The Geographer: Health (Summer 2016)

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Geographer SUMMER 2016

The newsletter of

the Royal Scottish Geographical Society

Health Inequalities “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Martin Luther King

• Mortality: Crisis and Contrasts • Annie Lennox OBE FRSGS on HIV/AIDS • Formulae and Foodbanks • Women and Water • Artistic and Historic Explorers • Luke Robertson at the South Pole • Climate: The Need and a Chance to Lead

Life expectancy for men in Glasgow

• Reader Offer: Deeper than Indigo

plus news, books, and more… Life expectancy for women in Glasgow



health inequalities


ften when we select a topic for The Geographer we unveil such a wide gamut of ways in which geography engages and influences the chosen issue that we have to carefully consider how to focus our approach.

Mike Robinson, Chief Executive RSGS, Lord John Murray House, 15-19 North Port, Perth, PH1 5LU tel: 01738 455050 email: Charity registered in Scotland no SC015599 The views expressed in this newsletter are not necessarily those of the RSGS. Cover image: © Paul Georgie Masthead image: © Mike Robinson

RSGS: a better way to see the world

The maps on the front cover, comparing life expectancy for men and women in Glasgow in 2005-09, were produced by Paul Georgie, a geospatial technologist enabling the use of open data and open source mapping for local planning and development, and involving local The residents in helping to bolster information relating to issues such as health, energy, transport Health Inequalities and public safety. The maps are based on SIMD (Scottish Index of Multiple Deprivation) 2012 open source data, joined with other geographical data, based on census and similar information. See for more information.

Geographer SUMMER 2016

The newsletter of

the Royal Scottish Geographical Society

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Martin Luther King

• Mortality: Crisis and Contrasts • Annie Lennox OBE FRSGS on HIV/AIDS • Formulae and Foodbanks

• Women and Water

• Artistic and Historic Explorers • Luke Robertson at the South Pole • Climate: The Need and a Chance to Lead

Life expectancy for men in Glasgow

• Reader Offer: Deeper than Indigo

plus news, books, and more…

Life expectancy for women in Glasgow

Health inequality for Scottish children A study covering 42 countries has shown that young people in Scotland have some of the highest rates of health and social inequality across Europe and North America. Gerry McCartney, Head of Public Health Observatory, NHS Health Scotland, said that “amongst boys, these inequalities are wider than in any other country included in the survey.” Scotland displayed the highest levels of inequality for multiple health complaints, moderate physical activity, starting smoking and using cannabis. Jamie Hepburn, Minister for Sport, Health Improvement and Mental Health, recognises the “deeply ingrained health inequalities in Scotland” which have existed for generations.

health inequalities

This has never been more true than for this current edition on health inequalities – everywhere we looked opened up a panoply of issues which could each have formed a whole magazine on their own, from obesity to fuel poverty, crime to alcohol. We may well come back to these in the future. And yet someone told me recently that they did not understand what role geography and geographers had to play in informing, shaping and resolving health policy. This despite the fact that the very birth of GIS is usually traced to the famous 1854 Broad Street case in which Dr John Snow mapped the proximity of cholera cases against local water pumps in Soho, London, and was able to evidence the causal link. Snow’s example probably saved thousands of lives, and it is not unreasonable to suggest that GIS in its many forms has gone on to save many more. Like Snow’s, the best maps not only make sense of the familiar but also tell us something we do not already know, or reveal something we have not already realised. GIS, the modern cartography, epitomises this, often answering specific questions by distilling huge amounts of data to reveal understandable patterns and trends. For example, that the health of a population is inextricably linked to the geography of that population and the characteristics that define that location. Geography then has helped to identify health problems for more than a century and a half. Geographical research helps to explain the causes and factors. And GIS gives the ability to combine and analyse a range of data, such as census, socioeconomic and geographical data, and to map and present the findings. I hope anyone reading this magazine is left in no doubt as to the value and importance of health geography in finding answers and informing health policy. And I hope you enjoy reading it as much as we enjoyed putting it together. I am grateful to Professor Jamie Pearce of the University of Edinburgh, and to our work experience student Heather Blair, for their help.

Life Expectancy in Glasgow

Young Geographer The editorial team for RSGS’s inaugural Young Geographer magazine recently met at RSGS HQ to hold their first planning meeting and to discuss the magazine’s set-up with Mike Robinson. During the meeting it became apparent that the team were all passionate about climate change and that the first issue of the magazine would be on this topic. The team decided to focus on four key themes: broadening your horizons (including volunteering and travel), age equality in the climate change debate, the cultural impact of climate change, and the future (which will focus on technology and resilience). The team have since met a second time, when they read articles submitted through Young Scot and RSGS. Stuart Murphy, Young Geographer Sub-Editor said, “It was really inspiring reading through the articles to see people’s desire for change. We hope to get this message across when we publish the magazine in autumn 2016. I hope you will look forward to reading the magazine.”

RSGS Board At the AGM in April, Robert Rogerson stepped down as a Board member, handing the reins of leadership on research to the newlyappointed Geographer Royal for Scotland, Professor Charles Withers, who joins the Board in that capacity. We are delighted to report that Lorna Ogilvie was also re-elected to serve a further term. There is still one vacant seat on Board for an elected member and one for a co-opted or ex officio member. If you are interested in joining the Trustees, please get in touch with Mike Robinson (Chief Executive) or Roger Crofts (Chairman).

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Fair Maid’s House refurbishment Thanks to generous donations received from our Members and from several local charitable trusts, we have recently completed some refurbishment work in our visitor centre in Perth, including the development of the new Croll Garden, and we invite you to come and see the new features for yourself! The refreshment of our interpretation started in earnest last year with an update to the large revolving globe in our Earth Room, which now allows you to explore the world’s oceans and tectonic plates, and even visit other planets, all from a touchscreen. We have added new panels to our Migration board which, along with a new interactive ‘Push vs Pull’ panel, includes a first-hand account from awardwinning journalist and RSGS medallist Lindsey Hilsum FRSGS. We also have a new board which explores health and development issues around the world.

visit or volunteer

The updates to our visitor centre mean that if you have not visited for a while then there is plenty to see, and even repeat visitors will find something educational and interesting. To plan a school group or special interest group visit, please contact us at HQ.

Strengthening Scotland’s Geographical Heart

please help us if you can

In recent years, with the help of our Members but with relatively little money, limited resources and few staff, we have transformed RSGS and generated an undercurrent of excitement about what we can achieve if we all work together. But our progress has been hampered by the lack of some basics, and this is not sustainable in the long term. Having tested and proven that RSGS has a vital role to play, we now need to strengthen the charity’s heart, consolidate recent improvements, and secure RSGS’s future.

Help Strengthen Scotland’s Geographical Heart “We now need to strengthen the charity’s heart, consolidate recent improvements, and secure RSGS’s future.” Professor Iain Stewart, RSGS President

Image © Yann Arthus-Bertrand

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We are currently making a special appeal to our Members and other supporters and contacts, asking for help to continue our recent good work, such as organising inspirational talks for school groups, arranging public events to celebrate the achievements of inspiring people, producing publications that promote greater geographical understanding, creating informative public exhibitions, improving access to our collections, and carrying out the many other small tasks involved in running an independent charity. Please get in touch with us at HQ if you can help with a donation of money or publicity or expertise or support in-kind, or in any other way.

Fair Maid’s House Opening Times 2016

SGJ under new management Editorship of the Scottish Geographical Journal (SGJ), RSGS’s scholarly publication, has passed to Dan Clayton and Charles Warren (Geography & Sustainable Development, University of St Andrews), after the previous incumbents, Tim Mighall and Lorna Philip (Geography & Environment, University of Aberdeen), spent six very effective years in charge. In their first SGJ Editorial, the new Editors highlighted the journal’s broad international reach, stressing that its remit had been to augment the Society’s worldwide outlook in providing a Scottish forum for geographical research from all parts of the globe. They characterised both RSGS and the SGJ as ‘globally Scottish’, and warmly encouraged the submission of original, high-quality academic work rooted in geographical scholarship and striving for excellence and impact in its particular niche. Submissions from any area of geography and any part of the world are welcomed, together with ones from allied research areas that tackle questions of geography, space and environment. While the journal is international in outlook, it also continues to welcome papers with a Scottish focus. Indeed, the Editors are keenly aware that research into the many worlds of Scottish geography can cast prescient light on some of the wider world’s most significant geographical problems. The Editors are passionate believers in Geography’s critical role as an integrative, holistic discipline which addresses pressing contemporary challenges. So many of these challenges – ranging from human inequality, health and governance, to energy, biodiversity and climate change – sit at the interface between the natural and social sciences, which has long been Geography’s heartland. A special ‘virtual SGJ’ on health has been produced to reflect the theme of this magazine, offering free online access to a number of articles from the SGJ archive. See page/pgas/sgj_the_geographer to access the special edition for free until the end of September.

Obesity, disease and poverty Recent statistics released by the Obesity Health Alliance show that more than seven million new cases of diabetes, cancer, stroke and heart disease will occur in the UK in the next 20 years due to a significant increase in the number of people classed as overweight and/or obese. Currently three out of ten adults are classed as obese, with this set to rise to at least four in ten by 2035. It is also predicted that, in the same year, 45% of adults in the lowest income bracket will be obese, a statistic which highlights the dangerously large correlation between social status and health. To combat these worrying statistics the Obesity Health Alliance are urging the government to do more to regulate the advertising of ‘junk food’ and to tighten regulations on the levels of fat and sugar in food.

