Environmental Geography, Climate, and Health

Spring, 2012

Tuesday and Thursday, 1:30-3:20

Smith 304



Dr. Jonathan D. Mayer, Professor, Departments of Epidemiology, Geography, Medicine (Div of Infectious Diseases). (Allergy and Infectious Disease), Family Medicine, Global Health, and Health Services

Tel: (206) 543-7110


Course listproc: (remember that

anything posted here goes to the whole class)

Rooms 412-C Smith Hall and Health Sciences F-259 (Dept of Epidemiology)

Office hours: By appointment


Course Rationale:


People, societies, and the environment are inextricably linked in both obvious and more obscure ways. At one time, some geographers argued that the physical and biological environments determined the characteristics of people and cultures. This “environmental determinism” is a concept that has been discarded, and caused many to not consider human-environment links for decades. It has become more and more obvious in the past half century or so that individuals, societies, and the environments are tied together in an intricate web of causation. The environment profoundly influences people and cultures. In turn, people and groups modify the environment through agriculture, water projects, urbanization, and other phenomena. Thus, the consensus in the social sciences generally in geography specifically, and in the public health sciences is that the human-environment linkages are myriad, complex, and frequently hidden. At a time when there are tremendous geographical inequalities in health status, life expectancy, and patterns of mortality, the relations between the environment and health are of paramount importance. It is from this realization that this course is offered.


Students are expected to have some familiarity with epidemiologic study design (case-control, prospective cohort, etc.) and other epidemiologic concepts, and/or statistical analysis. We will discuss and review basic study design as appropriate, but students must not be beginners. To put it another way, students must be able to understand original research articles, many of which are quantitative.



Course goal:


The main goal of this course is to demonstrate and investigate the many ways of appreciating how human-environment relations are expressed in the context of health and disease. The focus will be both local and global. This course draws attention to the relationships between geography generally and medical geography specifically on the one hand, and environmental studies, social analysis, and other biological, physical, and social sciences generally. Thus, medical geography, or as I have called it lately, “epidemiologic geography,” is at the intersection of the social. physical, public health, and biological sciences. We must realize that individual health should be seen in the context of public health, and that public health should be seen in the broader contexts of social, physical, and biological phenomena, in their complex and frequently hidden and unanticipated interactions. One of the ways in which this will be done is by reading, understanding, and critiquing original scientific research from major influential journals in environmental health, infectious diseases, and other subdisciplines. Put another way, not only will you gain knowledge, but you will learn how that knowledge is generated by going to the sources where scientific knowledge is shared and communicated: the scientific journals themselves. In the process, you will learn that the kind of research through which this kind of knowledge is generated is seldom perfect. We will see this in class by discussing and finding the strengths and weaknesses of one article each week from the published literature in the previous month or even the previous week. Even more than that, you will learn to see that in the three assignments.


My educational beliefs:


Students are inherently curious and seek to understand the world surrounding them and the world in which they live. This course is structured to foster critical analyses of human-health-environment relationships. This understanding and analysis must come from a solid knowledge of the factual, scientific, and conceptual bases from which such understanding and thinking must come. Some students will find that this course will contribute directly to their professional development, while others will find that it provides a basis for understanding issues of health and disease as citizens in a democratic society, in which we can all help to determine the course of society. My own role in this course will be multifaceted. Sometimes I will serve as an authority on the subjects that we will cover. At other times, I will be a facilitator of inquiry and debate. I hope that I will always be a resource for your own interests and investigations as we proceed through the course.


A word on academic honesty and integrity is in order. We will adhere strictly to the rules of the University of Washington and the academic community in prohibiting plagiarism, cheating, and academic dishonesty. These provisions are spelled out in detail at the following website, with which all students are expected to be familiar. Each year in this class, several cases of cheating and plagiarism, unfortunately, are discovered. To prevent this, you must read the contents of the following website



I will assume that each and every student is familiar with the contents of this web page, No excuses will be accepted for academic dishonesty.





Grades will be based on three essays/response papers, to be spaced throughout the quarter. These will require synthesis of readings and class materials, plus some (but not a burdensome) amount of additional research in the scientific literature. Each of these will be worth 30% of your grade. Participation, ascertained by the submission of a 1 paragraph “thought piece” on your reactions to the lecture material and reading for that week, will account for the remaining 10%.


Paper 1   30%

Paper 2   30%

Paper 3    30%

Participation 10%--one paragraph “thought piece” on the week’s reading material, to be submitted in class each Thursday





P. Martens and A. J. McMichael, Environmental Change , Climate and Health: Issues and Research Methods. Available as an e-book from Amazon with the free Kindle app for either PC or Mac.


Confalonieri, U., B. Menne, R. Akhtar, K.L. Ebi, M. Hauengue, R.S. Kovats, B. Revich and A. Woodward, 2007: Human health. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the

Intergovernmental Panel on Climate Change, M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E. Hanson, Eds., Cambridge University Press, Cambridge, UK, 391-431.

