman, 1990). Identifying the high-risk areas on a map is in many ways a stark contrast to the “total population” approach articulated in healthy-settings literatures. Place-based and more recent health geography ideas have transformed how health research conceives space and geographic context. These ideas can help us understand how to use a broader articulation of landscapes suitable for One Health.

In geographical studies of health and disease, the turn from a disease-ecology focus to a health-promotion focus has been occurring for over 25 years. Kearns (1993) identified place, health services, and community resources as central to a new “health geography.” This shift in emphasis can be seen in a methodological sense in the shift from space-centric to place-centric studies. Kearns and Moon (2002) describe this as changes in how geographic context is represented, from treating space as “an unproblematized activity container” to that of “alternative perspectives emphasizing constructed meanings and the experiential aspects of place.”


Review of the Ten General Principles Governing Landscape Epidemiology Described by Lambin et al. (2010) Focusing on Vector-Borne Zoonoses

Landscape Epidemiology Propositions

Healthscape Interpretation

Spatial or Platial?

1. Landscape attributes may influence the level of transmission of an infection

Landscape features, such as flooded banks, can be mapped from high- resolution imagery and examined for association with disease variables

Highly spatial

2. Spatial variations in disease risk depend not only on the presence and area of critical habitats but also on their spatial configuration

Spatial measures of habitat configuration (e.g. edge density) can be important indicators of disease risk for both animals and people

Highly spatial

3. Disease risk depends on the connectivity of habitats for vectors and hosts

Landscapes as a site of heterogeneity imply different levels of connectivity between habitat patches. Processes driving habitat fragmentation and reducing connectivity can predict changes in disease risk

Highly spatial, moderately platial

4. The landscape is a proxy for specific associations of reservoir hosts and vectors linked with the emergence of multi-host diseases

Landscape-level associations that can be easily mapped and modelled are frequently proxies for specific interactions and processes that cannot easily be measured Understanding specific associations is vital if interventions are to be designed to mitigate risks. Place factors typically operate at the level of specific associations, not the landscape

Moderately spatial Moderately platial

5. To understand ecological factors influencing spatial variations of disease risk, one needs to take into account the pathways of pathogen transmission between vectors, hosts, and the physical environment

Pathways of transmission are defined to be social interactions and processes, whether between animals or between animals and humans. Mapping their locations is insufficient to understand the causal mechanisms driving the interactions

Weakly spatial, highly platial

6, The emergence and distribution of infection through time and space is controlled by different factors acting at multiple scales

Scale is a key consideration of both spatial and platial factors that influence disease emergence and distribution

Highly spatial, highly platial

7, Landscape and meteorological factors control not just the emergence but also the spatial concentration and spatial diffusion of infection risk

Healthscapes are in part defined by abiotic conditions that correlate with life history requirements for survival. This applies to both pathogens and hosts

Highly spatial


TABLE 8.1 (Continued)

Review of the Ten General Principles Governing Landscape Epidemiology Described by Lambin et al. (2010) Focusing on Vector-Borne Zoonoses

Landscape Epidemiology Propositions

Healthscape Interpretation

Spatial or Platial?

8. Spatial variation in disease risk depends not only on land cover but also on land use. via the probability of contact between, on one hand, human hosts and. on the other hand, infectious vectors, animal hosts, or their infected habitat

Land use is governed by an assemblage of human and place-based factors, including cultural, economic, political, and social practices. Land use change is typically cited as disease emergence risk factor. Land use continuity may play an important role in conservation of healthy populations

Highly spatial highly platial

9. The relationship between land use and the probability of contact between vectors and animal hosts and human hosts is influenced by land ownership

Land ownership controls access to land and helps to define flows of people and animals on the landscape. As such, this can determine infection contact rates. Different forms of land ownership arrangements may contribute to healthful populations

Moderately spatial Highly platial

Human behaviour is a crucial controlling factor of vector-human contacts, and of infection

Whether people interact with pathogen vectors or animal reservoirs is an outcome of human behaviour. Animal health is also largely an outcome of human behaviour as it relates to change, contaminants, and other sources of animal morbidity/mortality

Weakly spatial Highly platial

Kearns (1993) called for the geography of health to consider the “dynamic relationship between health and place and the impacts of both health services and the health of population groups on the vitality of places.” This latter consideration how subpopulations’ health relates to the overall “vitality” of places has important connotations for a healthy settings perspective. Settings are the environments of everyday life. Much health policy and promotion literature focuses on distinct and various types of settings, such as schools and hospitals, to more variable entities such as homes, communities, and cities. Settings can equally be seen as population- level activity spaces, w'here people spend significant amounts of time engaged in activities of life, undergoing a variety of exposures at a multitude of scales. A settings framework from health policy and programming addresses health issues in a holistic nature, focusing on provision of resources that address health priorities.

The question of how to apply concepts from the “new” health geography to the shared health of humans and animals remains to be fully explored. Neely and Nading (2017) offered critical insights in their critique of global health research and practice from the perspective of place-based research. They considered the social construction of place through a unique set of social relations, understanding, and experiences (King, 20Ю) within an underlying biophysical environment. Biota of all types (i.e. so-called “non-human elements”) are equally considered in this construction of place. Yet precisely how to operationalize these concepts remains challenging. Neely and Nading (2017) reviewed the case of an elderly Zulu woman who contracted a rare infectious disease in rural South Africa. The factors that convened to determine her diagnoses and treatment included internationally funded global health HIV programmes (which initially refused to treat her and presumed she was HIV positive), which stipulated treatment options for HIV patients, individual factors such as her age and socio-economic status, as well as the local geographic context characterized by “high numbers of immunocompromised people, rampant tuberculosis, crowding, and poor ventilation” within which she was embedded. Although used in Neely and Nading (2017) to critique the place-deaf specification of global health programme protocols, we see here how local and global forces intermix with local environment and individual factors to determine both the health and the health care of this person.

The Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) addressed nature/society linkages in its own conceptual framework (Figure 8.1). Key here is the framing of benefits of the natural world to humans through the lens of ecosystem services. This framing, while addressing the role of governance and institutions in structuring natural drivers of change, narrowly conceives of health in human terms. Work on animal geographies and health has begun to reconsider these anthropocentric concerns, though empirical work in this vein is challenging.

In a compelling example, Enticott (2008) used sociological concepts of health to construct understandings of bovine tuberculosis biosecurity initiatives in the United Kingdom. They noted that “the population approach to animal health attempts an important transformation within farming styles,” albeit without considering the highly localized nature of farming cultures and understandings. Here, farmers’ own understandings of bovine tuberculosis risks and outcomes - termed lay epidemiology - which include some officially communicated risk factors, as well as luck and circumstance, were validated by (geographically) generic risk messaging from animal health authorities, because there are just as many other unknown or unmeasurable factors that relate to transmission. They note that such an ecological paradox emerges when there is a

fundamental gap which exists between a person’s experience of a given reality and

science’s explanation of that same reality (Gifford, 1986). This gap can be traced

to a clash of spatial logics inherent within the population approach and fanners’

understandings of animal health.

Thus, farmers’ own cultural understandings of disease, outcomes, risky and safe behaviours, and their concern for the welfare of their animals, which are locally

Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) conceptual framework. (From Diaz et al., 2015.)

FIGURE 8.1 Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) conceptual framework. (From Diaz et al., 2015.)

rooted in cultural geographies, needed deeper consideration and engagement in creating appropriate health promotion tools. These are critical variables of the Eco-Healthscape within which health is actively created, maintained, and sometimes reduced.

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