Instagram RSGS now has an Instagram account; visit to explore!

health inequalities

1.00pm to 4.30pm • Tuesday to Saturday • 9 April to 22 October

2 SUMMER 2016


This year’s National Volunteers Week ran from 1st to 12th June and was celebrated across the UK. RSGS took part by inviting potential volunteers to visit us and to chat with existing Fair Maid’s House volunteers. We also published blog posts and interviewed volunteers about their memories of RSGS and what they enjoy most about their involvement with the Society. Look out for excerpts from these interviews in our monthly E-blast email newsletter and on our blog. Once again, thank you to all our volunteers for the hard work you do to keep RSGS moving forwards.

Nepal’s indoor air pollution

Membership rates

The US Environmental Protection Agency claims that cook stoves are “the world’s leading source of environmental death,” killing more than malaria, HIV/AIDS and tuberculosis combined. Dr Maria Neira, the World Health Organization’s Director of Public Health and the Environment, stated that 4.3 million people die yearly from household pollution, 0.6 million more than from outdoor pollution.

For the first time since 2013, we will this year be increasing our membership rates, to £45 for single members and £67 for joint members. We believe this still represents really good value for money, and we hope it will help ensure RSGS can improve its financial sustainability in the longer term. The new prices, which are necessary to keep up with other inflationary pressures, will take effect on 1 August 2016.

George Basch, a 79-year-old businessman, has created a nonprofit Himalayan Stove Project, which has already shipped over 3,000 environmentally friendly clean-burning cook stoves to rural communities in Nepal. Each stove, sold for a few dollars with all revenue used for local projects, reduces indoor air pollution by up to 90%, using 75% less fuel.

Non-members attending talks will see an increase in admission rates from September 2016, from £8 to £10. As before, anyone who then joins as a member can reclaim their £10 entry fee against the cost of their first year of membership.

Inspiring People 2016-17 Planning is well underway for next season’s Inspiring People programme of public talks. Between September 2016 and March 2017 we are planning 90 illustrated talks at 13 locations across Scotland, bringing stories of adventure, an insight into other cultures, and new ways of looking at the world around us.

Give it a whirlpool Our Chief Executive, Mike, has decided to swim the Corryvreckan whirlpool between Jura and Scarba (during slack tide) in early August, where he hopes to exorcise a few demons and raise some money Licensed under Creative for RSGS into the bargain. There is about Commons © Walter Baxter an hour during which a crossing is possible, so he needs to be quick, as he braves jellyfish and the cold dark waters to make the crossing. The Corryvreckan is the third largest whirlpool in the world, and is infamous amongst seafarers. Please contact the office if you would like to sponsor Mike in his endeavours.

Land Reform Scotland Further to a wide-ranging debate by a diverse body of experts in early 2016, RSGS and the Scottish Consortium for Rural Research have produced a series of notes and ‘think pieces’ reflecting the research requirements that are necessary to maintain and explore the impacts of proposed land reform in Scotland. See exploring-geography/interesting-issues/land-use for the papers.

The Patron’s Lunch On Sunday 12 June 2016, five RSGS members and guests attended The Patron’s Lunch, a street party in The Mall, London, held in celebration of the 90th birthday of Her Majesty The Queen, and her patronage of more than 600 charities, including RSGS. They greatly enjoyed the day, despite the weather!

Universal Health Coverage The Elders launched their new initiative on Universal Health Coverage (UHC) at the Women Deliver conference in Denmark in May, calling for universal access to health care and urging governments to introduce UHC as a way of saving lives, tackling poverty, empowering women and achieving the Sustainable Development Goals. UHC requires that everybody receives the health services they need without financial hardship. The discussion featured Gro Harlem Brundtland and representatives from the World Health Organization. The Elders state that: • UHC is the best way to achieve the health Sustainable Development Goal; • UHC delivers substantial health, economic and political benefits across populations; • women, children and adolescents must be covered as a priority; • public financing is the key to UHC.

health inequalities

One of our key speakers will be Doug Allan, wildlife cameraman and documentary film-maker. Doug will be visiting several Local Groups, from Dumfries to Inverness, with his Doug Allan, with a husky friend. stunning pictures and his first-hand experience of the effects of climate change on the oceans and marine life. We are also delighted that extreme diver Andy Torbet will be returning to tell us more of his adventures.

health inequalities

National Volunteers Week

news Geographer The






After the very popular event last year, we are pleased to announce the return of our Geography Day. Indeed it was so popular that we have decided to run two this year – one in July, one in September. The day consists of a series of small talks, a chance to see collections items with on-hand experts, a guided tour of the visitor centre and garden, and other activities aimed at anyone who would like to know more about our work and the wonderful stories we hold. Lunch and refreshments are provided. Contact the office to reserve a place for this full-day activity (11am to 3pm). Please check our website for further details.

Remembering Mrs Sowter We were sorry to hear of Margaret Sowter’s death at the beginning of March. Having become an RSGS Member relatively late in life, she was an enthusiastic supporter – regularly attending our talks in Stirling, visiting HQ in Perth for special events, and giving donations to help us continue our work. She was a delightful character, and we shall miss her positive energy. We were touched to learn that she had kindly remembered us in her Will, and we are most grateful for her gift of £5,000. The support of our Members, through subscriptions, donations and legacies, is vital to our future, and we are grateful for Mrs Sowter’s generosity and thoughtfulness to the end. Please consider helping RSGS into the future by writing a bequest into your Will. If you would like to know more, please contact Mike or Susan on 01738 455050.

Professor Roger Crofts CBE has been awarded the prestigious CIEEM Medal in recognition of his outstanding, lifelong contribution to environmental conservation, governance and management. The Medal, the Chartered Institute of Ecology and Environmental Management’s highest accolade, recognises Roger’s exceptional record of leadership at both national and international levels.

Sir Chris Bonington We are delighted to have received, from a frequent visitor to the Fair Maid’s House, a donation of a signed photograph of our 1991 Livingstone Medallist Sir Chris Bonington CVO CBE, to add to our collections. If you have an item that you think might be of interest and you would like to donate it to RSGS, please contact us at HQ.

Recently published data from the World Health Organization (WHO) highlights that Glasgow has breached air pollution safety levels. Poor air quality causes more than three million deaths globally each year and about 40,000 early deaths in the UK alone, according to Jenny Bates, Friends of the Earth air pollution campaigner. WHO are able to examine the levels of specific particulate matter which results in increased risks of stroke, heart disease and lung cancer, amongst others. Dr Penny Woods, British Lung Foundation Chief Executive, stated that unfortunately the government’s response so far has been inadequate.

Conservationist of the Year Dundee University’s Professor Tony Martin has been named as the Zoological Society of London’s ‘Conservationist of the Year’. Professor Martin is leading the world’s largest rodent eradication project in South Georgia, to allow an estimated 100 million seabirds to recolonise the archipelago, reversing 200 years of damage to this South Atlantic seabird reserve. Initial monitoring has indicated the success of the first phase of baiting the rats, whilst a large survey next year will determine the outcomes of the second and third phases.

Dundee Geography PhDs The University of Dundee’s Geography Department has secured funding from ESRC and NERC, and a Hydro Nation Scholarship, for five PhD studentships to start in September 2016. The subject areas are Police Scotland’s transition to the new policy and practices for ‘Stop and Search’, and the introduction of a code of practice; the relationships between child domestic workers and the children within the families they serve, focusing on an area in Tanzania; the role of social relationships within local communities in building resilience in response to climate change related weather events, focusing on three flood affected communities in Scotland; the potential of hyperspectral remote sensing to detect and monitor the impact of hydrocarbons on vegetation; and the foodwater-energy nexus in India.

University News

CIEEM Medal for RSGS Chair

Glasgow’s air pollution crisis

© Mike Robinson


health inequalities


Discovering RSGS



a rich pas t – a dyn amic pre sent – an inspiring future

Look out for our newly updated booklet about RSGS and our work, which we will be making available through our Local Groups, and distributing to many of our contacts.

“We are all of degrees. Geog us geographers in varying raphy is ever shapes us, ywhere: it explains Mike Robins us, it is part it on, RSGS of us.” Chief Executi ve

Inspiring People Conserving Heritage Exciting Learn ing Promoting Science Engaging Interest

www.rsgs. org

RSG S: a bet ter way to see the wor ld T 2016 14.indd



us er! in b Jo mem a



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4 SUMMER 2016

news Global health spending Two new reports, led by Dr Joseph L Dieleman of the University of Washington, funded by the Bill & Melinda Gates Foundation, and published in The Lancet, suggest that changes in the provision of development aid for global health mean that international health spending inequalities will persist.

Gail Wilson (second from left) has co-ordinated the largest coalition ever formed in Scotland – Stop Climate Chaos Scotland (SCCS) – which has represented church groups, humanitarian bodies, environment charities, unions and others in the move to create the Climate Change Scotland Act 2009, and more recently the Scottish Climate Justice Fund. Gail’s role has been integral to the success of this very broad group, and at SCCS’s AGM in Glasgow she was presented with RSGS Honorary Fellowship by RSGS Chief Executive Mike Robinson and Dr Aileen McLeod (previously Minister for Environment, Climate Change and Land Reform). Also pictured is SCCS Chair Tom Ballantine.

Expedition America 2016

University News

Energy, sanitation and sustainable livelihoods Dr Jen Dickie, Lecturer in Environmental Geography at the University of Stirling, recently visited Tezpur University in Assam, India, as part of the Postdoctoral and Early Career Researcher Exchanges scheme funded by the Scottish Alliance for Geoscience, Environment and Society. The objectives of the exchange were to facilitate knowledge transfer and mutual learning of rural energy challenges between academics in India and Scotland, and to identify research gaps and synergies in both countries. The visit focused on the role of biogas on rural energy services and its impact beyond the ‘energy silo’ by exploring food, water and health interactions and its contribution to a local and circular economy.