Available for free download at:


Download Ch. 8 only, pp.391-431.


Devra Davis, When Smoke Ran Like Water: Tales of Environmental Deception and the Battle Against Pollution. New York: Basic Books, 2002.


Jonathan Harr, A Civil Action. New York: Vintage Books, 1995.


Lancet and University College London Institute for Global Health Commission. Managing the health effects of climate change. Lancet 2009; 373: 1693–733. Available for free download from UW e-journals.


Neil Pearce, A Short Introduction to Epidemiology, 2nd edition. Wellington: Centre for Public Health Research, 2005. Available for free download at:

`  On electronic reserve for this course


V.J. Schoenbach, Fundamentals of Epidemiology: An Evolving Text. Chapel Hill: University of North Carolina, Department of Epidemiology, 2000. Available for free download at:




 Concepts of Health and Disease; Health in an Ecological Perspective

Basic Concepts (March 27, 29)


Martens and McMichael, ch.1, 2, 3, 11.  Optional: M and M, ch. 4

Schoenbach, ch. 1, 2, 4;

Pearce ch. 1


Epidemiology, Epidemiologic Geography, and Global Environmental Health (April 3)

Jonathan Mayer, “Medical Geography” in Companion to Health and Medical Geography. E-reserve and emailed to class.


Review of specific infectious diseases and their environmental components; Emerging Infectious Diseases (April 5, 7)

            Reading: Martens and Michael, ch. 11-12

Jonathan Mayer, “Geography, Ecology, and Emerging Diseases.” E-reserve and emailed to class.

            Jonathan Mayer, “Emerging Infectious Diseases” 

            E-reserve and emailed to class.


Study Design; Research Articles in Environment and Health


Study Design and Causal Paths (April 12).



Martens and McMichael, ch. 5-6. Optional: ch. 9

Pearce, ch. 2, 3, 6. See also ch. 9, 10, 11.

Schoenbach, ch. 8.


How to read a research article: (April 17).

Article to be announced on Tues. April 10th. Will be on electronic reserve, and also posted to the class list. This will be from a research journal published since the beginning of class.


Assignment 1 due Tuesday, April 24. Click here for the assignment.


Global Climate, Climate Change, and Health

            Science of Climate Change (April 19, 24th)

Lancet article on climate change (above).

Confalioneri et al. above (IPCC report)

Martens and McMichael, ch. 10, 2, 7, 8


            Health Effects 1 (April 26)

            Direct Effects of Global Warming

            El Nino Southern Oscillation (ENSO) and infectious diseases



            Health Effects 2  (May 1)

            Global Climate Change and Infectious Diseases


            Health Effects 3 (May 3rd)

            The Ozone Layer and Carcinogenesis


            Assignment 2 due Tuesday May 15th. Click here for the assignment.


Environmental Pollution, Health, and Carcinogenisis


Nature and Epidemiology of Cancer (May 8th)

Pollution and Cancer (May 10, 15)

Pollution, Environment and Asthma/Respiratory Diseases; Hygiene hypothesis (May 17)

Reading: Davis, When Smoke Ran Like Water.


Moving to the Local: Cancer Clusters and Civil Action (May 22th, May 24th, May 31st)

            Harr, Civil Action.

            Additional readings to be announced


Assignment 3 due first day of final exam week, Monday, June 4. Click here for the assignment.



PubMED. The interface with the National Library of Medicine, which contains most of the relevant articles in medicine, public health, and medical geography.


Centers for Disease Control and Prevention (CDC)


Morbidity and Mortality Weekly Report (MMWR). An essential short digest of vital health information and outbreak investigations in the US.


Emerging Infectious Diseases. A top-notch publication by CDC. You may subscribe to either the online or hard copy editions for free.


World Health Organization


Intergovernmental Panel on Climate Change

*IPCC 4th Assessment--Impacts Chapter 8 is the health section


National Institutes of Health (NIH)


National Center for Health Statistics



UNAIDS (UN Program on AIDS)


Stop TB Partnership


Global Fund to Stop AIDS, Tuberculosis, and Malaria


UW electronic journal collection


PubMED. (Interface with National Library of Medicine—all major public health, medical, and relevant geography articles are included here) Make sure that you sign in on the top right if you will need links to the actual articles in e-journals.


Google Flu Trends


Health and Medical Geography Specialty Group


Toxic Release Inventory Program—geographically referenced dataset of toxic releases in the US


National Cancer Institute cancer clusters homepage


CDC cancer clusters


CDC National Environmental Health Tracking Program


American Cancer Society

            ACS Data and Statistics


National Cancer Institute Maps and Graphs


Environmental Health Perspectives—foremost journal in environmental health