Whilst the wealthiest countries by 2040 are predicted to spend an average of $9,019 per person on health, this figure for the poorest countries is only $164 per person, reiterating global health inequalities.

Talking about RSGS We are grateful to those volunteers who have given talks in their local areas about RSGS’s history, collections and current work. If anyone else would like to give talks to local groups such as Rotary Clubs or U3A groups or local history societies, we would be happy to provide you with a slide presentation. Please contact HQ if you are interested in helping us in this way.

Eradicate fuel poverty – improve health outcomes Home Energy Efficiency Programmes for Scotland is the government’s principal mechanism for increasing domestic energy efficiency, tackling fuel poverty and providing health-related benefits for residents, together with CO2 savings. Part of this mechanism is the Area Based Schemes initiative which provides energy-efficiency upgrades to properties in the most deprived areas. There are known links between achieving energyefficient housing interventions and subsequent health improvements, specifically regarding respiratory health, which is often linked to cold conditions at home. Results are most noticeable when property baseline conditions are the poorest or when residents have pre-existing respiratory illnesses. The 118 households taking part will be revisited between December 2016 and March 2017 to assess the full extent of the benefits from these insulation upgrades. Whilst the number of participants likely to experience large health benefits is potentially limited, improvements in mental health by reducing anxiety about paying fuel bills, for example, are to be expected, creating the positive knockon effect of reduced absences from work due to illness.

health inequalities

In April, Draken Harald Hårfagre, the world’s largest Viking ship, set sail from her homeport of Haugesund, Norway, in the wake of the original Vikings some 1,000 years before, to cross the North Atlantic through Iceland, Greenland, Canada, and finally arrive in New York in mid-September. The 115ft ship is a recreation of what the Vikings would call a ‘Great Ship’. It was built with the archaeological knowledge of found ships, using old boatbuilding traditions and the legends of Viking ships from Norse sagas. See www. to follow the voyage.

Development assistance for health: past trends, associations, and the future of international financial flows for health found that the growth in development assistance for health has slowed since 2010, and that the focus is shifting away from HIV/AIDS, malaria, and tuberculosis; it anticipates critical effects on health services in some low-income countries. National spending on health by source for 184 countries between 2013 and 2040 found that many lowincome and lower-middle-income countries will not meet internationally-set health spending targets, and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur.

health inequalities

Gail Wilson FRSGS

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UN appointment for Scottish geographer Professor Michael Pacione FRSGS has been appointed by the UN Habitat Human Settlements Agency as Advisor for a joint United Nations – European Commission research project on The Future of Europe’s Cities. The completed Report will be published and presented to the forthcoming Habitat III Conference to be held in Quito, Ecuador in October.

‘Your Scotland’ Do you have a favourite place in Scotland? Somewhere that has an incredible view or atmosphere? A favourite village or spot in a city? If so, we invite you to share your favourite spots in Scotland with us. We have already had some great entries from RSGS staff and Board members, and now we would really like to hear from you. Email with your entries and any photographs. We will be using entries across social media, our E-blast and blog.

Commenting on his appointment, Professor Pacione said, “it is always gratifying to have one’s particular research expertise acknowledged in this manner by an international agency. Equally this appointment is recognition of the importance of an applied geographical perspective on the urban challenges facing our contemporary world in the 21st century.”

University Medals 2015 The RSGS University Medals for 2015, recognising the outstanding Geography graduates in each university, were awarded to Fiona Arthur (University of Aberdeen), Zoe Catherine Ross (University of Dundee), and Elizabeth Prosser (University of Edinburgh). Our congratulations to them all!

Portrait of Pskov – correction

Harris. Licensed under Creative Commons © D Gore

Northton, Harris John McCrone My favourite place would be Northton, Harris because I stumbled across it whilst on a walking holiday with my then girlfriend, soon-to-be wife, and camped there post-engagement for a week! Northton has incredible beaches, as well as the ancient chapel on the site of a broch which overlooks the Sound of Harris. Neither the beaches nor the chapel are visible from any road, and we basically had no idea whatsoever that this place existed nor was it promoted at all at the time.

We would like to apologise to photographer Andrej Koksharov for a mistake in our previous magazine. This stunning image, and the others attributed to Stanislav Tikhonov, were in fact taken by Mr Koksharov.

Scottish geological attractions rank highly Three of Scotland’s key geological locations have ranked in the top ten ‘geological holiday spots’ put together by the British Geological Survey using data from their app. Ullapool came second on the list, with Skye following close behind in fifth place and Arran in ninth. The BGS app identifies local rock formations and allows users to access BGS databases in order to dig out more information on their genealogy.

Having discovered this hidden gem, we have returned many times en famille and had proposals and marriages re-conducted at the chapel by our four girls. The monks from the chapel are thought to have buried treasure in the hill above Northton in order to prevent it from being taken by an approaching army of Viking invaders. Legend has it that the treasure was never recovered and it remains buried in the hillside, which provides further opportunities for adventures with children.

David Hempleman-Adams’ Arctic adventure RSGS Vice-President David Hempleman-Adams FRSGS recently announced his latest expedition, to circumnavigate the North Pole in a single season. The journey would once take three years; however, receding ice means that it should now be possible in one season. Hempleman-Adams is using his voyage to highlight the plight of the Arctic and the effects of climate change on its delicate habitat. The four-month voyage will see the adventurer and his team sail through the Arctic seas to Siberia and Alaska, before rounding the Pole and returning via Greenland.

6 SUMMER 2016

Geographies of health inequalities Professor Jamie Pearce, Professor of Health Geography, Centre for Research on Environment, Society and Health, University of Edinburgh It is widely recognised that, at a range of geographical scales, health is distributed unevenly. At the national level, life expectancy at birth ranges from 83.7 in Japan to only 50.1 in Sierra Leone. Within countries there is also a great deal of variation in health outcomes. In the UK, life expectancy at birth is highest in the London borough of Kensington and Chelsea (85.1 for males and 89.8 for females) and lowest in Glasgow city (71.6 for males and 78.0 for females). Health also varies markedly across short distances such as between neighbourhoods in the same city. For example, in Scotland there is a 28-year difference in life expectancy between two Glaswegian children living only 14km apart. Yet this health gap is not restricted to simple dichotomies (eg, north or south, rich or poor) but, instead, a gradient in health is evident; area-level health incrementally improves from the least to most socially advantaged places. Furthermore, these differences are not restricted to mortality and life expectancy, but are consistent across most measures of physical and mental health, health behaviours, and health care utilisation. The recording and revealing of health inequalities have a long history, which in Scotland extends at least as far back as the pioneering work of Dr Henry Littlejohn during the mid-19th century. His Report on the Sanitary Condition of Edinburgh (1865) was a landmark publication, providing insights into the connections between social circumstances, employment and health in Victorian Edinburgh. Littlejohn’s analysis, which is contextualised and revealed in a recent book by Laxton and Rodger (Insanitary City: Henry Littlejohn and the Condition of Edinburgh), showed for example how childhood mortality varied four-fold across districts of Edinburgh, and that the mortality rate in Edinburgh was 10% above the highest recorded anywhere in England. More than a century later, geographical inequalities in health persist. Since Littlejohn’s time, whilst inequalities in health across UK parliamentary constituencies fell, particularly from the 1920s to early 1970s, since the 1970s health inequalities in the UK have risen sharply. Health inequalities are now as substantial as at any time since the economic depression of the 1930s. Whilst monitoring and describing geographical inequalities in health has been an important task for researchers and policy makers, explanations for this changing social and geographical profile are important. This edition of The Geographer provides some insights into how geographical ideas can reveal the social, political and environmental factors affecting health inequalities. Together this collection of work shows some of the value of geographical work in helping to understand why health conditions continue to be so uneven into the 21st century. The contributions show that it is vital to understand the connections between global, national, regional and local processes that operate to affect our health. This includes: the need for global responses to major public health challenges such as HIV prevention; the impact of the global financial crisis and associated austerity measures; the importance of wide-scale political, economic and social reforms; and the role of ‘local’ context in influencing mental health and health-related behaviours such as the consumption of tobacco and alcohol. All of the work presented here provides vital policy insights including identifying ways in which policy makers in Scotland and elsewhere can intervene to reduce health inequalities.

Over the past 150 years there have been significant improvements in the health of Scotland’s population, but these gains have not been equally shared, and health continues to become more uneven. There are compelling reasons for addressing health inequalities: they are not only unfair, they also affect everyone through higher rates of infectious diseases, greater health care costs, and ‘spillover’ effects (eg, from alcohol harm and violence). They also undermine social and economic development, and represent a waste in talent as more people are unable to fully participate and have a full stake in society. Therefore, addressing health inequalities is a key policy priority for the Scottish Government and NHS Scotland. Geographical perspectives are increasingly recognised as a vital component of a strategy to reduce health inequalities, and in Scotland the importance of social, physical and built environments that foster good health and reduce inequalities is recognised through policy initiatives such as the Scottish Government’s Good Places, Better Health strategy and the recently launched Place Standard tool. Clearly, reducing health inequalities is in everyone’s interest, and as this collection of papers shows, geographers have important roles to play in developing a comprehensive understanding of health inequalities and identifying solutions to this global concern. Critiquing, evaluating and shaping the efforts of policy makers responsible for reducing health inequalities in the Scottish Government and elsewhere will continue to be an important area of geographical enquiry.

“Over the past 150 years there have been significant improvements in the health of Scotland’s population, but these gains have not been equally shared.”

Follow the work of the Centre for Research on Environment, Society and Health on Twitter @CRESHnews




Health inequalities and foodbank use in the UK Dr Kayleigh Garthwaite, Postdoctoral Research Associate, Department of Geography, Durham University

Britain is experiencing a food poverty explosion. Increasing food poverty and insecurity has led to foodbanks becoming an ever more prominent and politically controversial feature of the welfare landscape in the UK and beyond. Foodbank use remains at a record high in 2015-16, with over 1.1 million food parcels being handed out, a 2% increase on the previous year according to the latest Trussell Trust statistics. These figures are just the tip of the iceberg. They do not include those helped by other emergency food providers, those living in towns where there is no foodbank, people who are too ashamed to seek help, or the large number of people who are only coping by eating less and buying cheaper food.

adults and children alike. Many of the people I met at the foodbank were experts in budgeting, spending hours trawling the shops for the cheapest but most nutritious food. People told me how they wanted to eat healthy food that was good for them and their family, but often had to buy less nutritious food that would keep them feeling full for longer, sacrificing more expensive fruit, vegetables and meat. Regularly skipping meals, eating out-of-date foods, relying on friends and family for meals, and a worsening of existing health problems due to not having the right nutrients, were commonplace. This led to a worsening of pre-existing ill health, particularly mental health issues, for many people I met at the foodbank.

“Food insecurity has serious adverse consequences for the mental, physical, and social health of adults and children alike.”

Recent data from the UN show that an estimated 8.4 million people, the equivalent of the entire population of London, were living in households reporting having insufficient food in the UK in 2014. Statistics show the primary causes of referral to a Trussell Trust foodbank – by far – are benefit delays, low income and benefit changes. People are not turning to foodbanks out of choice. There is a proven link between foodbank use and welfare reform which the government has consistently denied, instead preferring to blame lifestyle choices for the rising use of emergency food provision. Food poverty and insecurity has reached epidemic proportions, with an estimated 4.7 million people in the UK now living in food poverty. Poverty leading to inadequate nutrition is one of the oldest and most serious global health problems. But in 2015, dangerously poor diets are leading to the shocking return of rickets and gout – diseases of the Victorian age that affect bones and joints – according to the UK Faculty of Public Health. One in five family doctors has been asked to refer a patient to a foodbank in the past year, with GPs reporting that benefits delays are leaving people without money for food for lengthy periods of time. There are even rare reported cases of people visiting their GP with “sicknesses caused by not eating”. Evidence from GP surgeries is matched by hospital diagnoses of malnutrition, which have nearly doubled in the past five years. NHS statistics show that 7,366 people were admitted to hospital with a primary or secondary diagnosis of malnutrition between August 2014 and July 2015. These issues are central to my book, Hunger Pains: Life inside foodbank Britain, which presents rich descriptive data gathered through 18 months of field notes, observations, and in-depth interviews inside a Trussell Trust foodbank in Stockton-onTees, North-East England. Food insecurity has serious adverse consequences for the mental, physical, and social health of

As food insecurity grows, foodbanks are a vital resource and provide a lifeline for many. But we must not let them be a substitute for the changes to policy and society that need to come. We need government intervention, to stop stigmatising people who live in poverty, and to listen to the people using the foodbanks. Maybe then we can start to do something about it. How we express the collective shame that should be felt over the existence of emergency food aid will be key to the future of foodbanks in the UK.

Dr Garthwaite is the author of Hunger Pains: Life inside foodbank Britain (Policy Press, June 2016).

8 SUMMER 2016

The Scottish mortality crisis Professor Danny Dorling, Halford Mackinder Professor of Geography, University of Oxford

Death in Scotland by week, 2004-2016 – continuous series.

following graph and emailed it to me, suggesting – again – that it suggested little cause for concern.

On 16 February 2016 it became clear that a health crisis had occurred in England and Wales. Weekly death counts for the previous year revealed that the greatest annual rise in mortality had occurred in almost 50 years: a 4.6% rise in deaths in 2015 as compared to 2014. The Telegraph newspaper reported that “the elderly were now bearing the brunt of a growing crisis in the NHS and cuts to social care, with women suffering the most.” In August 2015 some 26,000 patients had waited on trollies for more than four hours to be treated, south of the border. No mention was made of what was happening in Scotland in the national or Scottish press.

Death in Scotland by week, 2004-2016 – continuous series.

There is a long and sorry history of the flu being blamed for rises in mortality that were, in retrospect, found to have other causes. In its final report on the London smog, the British Ministry of Health reported that 5,655 London deaths from influenza had occurred in the first three months of 1953. That estimate turned out to be entirely spurious. A study of influenza in London at the time confirmed this. The reason for the rise in mortality back then was the smog, smoke from burning coal. In early 2015 the reported rates of flu were low in Northern Ireland, low in Wales, low in North-West England, and within the normal thresholds in Scotland. I pointed this out at the time, and Scottish public health officials then produced the

Weekly deaths data (5-weeky rolling average)





10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52+

Week Number Death in Scotland by week, 2004-2016 – years compared. Death in Scotland by week, 2004-2016 – years compared.

Crude number of deaths per week

When officials in Scotland were altered to the crisis, they produced the graph shown below and sent it to me. They assumed that Scotland had simply suffered an unusually bad winter in early 2015. It is likely that Scottish public health officials read the advice of their counterparts in England, which The Telegraph duly reported: “We have been monitoring changes in life expectancy and mortality in England… We find the statistics for older people fluctuate quite a bit from year to year and around the country. There is often no obvious pattern to this but it is clearly important to keep a close eye on the trends and consider a range of possible explanations. In 2015, the monthly death figures suggest that cold weather and flu may have played a part in the high numbers of deaths in the early part of the year.” Health officials in Scotland thought that the 2015 rise in deaths in Scotland was simply due to the flu.

Crude number of deaths per week

“It is almost certainly the case that future analysis will show the 2015 rise in deaths in Scotland to have been unprecedented in peacetime.”

Death numbers tend to fall over time as death rates fall, and they also fall because there were so few births in Scotland in Crude annual death counts the two decades before 1946. If you draw a graph like that 58000 shown 57000 above, it is possible not to see how big the 2015 rise in deaths in Scotland actually was. I suggested that they 56000 Death in Scotland by week, 2004-2016 – continuous series. look again at their data as there had been warning of what 55000 was likely to come in 2015. In June 2014 the outgoing chair of54000 the British Medical Association in Scotland had said this: 53000 I have seen over the past five years is the continuing “What crisis 52000 management of the longest car crash in my memory – and it is time for our politicians to face up to some very hard 51000 questions. We see reports of geriatric provision coming under 50000 increasing care 2004 criticism 2005 2006 through 2007 2008 inadequate 2009 2010 2011 2012packages 2013 2014 and 2015 increasing bed-blocking and, at the same time, GPs coping with a 20% increase in workload.” I suggested that a simpler graph would be more useful: one that just showed the crude number of deaths that have occurred in Scotland in recent years. That graph should show a declining number as mortality rates tend to improve and there has not been a sudden influx of elderly migrants to Scotland. The officials drew the following graph for me. It shows an 8.5% rise in mortality in Scotland in 2015. This is almost the size England in 1 4 6 8 twice 10 12 14 16 18 20 22of 24 the 26 28 rise 30 32 in 34 36 38 40 42 44and 46 48 Wales 50 52+ Week Number that same period. It is almost certainly the case that future analysis will show the 2015 rise incompared. deaths in Scotland to have Death in Scotland by week, 2004-2016 – years been unprecedented in peacetime. All three graphs shown in this short paper were produced from the same set of statistics – the weekly death counts. Crude annual death counts 58000 57000 56000 55000 54000 53000 52000 51000 50000 2004















Health inequalities in Scotland Audit Scotland

On 18 February 2016 I received the following reply from colleagues in NHS Scotland: “Hi Danny, I’ve just had a chat with a colleague in Health Protection Scotland. They are aware of a spike in deaths in Q1 2015 which occurred across Europe and looks likely to be flu (see I will let you know what comes of the age/cause stratified data when we get it collated.” As I write, I have heard nothing more. The story appears to have gone away – for now. But it won’t go away for long. At the end of June 2016 the mid-year estimates of the Scottish population will be released and death rates for 2015 will be calculated. And then the search for the real cause of the rise in deaths will begin in earnest. There will be many candidates to look to. At older ages, death can be accelerated if care resources are overwhelmed, but we also need to know why they were overwhelmed: why was demand so high? In December 2015 it was pointed out that in Scotland “there are currently over 2,400 vacancies for nurses and midwives, up from 615 in 2011, 500 of which have been unfilled for more than three months.” Two years earlier, in 2013, it became apparent who in Scotland had been most affected by the welfare cuts. Hospitals in Scotland have been overwhelmed by less affluent elderly patients who are in poorer health, with their health having been harmed almost certainly as a result of austerity in Scotland imposed by the government that took power in Westminster in 2010. This finding has recently been reported for England in a peerreviewed medical journal. The rise in mortality in Scotland was foretold, and it could have been prevented. The crises to come this summer, when there are too few staff to cope, and in the winters to come could still be prevented, but not if those in power are not aware of the implications of their actions, or if some see the rise in early mortality as a price worth paying for the great economic good. The Chief Medical Officer’s report for Scotland was released on 20 January 2016. It made no mention of the huge rise in deaths that had occurred a year earlier. Instead it began by asking: “How can we further reduce the burden and harm that patients experience from over-investigation and overtreatment?”

Professor Dorling is the author of many books, including Unequal Health: The Scandal of Our Times (Policy Press, March 2013). In February 2014 he published an analysis in the New Statesman magazine entitled Why are the old dying before their time? How austerity has affected mortality rates. See for more information.

Tackling health inequalities is challenging. Health inequalities are influenced by a wide range of factors including access to education, employment and good housing; equitable access to healthcare; individuals’ circumstances and behaviours, such as their diet and how much they drink, smoke or exercise; and income levels. Given the complex and long-term nature of health inequalities, no single organisation can address health inequalities on its own. Community Planning Partnerships (CPPs) are responsible for bringing all the relevant organisations together locally and for taking the lead in tackling health inequalities. Many public sector bodies and professionals contribute to reducing health inequalities; it is not just the responsibility of health services. Councils have a major role through their social care, education, housing, leisure and regeneration services. The voluntary sector also has a role in reducing local health inequalities. There have been long-term increases in average life expectancy in Scotland and considerable improvements in overall health. However, there are still significant differences in life expectancy and health depending on deprivations, age, gender, where people live, and ethnic group. Reducing health inequalities will help increase life expectancy and improve the health of people in disadvantaged groups. It could also bring considerable economic benefits. For example, if the death rate in the most deprived groups in Scotland improved then the estimated average economic gains would be around £10 billion (at 2002 prices); and if the death rate across the whole population fell to the level in the least deprived areas, the estimated economic benefit for Scotland could exceed £20 billion. These are conservative estimates as they relate only to differences in life expectancy and do not include other health inequalities. Tackling the problems most commonly associated with health inequalities would also help to reduce the direct costs to the NHS and wider societal costs. For example, the Scottish Public Health Observatory has estimated that a 1% reduction in smoking prevalence would save around 540 lives a year; reduce smokingattributable hospital admissions by around 2,300; and reduce estimated NHS spending on smoking-related illness by between £13 million and £21 million.

This information has been extracted with permission from Health Inequalities in Scotland (Audit Scotland, December 2012).

10 SUMMER 2016

Explaining ‘excess’ mortality in Scotland and Glasgow David Walsh, Public Health Programme Manager, Glasgow Centre for Population Health; Dr Gerry McCartney, Head of Public Health Observatory, NHS Health Scotland The poor health profiles of Scotland, and especially that of its largest city, Glasgow, are well known. Headlines such as ‘The Sick Man of Europe’ feature frequently in the Scottish press. Much of this poor health is explained by recent experiences of deindustrialisation, deprivation and poverty: the latter are the root causes of poor health in all societies, not just Scotland. However, in addition, high levels of excess mortality – that is, higher mortality over and above that explained by differences in socio-economic conditions – have been observed for Scotland compared with England & Wales, as well as for Glasgow compared with similar UK cities.

“The comparisons of Glasgow with Liverpool and Manchester have been particularly intriguing.”

The scale of this excess is considerable. In Glasgow’s case, the rate of deaths under the age of 65 years (‘premature mortality’) has been shown to be around 30% higher than in Liverpool and Manchester, and also Belfast – all cities with similar histories, and comparable levels of poverty, to Glasgow. And that 30% higher mortality was calculated after (statistically) taking into account any remaining differences in levels of deprivation across the cities’ neighbourhoods. In Scotland’s case, the ‘unexplained’ levels of higher mortality compared with the rest of Britain add up to a staggering 5,000 extra deaths every single year. The comparisons of Glasgow with Liverpool and Manchester have been particularly intriguing. All three cities’ recent histories of industrialisation and deindustrialisation, of population growth and subsequent decline, have been remarkably similar. As are their current socio-economic profiles, with comparable (and comparably high) levels of adult poverty, child poverty, broader deprivation, and a whole

range of associated social characteristics and health behaviours (eg smoking, diet, obesity). Such similarities in the main determinants of health would normally predict similarities in the cities’ health profiles: and yet that is not the case.

A great many hypotheses have been proposed to explain what have become commonly known as this ‘Glasgow effect’ and, in the case of Scotland, ‘Scottish effect’. These have ranged from the plausible (eg inadequacies in the manner in which we measure poverty and deprivation) to the less plausible (eg the weather). The evidence behind no fewer than 40 such hypotheses was systematically and scientifically assessed in new research undertaken by the Glasgow Centre for Population Health alongside NHS Health Scotland, the University of the West of Scotland and University College London, and published in May this year in a report entitled History, politics and vulnerability – explaining excess mortality in Scotland and Glasgow. From this assessment of the evidence, the authors created an ‘explanatory model’ of the most likely underlying causes of the excess mortality in Glasgow, alongside a similar model for Scotland as a whole. The picture that emerged is, perhaps predictably, a deeply complex one. Key to the understanding of the Glasgow experience is that the city’s population has been made more vulnerable to the important influences on population health (poverty, deprivation, deindustrialisation, economic decisions taken at UK government level), consequently leading to poorer health than in other places like Liverpool and Manchester that were subject to the same influences. And this greater vulnerability has been created by a toxic combination of a whole series of historical factors, processes and political decisions. These include decades of adverse housing conditions, poor urban planning decisions, detrimental UK government Scottish Office regional economic policy, and differences in responses by local governments. Linked to some of these factors, there is also evidence of ‘protective factors’ operating in Liverpool and Manchester which have helped to reduce the adverse impact on health in those cities (and which, in relative terms, have helped to make Glasgow’s position even worse). Because of geographical scale (ie, given the large percentage of the Scottish population that live in and around Glasgow), many of the factors identified as underpinning the excess mortality in Glasgow are also relevant to the excess observed at the national level. In addition, a number of other vulnerabilities – related to, for example, other aspects of UK government Scottish Office regional economic planning – were identified as being


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linked to excess mortality in other parts of Scotland. The findings of the report (and a detailed list of policy recommendations aimed at Scottish and local government) have been endorsed by a wide range of experts in public health, history and other disciplines. There is now, therefore, a broad consensus of what the underlying causes of the excess mortality are likely to be. One consequence of this is that the unhelpful and frequently inappropriately used expressions ‘Glasgow effect’ and ‘Scottish effect’ have now arguably become redundant. This is because they were coined to describe unexplained phenomena, but most agree that the new research has identified the most likely explanations. What is now important is that people understand how the situation has arisen, the political dimensions to it, and urge politicians at different levels of government to do something about it.

Thanks to Sheena Fletcher, E-Communications Officer, Glasgow Centre for Population Health, for producing these helpful infographics.

12 SUMMER 2016

Looking behind the numbers Dr Emma Laurie, School of Geographical and Earth Sciences, University of Glasgow

The field of global health is somewhat fixated with numbers, data gathering, and statistics. Numbers are so often afforded an authority in policy, and frequently served up as rational, apolitical fact. Yet a lot lies behind the figures we encounter. Not only is there a politics to the gathering and production of these statistics, but trying to comprehend health through statistics obscures the humanity and lived reality of those who experience illness, particularly those experiencing diseases of poverty in the Global South.

“DALYs were designed with the laudable aim of taking seriously the time spent unwell, or years living with disability.”

Take Disability Adjusted Life Years (DALYs), for example, currently one of the most persuasive measurements in global health, particularly when it comes to deciding funding allocation or evaluating the success of interventions. DALYs were devised in 1993 by the World Bank, as a way of capturing the ‘disease burden’ as a single figure (calculated in US dollars). Importantly, DALYs were designed with the laudable aim of taking seriously the time spent unwell, or years living with disability after an illness, rather than simply tallying up deaths. This more comprehensive understanding of the ‘disease burden’ also allows for a direct comparison between vastly different diseases or ailments. Additionally, in capturing the burden in economic terms, they can be utilised to demonstrate ‘cost-effective’ interventions and ensure funders get ‘value-formoney’ for their investment. This economic narrative is writ large across the global health arena, and is telling of a decisive shift within global health governance under pressure to provide quantifiable results that can, arguably, push for efficiency over equity. DALYs were not without their critics when they were first developed; nonetheless, for over 20 years they have maintained a prominent position in global health, peppering the pages of numerous policy documents, and the go-to measurement for major funding bodies such as the Bill and Melinda Gates Foundation. In policy documents, the rather cumbersome (and, for me, intimidating) equation is hidden from sight. When one engages with what lies behind the number, it quickly becomes clear that DALYs are far from the rational fact we are encouraged to encounter them as. Hidden within the brackets and superscripts are a series of value-laden judgements that understand people primarily as economically productive beings. DALYs are ‘weighted’ in such a way that provide an optimum value to a 25-year-old, able-bodied, male – a decision based on (perceived) economic productivity. The lives of the very young, and old, alongside those living with pre-existing disability, are ultimately considered less valuable. William Murray, the principal economist who devised DALYs, made no apology for understanding the body through its economic potential, explicitly referring to the body as a type of machine with expected outputs after investments. Not only does this overlook the economic contribution of women and indeed children in the Global South, it is, of course, not

only the economically productive whose lives we mourn.

Also obscured within the equation are the stories of individuals who carry the burden of disease. In truth, the economic cost of illness is far more than a numerical figure, as revealed in my conversations with women living on the outskirts of Dar es Salaam, Tanzania. The strategies for finding money for medical treatment brought considerable emotional distress. Some women pawned mobile phones, mattresses, anything of value. Others borrowed, entering into a cycle of debt. In most cases, the attempts to get money had lasting consequences. Elizabeth, for example, had been paying for her daughter to go to extra-curriculum study classes, as well as saving to pay the exam fees, when her son became ill with suspected malaria. The exam money was all she had, so Elizabeth had to use this to get her son treatment. She then went to her daughter’s school and, in her own words, ‘begged’ the school to let her sit the exams, promising to pay the exam fees shortly. The school refused. Elizabeth spoke of the pain of watching her daughter stay at home the day she should have sat her exams to progress in her education. In any given story, the true cost of illness was always far more than can be captured in an equation. There is emotional turmoil and fear about being able to find the money required, and there are lasting consequences to the economic burden of diseases carried by individuals. Personalising the experiences does more than provide a series of unconnected individual stories, for individual stories have the power to tell more collective tales, politicising poverty and exposing furious injustices in the world today. Crucially, geographers are well placed to tell such stories and should take a key role in debates around health to ensure individuals are not reduced to mere floating biological beings, economic entities, or simple statistics. It is a geographical vision required to traverse scales from the individual bodies to global systems and structures, and to recognise the relationships between the political decisions made by people looking at equations in offices in wealthy cities to the lived reality of those experiencing the disease of poverty. A lot more exists when you look behind the numbers. FURTHER READING Arnesen T & Kapiriri L (2004) Can the value choices in DALYs influence global priority-setting? (Health Policy Vol 70) Laurie E (2015) Who Lives, Who Dies and Who Cares: Valuing Life Through the Disability Adjusted Life Years Measurement (Transactions of the Institute of British Geographers Vol 40)

Disability Adjusted Life Year equation (Arnesen and Kapiriri 2004)


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Where you live and how long you live Professor Clare Bambra, Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University In 1842 the English social reformer Edwin Chadwick documented a 30-year discrepancy between the life expectancy of men in the poorest social classes and that of the gentry. He also found a North-South health divide, with people from all social classes faring better in the rural South than in the industrial North. Today, these inequalities persist. People in the most affluent areas of the United Kingdom, such as Kensington and Chelsea, can expect to live 14 years longer than those in the poorest areas, such as Glasgow or Blackpool. Men and women in the North of England will, on average, die two years earlier than those in the South. Scottish people also suffer a health penalty with the highest mortality rates in Western Europe. Such inequalities exist, to varying degrees, in all high-income countries. People living in more deprived areas fare particularly badly in the ‘casino capitalism’ of the United States, where gaps in life expectancy between rich and poor areas of some cities, such as New Orleans, are as large as 25 years. Indeed, the US as a whole has a significant health disadvantage in comparison to other high-income countries with, for example, American men living on average three years less than their counterparts in France and five years less than Swiss men. Understanding and reducing these health inequalities remains a major public-policy challenge worldwide. It is not only a moral issue though; health inequalities carry significant economic costs to individuals and society (eg NHS costs, lost productivity). But the causes of such inequalities are complex and the solutions contested. Explaining Health and Place Geographical research suggests that the health of places is determined by the population composition (who lives here) and the environmental context (where you live). Who lives here. The demographic, health behaviours, and socio-economic profile of the people within a place influences its health outcomes. Generally speaking, health deteriorates with age, women live longer than men, and health status also varies by ethnicity. Levels of smoking, alcohol, physical activity, diet, and drugs all influence the health of populations significantly. The socio-economic status – or social class in ‘old money’ – of people living in a country also matters, as those with higher occupational status (eg professionals such as teachers or lawyers) have better health outcomes than non-professional workers (eg manual workers). So differences in the characteristics of people living in a country, city or neighbourhood will impact on the health of that place. Where you live. The economic environment of a country, such as poverty rates, unemployment rates, or wage levels, can influence health. The social environment, including the services provided within a country to support people in their daily lives, such as child care or health care and welfare, can also impact on population-level health. The physical environment is also an important determinant, with research suggesting that proximity to waste facilities and brownfield or contaminated land, as well as levels of air pollution, can negatively affect health. So countries, cities or neighbourhoods with worse economic, social or physical environments will have worse health outcomes.

Reducing health inequalities However, given that both composition and context matter, and can be supported by scientific evidence, politics can matter more than science in determining which strategies policymakers pursue to reduce health divides. After all, some potential solutions are politically easier to implement within existing systems than others.

“Health inequalities carry significant economic costs to individuals and society.”

For example, interventions aimed at changing individual health behaviours are far less challenging to prevailing power structures than those that demand extensive investment in improving the social environment. Indeed, by blaming people for their own health problems, such interventions let governments and businesses off the hook for the wider economic, social and environmental determinants of health inequalities. Such ‘downstream’ approaches only tackle one side of the coin and there is little evidence that lifestyle interventions are effective in reducing health inequalities: more comprehensive measures are needed. Most of the health gains over the 19th and 20th centuries were brought about by far-reaching economic, political, and social reforms which improved the environment and the position of the poorest. It has been clearly demonstrated (for example in Kate Pickett’s and Richard Wilkinson’s 2009 book The Spirit Level: Why More Equal Societies Almost Always Do Better) that more equal societies almost always do better in health terms, and the poorest and most vulnerable groups, say in Sweden or Norway, are far healthier and live longer than the equivalent groups in the UK or the US. These countries have done so through the development of a stable inclusive economy, a supportive welfare system, and a high standard of living. So, where you live matters for how long you live – and changing how we live could reduce health inequalities.

Professor Bambra is the author of Health Divides: Where you live can kill you (Policy Press, August 2016), and can be followed on Twitter @ProfBambra FURTHER READING The Scottish Public Health Observatory ( UCL Institute of Health Equity ( The Equality Trust (

14 SUMMER 2016

Artistic explorers and naturalist scientists Brian J D’Arcy

Geography is a discipline that has traditionally spanned a spectrum of interests from the arts to the sciences, covering subjects as diverse as social studies and economics, Earth science and biogeography. All those elements were developing fast during the great era of scientific exploration in the late 18th and early 19th centuries that opened up the East Indies, the Pacific and especially Australasia to the western world. That period did not simply discover new lands, colonial territories and new sources of economic wealth for the UK. It also opened up and developed new ideas to explain natural phenomena, from geology to the evolution of life on Earth. An often overlooked contribution to that scientific exploration was the contribution of natural history artists.

John Gould and Henry Constantine Richter, Tasmanian echidna. Originally published in Gould J (1863) The Mammals of Australia, Vol I.

With a strong tradition of natural history interests, The Royal Society of Tasmania is active in presenting science and art in Tasmania, a land where, even now, possums, pademelons and potoroos frequent field and forest, along with wombats, quolls, devils and flightless native hens, in a surprisingly rich diversity of life. So imagine how the island must have mystified the early European visitors, before the giant trees were felled, before any significant development, at a time when the Tasmanian tiger (Thylacinus cynocephalus) still hunted beneath the Huon pines and eucalypts of the temperate forests, and the original peoples were encountered along the coast. Not just Tasmania, but mainland Australia, New Guinea, New Zealand and the vast Pacific beyond were all being charted, surveyed and investigated, by adventurers travelling in relatively frail timber sailing boats at the mercy of the weather, on long voyages thousands of miles from home. A notable feature of that exciting era of exploration was the presence of a ship’s naturalist on a voyage. As well as collecting specimens to bring home, they needed good artists to record material, but there were no funds for such posts. One French artist, Charles-Alexandre Lesueur (1778–1846), was appointed as a gunner on the French scientific expedition to the Southern Oceans, under the command of Nicolas Baudin who used him to illustrate his private journal. An unsung Scottish artist, born in Edinburgh, was Sydney Parkinson who accompanied James Cook on his first voyage to Australia (1768-71). Faced with a daunting challenge to document an enormous variety of new plant species, he produced innovative scientific art work, using a novel technique of outline drawings and only adding colour to critical sections of the plants to allow identification and an idea of

appearance. That allowed him to represent far more species than would otherwise have been possible, and his output totalled more than 750 natural history drawings from the voyage, before he died at sea, tragically from a fever contracted during a stop-over in Batavia. He was only 26. Fortunately his remarkable drawings and paintings did make it back to Britain and remain a testimony to his contribution to our knowledge and understanding. Another laudable Scot, Walter Hoof Fitch, hailed from Glasgow. Fitch helped Sir William Hooker, then Professor of Botany at Glasgow University, with herbarium specimens, and his artistic skills led to him following Hooker when he became Director of the Royal Botanic Gardens, Kew. Fitch was employed as Kew’s official artist, and was one of the most prolific of all time; over 40 years he produced over 12,000 illustrations, including plants from lichens to orchids in the Flora Tasmaniae. The Glasgow Hookers are of course well known. Sir William was the father of Joseph Dalton Hooker, who achieved fame as a botanist explorer scientist. JD Hooker was appointed as Assistant Surgeon to the Erebus for an epic voyage to the Southern Ocean, although as he wrote enthusiastically to his father “Captain Ross considers me Botanist to the expedition.” His subsequent publications were completed with the two-volume Flora Tasmaniae (1855-59), which included in its Introductory Essay an explicit endorsement of Charles Darwin’s Theory of Evolution by Natural Selection.

“A notable feature of that exciting era of exploration was the presence of a ship’s naturalist on a voyage.”

Tasmanian echidna (Tachyglossus aculeatus setosus) foraging in northern Tasmania, January 2015. © BJ D’Arcy

Of the new discoveries, it was probably the mammals of Australia that caused most excitement when news of them began to reach European scientists. Zoological knowledge of the marsupials of Australia was of course extremely limited, initially, often based only on a few skins or skulls sent on the long voyages back to Britain without the benefit of either scientific descriptions of the animal in the wild, or preservative for the tissues of the larger specimens. The kangaroos were among the first animals to be described, and made a big impression on people. There are examples of other species of marsupial which were incorrectly


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mounted on arrival at museums, showing them as kangaroolike in stance rather than as more orthodox quadrupeds. British zoologist John Gould (1804-81) travelled to Australia in 1838, accompanied by his wife Elizabeth, who was an accomplished artist. Together they studied for two years, but following the tragic death of his wife in childbirth shortly after returning to England, Gould began an even more productive collaboration with another artist, Henry Constantine Richter, with whose help he published The Birds of Australia and the Adjacent Islands (1848) and The Mammals of Australia (1863).

lifelike. They included drawings of the Tasmanian race which has far less prominent spines and a more furry appearance than its mainland relatives.

Despite such good work, misconceptions continued, in portraying the mammalian fauna of Australia. For example, the echidna (like the duck-billed platypus, a monotreme – an egg-laying mammal) was represented in a picture by Harriet Scott, published in 1871, with eyes drawn where in fact the animal’s ears are located. A major step forward was the description of animals as close to life as possible, based on actual fresh specimens, often supported by observation of living individuals. Gould and Richter were an unusual combination of traveller scientist and home-based artist, working up material from a series of voyages. Their echidna drawings for example are more accurate, although still short of

In this era of photography – especially the digital age – it is easy to forget how dependent scientists and explorers were on naturalist artists in the formative days of geographic exploration and scientific endeavour. It is a pleasure now to be able to browse samples of the outputs of those pioneers of natural history artwork. They were major contributors to knowledge of far-flung corners of the planet in their time, and their legacy remains, as prolific and seriously talented contributors to the world’s natural history art heritage. They were also notable as part of an era when artists and scientists worked hand-in-glove to further our understanding and appreciation of the planet.

With the sad and notable exception of the extinct thylacine, happily most of the other fantastic Tasmanian mammals still survive there. The echidna still wanders around in Tasmania searching for ants and termites, as it and its ancestors have done for millions of years. And it is a lot easier to photograph a living example, behaving naturally, than to try and represent it by paintings.

WH Fitch, Sticta granulata. William Archer and WH Fitch, Large Tongue-orchid and Three-horned Bird-orchid. Both originally published in Hooker JD (1859) Flora Tasmaniae, Vol III.

The author is indebted to The Royal Society of Tasmania (RST), and especially Anita Hansen, for help with this article. The handcoloured lithographs are reproduced with permission from RST, from Hansen A & Davies M (2014) The Library at the End of the World: Natural Science and its Illustrators (RST, Hobart, Tasmania). Many of the original drawings and paintings are held in the Natural History Museum, London. RST’s archives of original publications are in The Royal Society of Tasmania Rare Book Collection held in the Morris Miller Library of the University of Tasmania.

16 SUMMER 2016

On becoming an HIV/AIDS campaigner Annie Lennox OBE FRSGS

In November 2003, I took part in a concert in Cape Town, South Africa, to celebrate and publicise the launch of Nelson Mandela’s HIV/AIDS Foundation – 46664. The day before the concert, all the artists were invited to join Mandela at a press conference held in Robben Island prison, where he had been incarcerated for 18 years. Standing in the exercise yard in front of his former cell, facing an assemblage of international press, Mandela delivered a powerful speech, describing the HIV/AIDS pandemic affecting South Africa as a genocide, with women and children as the frontline victims. With no access to treatment, thousands of lives were being wiped out on a daily basis across the country. With the highest rates of HIV infection in the world, the optimistically entitled ‘Rainbow Nation’ was in the throes of a lethal pandemic that was literally wiping out two generations.

mother wants the same thing. We want our children to be able to lead happy, healthy and fulfilling lives, with access to resources and security. Leaving the Western comfort zone to encounter people living in unbelievably challenging circumstances in so-called developing countries gives you an opportunity to reframe your references and re-quantify your values. When you begin to realise that the resources you have consumed and taken for granted on a daily basis are unavailable and unimaginable for billions of others, you start to see things very differently…

“The ‘Rainbow Nation’ was in the throes of a lethal pandemic.”

By the time I left Cape Town, I was determined to do something to contribute towards making a difference. Mandela’s words had shaken and awakened me. That was the moment I became an HIV/AIDS campaigner. As an advocate and campaigner, my main passion is identified and aligned with the rights of women and children. As a woman and mother, I have something in common with billions of women around the planet. No matter which culture, creed or social/economic strata we come from, fundamentally every

Imagine living in a remote rural environment, where the healthcare clinic is several miles away. You have no means to afford transport and can only get there by foot. If you’re desperately ill with AIDSrelated TB or pneumonia, your life depends on making that journey, so desperately sick people are lifted into wheelbarrows or pulled up onto someone’s back, to be pushed or carried for miles under the blazing sun or heavy rainfall. When you finally make it there, you usually encounter the kind of queue that will take a full day to process, and most likely there will be no doctor in attendance to properly diagnose or prescribe medical treatment, so the long journey begins once more, to return back home, defeated. Broken-down overburdened public healthcare systems, lack of trained doctors and nurses, lack of facilities, stock-outs of medication, etc. All these factors play into the HIV/AIDS pandemic with devastating consequences. I spent some time in hospital in the Eastern Cape of South Africa with a seven-year-old girl called Avelille, who weighed less than a one-year-old baby. Born with the virus, she was suffering from full-blown AIDS and pneumonia. She was terribly sick and her life was precariously in the balance. Despite the odds however, with good nutrition, AIDS treatment and health care, she did survive. And five months later, her little body of skin and bones had been transformed into a gorgeous chubby girl. Avelille is sixteen years old now. She has been doing well at school and wants to be a doctor when she grows up. Shouldn’t all children have the right to life-saving treatment and good health care? Doesn’t it make sense to give HIV positive mothers, and pregnant women, treatment and support so they can live a healthy life, and bring up their children in turn? AIDS being the biggest global killer of women of reproductive age has prompted me to ask many questions, especially concerning the chronic lack of women’s rights and health care. We will only be able to protect infants from acquiring HIV and keep their mothers alive when we protect the sexual and reproductive rights of all women. This must include the right to access quality medication and services, especially regarding family planning and the possibility of bearing children in a safe environment, with adequate facilities, free from stigma and discrimination. Additionally, we must not forget that mothers are also women in their own right, not just vessels for reproduction, as they are unfortunately so often viewed in so many places. Everyone must be treated with dignity and respect, and be supported to know their rights. Stigma, discrimination, gender-based violence, poverty and economic dependency are some of the major obstacles. This


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needs to change. We must continue working until all these barriers to services are overcome. Everywhere. Additionally, where services exist, we need to be absolutely sure that women know how to access and make use of them. Healthcare planners and service providers must respond to the needs of women living with HIV. Given the opportunity, women are powerful agents for change. We must support them in becoming so. Everyone has a part to play… from the grassroots to the law-makers, from the artists to the media, the church leaders to the marginalised, the activists, the politicians… from every cultural and socio-economic walk of life.

“Mandela’s words had shaken and awakened me.”

In March 2016 Annie Lennox received the RSGS Livingstone Medal, in recognition of her humanitarian work in helping to draw attention to the inequalities of HIV/AIDS and its impact on women and children, particularly in the poorest societies.

•3 4 million AIDS deaths. c36.9 million people living with HIV. Two million people newly infected every year. (statistics from the end of 2014) • I n 2016, HIV/AIDS is the leading cause of death of women of reproductive age globally. •O ne in three pregnant women is HIV positive in South Africa. •A IDS is the number one cause of death among adolescents in subSaharan Africa. •T here are approximately 14 million orphaned children in Africa; many of their parents died through AIDS-related causes.

18 SUMMER 2016

Women, children, water and sanitation: a way forward Professor Susan J Elliott, Professor of Geography, University of Waterloo, and Adjunct Professor, United Nations University Institute for Water, Environment and Health daily fetching water. What else could be done with those hours? Imagine the physical toll on the body of carrying 20-litre jerry cans full of water on your head, with an infant strapped to your back, no shoes on your feet, scrambling up and down steep embankments to provide (typically unsafe) water to cook, wash clothes, clean your home and your children – day after day. Many teenage girls who reach the age of menstruation have to stop attending school because they don’t have access to the privacy and hygiene resources they need. And some women with no access to sanitation facilities go far into the bush to ‘do their business’, perhaps under the cover of darkness, and are raped, a more common occurrence than any of us would ever care to imagine.

Water is the stuff of life – so why do so many suffer without it? And why do women and girls suffer more than the others? The UN member states worked very hard to attain the Millennium Development Goals (MDGs), established in 2000 and culminating in 2015. While water and its associated partner in crime – sanitation – were not explicit goals under the MDGs, they snuck in as a target under Goal 7: Ensure environmental sustainability. Specifically, Target 7C stated: To halve, by 2015, the proportion of the population without access to safe drinking water and basic sanitation. There are two takehome messages for me from this target. First, if water be the stuff of life, why didn’t it deserve its own goal? Second, one cannot address water without addressing sanitation, despite the fact that it is a rather unpalatable subject of conversation for many. A key question remains: did we attain our target? Well, in fact, we did quite well on the water front, having met the target five years ahead of schedule, with 2.6 billion people having gained access to improved sources of drinking water. According to the WHO/UNICEF Joint Monitoring Program for Water and Sanitation, an ‘improved’ drinking water source is one that adequately protects the source from outside contamination. Increased access to improved sources should be celebrated, but it does not mean that women and children (primarily girls) are not still spending countless hours (125 million hours per day on a global scale, according to water. org) fetching water for their households. Further, there remain approximately 663 million people in the world that still go without. And sanitation? Well, we fell far from our target there, with 2.6 billion continuing to lack access to adequate sanitation: almost one million of these report practising open defecation, using the bush as a toilet, with the obvious potential ramifications for the water supply, especially during the rainy season. Approximately 10% of the global burden of disease is due to water-related illness. Put more bluntly, every 90 seconds, a child somewhere in the world dies of a water-related illness. But those are just the health consequences… there is no doubt that those most greatly affected by the global water crisis are women and girls. Think about it: 125 million hours

On a recent visit to a seniors health centre in rural Africa, I attended a fellowship gathering of grandmothers; it was held in an empty classroom at a school. While enjoying the tremendous social comradery and traditional foods provided by the grandmothers themselves, I saw out of the corner of my eye a young girl of about seven years old who left her classroom, and came around to the back wall of a building, pulled down her underpants, and squatted to relieve herself. There were no sanitation facilities at the school. There was no water for her to wash her hands. Will she be a headline someday? Or worse, will she be raped and keep it to herself as many young girls do, due to issues of shame or embarrassment? So, where do we go from here? Well, the new Sustainable Development Goals finally include a specific goal – Goal 6: Ensure availability and sustainable management of water and sanitation for all. At least this time, the entire global population is included! Will we achieve it this time? And what will be the all-important ROI (return on investment)? Well, according to the United Nations University Institute for Water, Environment and Health (, meeting anticipated world water goals requires an annual investment estimated at $840 billion to $1.8 trillion over the next 20 years, but could also deliver more than $3 trillion annually in economic, environmental and social benefits. To perhaps bring this into a scope that’s easier to understand for many of us, for every $1 invested in water and sanitation, we could in fact achieve up to a $4 economic ROI, an inexpensive investment which will empower women and lift countless millions out of poverty.

“Approximately 10% of the global burden of disease is due to water-related illness.”


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Health inequalities: think about the bloody categories Dr Mike Kesby and Dr Matt Sothern, Department of Geography and Sustainable Development, University of St Andrews

population-scale lifestyle category is understandable.

Following the tragic shooting of 49 people from the LGBT community in Orlando, Florida (June 2016), thousands queued to donate blood to help the injured. Ironically given the circumstances, many gay men in those lines will have been turned away. The same would happen in the UK because, while Men-who-havesex-with-men (MSM) can donate blood after 12 months abstinence, sexually active MSM remain indefinitely deferred. Social and medical scientists seek to alleviate ‘health inequalities’, but in the case of blood donation can defend unequal treatment. Of course, prospective donors are not ‘patients’, but human rights groups complain that group-exclusion of active MSM is a violation of rights that unjustly denies inclusion and citizenship. In response, medics and epidemiological researchers observe that the objective science demonstrates higher prevalence of blood borne infections (BBI) like Hepatitis and HIV among MSM as a population, and that therefore the exclusion is not unequal but part of a consistent policy to prevent donation from potentially risky donors. While all blood is screened, tests remain imperfect and false negatives can be returned in the ‘window period’ between transmission and the test’s ability to detect BBIs.

The homogenisation of MSM is a classic example of the ‘ecological fallacy’: assuming that the characteristics of an individual can be read from population-level data. Geographers have long discussed the ‘modifiable areal unit problem’, whereby the results that emerge from data are strongly affected by the size of the scale units into which point data are aggregated. Units of analysis are ‘modifiable’, and the decisions made about where the lines are drawn are not innocent but are productive of results. In the case of blood donor selection, the ecological fallacy applies as much to the broader ‘general [heterosexual] population’ as it does to the smaller MSM group. The former, largely undifferentiated category (against which the higher risk of the MSM group is calculated) conceals within it a minority (but numerically large number) of heterosexuals who carry BBIs and also engage in the same, clinically relevant high-risk sexual practices, but these high-risk heterosexuals are not asked about sexual practice, only about direct connection to a partner from a high-risk population category (eg sex-worker, recent migrant, MSM).

“The science of current categorisation is flawed and is producing health inequalities.”

What is at stake here is not a clash of rights v science, but a question of how the science that informs policy is put together. It is a question about what categories are being used to collect and analyse health data, and their degree of fit with the phenomenon being described. The example of blood donation, important in and of itself, therefore has broader relevance for understanding health inequalities in general. Numerous studies of available large-scale data suggest that sexually transmittable BBIs are higher among the MSM category, when compared to figures for the general (heterosexual) population. This science informs the predonation questionnaires designed to profile and exclude individuals whose “practices and lifestyle” present a higher risk of recent BBI infection and therefore a window-period donation. Particular behaviours (eg frequent multiple partnering especially when associated with unprotected receptive anal sex) are strongly associated clinically with incidence. However, the pre-donation questionnaire does not in fact ask questions about practice, but rather ascribes individuals to broad and relatively undifferentiated population categories (often based on lifestyle, eg MSM) statistically associated with risk. As individuals, many MSM do not pursue high-risk practices (they are monogamous, use protection consistently and/or do not engage in anal sex) and so their sense of injustice at being deferred on the basis of a

By failing to collect data on sexual practice and to disaggregate the ‘general population’, health researchers and clinicians not only deny each other valuable information about clinically relevant phenomenon; this use of categories is neither scientifically rigorous nor equal. Health geographers could design a set of carefully directed practice-based questions that would identify and exclude the bulk of individuals pursuing the highest risk practices (across all groups). These could even be linked to existing population categories to augment rather than arrest longitudinal data sets. But first there must be recognition that the science of current categorisation is flawed and is producing health inequalities, not merely representing them. Blood donation is an example of the role that critical health geographers can play in health policy to sharpen thinking about data collection and categorisation.


Kesby M, Sothern M (2014) Blood, sex and trust: The limits of the population-based risk management paradigm (Health & Place Vol 26)

20 SUMMER 2016

Commander Edward ‘Teddy’ Evans, RSGS Livingstone Medallist 1913 Jo Woolf, RSGS Writer-in-Residence “We shook hands, and said good-bye; as they moved off we gave them three ringing cheers. We little thought that those cheers were the last appreciation those brave men would ever know. We then turned and marched homeward, constantly looking round and watching the other party until they became a little black speck on the great white horizon.”

“Evans dreamed of adventure on the high seas.“

From the days when Polar exploration meant sacrificing years of your life, if not your life itself, a handful of names are held in honour and awe. Of these, perhaps the better known are Nansen, Scott, Shackleton and Amundsen, but alongside them, and just as worthy, are men such as Teddy Evans. Born in London of Welsh and Irish descent, Evans was a rebellious schoolboy who surprised his parents, and possibly himself, by turning into a first class Naval cadet. He was despatched first to the Mediterranean, but these tame waters were not quite enough. Evans dreamed of adventure on the high seas, and his chance came in 1902 when he embarked on the Morning, a relief ship that was being sent to the aid of Robert Falcon Scott’s icebound Discovery in the Antarctic.

Evans had nothing but praise for Captain Scott, revealing in later years that to have known him was “a great thing in my life”; but the admiration was not entirely mutual. Scott, by nature cautious and reserved, was suspicious of Evans’ “boyish enthusiasms”, and described him as “well-meaning, but terribly slow to learn.” In view of Evans’ later exploits as a Naval Commander in the First World War, this sounds like a misreading of his character; but Scott did name a mountain in Evans’ honour, and when he failed to reach the South Pole at his first attempt Scott appointed Evans second-incommand of his next enterprise – the Terra Nova expedition of 1911. The distance from Scott’s winter base at Hut Point to the Pole and back was 1,766 miles – more than twice the distance from Land’s End to John O’Groats. Temperatures never rose above -18° Celsius. When you read about the long drawn-out stages of Scott’s fateful expedition, the distances they had to cover and the unbelievable loads they had to pull, it seems as if the question of who lived and who died was just a cruel game of chance. When Scott chose his final team of five men to make a bid for the South Pole, it was as if the cards of fate were drawn, but laid face down. Evans had not been chosen, and was ordered to head back with William Lashly and Tom Crean towards the base at Hut Point. He could not have known that the “little black speck on the great white horizon” was the last he would ever see of Scott and his comrades. Only 160 miles from the Pole, Evans was secretly disappointed at not being chosen for the final push. However, he had no leisure to brood, because the signs of scurvy were making themselves all too apparent, and his little party now had to turn and face the daunting trek back. With typical British stoicism he endured it in silence until the pain became impossible to bear. “After he had fainted three times in one day, thinking his end was not far off, he told the men to leave him with his sleeping bag where he was and send out relief if possible. Then took place the one act of disobedience in the expedition. They said ‘No, sir, you have stuck to us,’ and said that if he went out they ‘would all go out together.’ They put him in his sleeping bag and hauled him along with them…” With dark humour, Evans later remarked that this was “the first and last time my orders as a naval officer were disobeyed.” Lashly and Crean were eventually awarded the Albert Medal for saving his life.

Evans was taken on board the Terra Nova, and over the next few months he slowly regained his health as the ship sailed north to New Zealand. Meanwhile, on 17th January 1912, Scott became the first British expedition leader to reach the geographic South Pole. It seemed he had won the hand, but not the game, because the Norwegian explorer Roald Amundsen had beaten him to it by 34 days. And then the dice were rolled one last time. A year later, Teddy Evans was well enough to command the Terra Nova as it sailed south again into the long Antarctic summer. The crew were hoping and expecting to find Scott and his four companions safe and well, having rejoined the other team members to spend the winter in purpose-built huts on Ross Island. No communication was yet possible between any Polar base and the rest of the world. The Terra Nova reached Hut Point in January 1913, a year to the day after Scott’s arrival at the Pole. Her decks had been scrubbed and she was ready for a celebration, “our best Jacks and Ensigns hoisted in gala fashion to meet and acclaim our leader and our comrades.” Evans spied Victor Campbell, Scott’s First Officer, among the welcoming party on the beach. “I shouted out, ‘Campbell, is every one well,’ and after a moment’s hesitation he replied, ‘The Southern Party reached the South Pole on the 17th January, last year, but were all lost on the return journey – we have their records.’ It was a moment of hush and overwhelming sorrow – a great stillness ran through the ship’s little company and through the party on shore.” On 18th November 1913, Commander Evans delivered a lecture to a packed audience of the Royal Scottish Geographical Society at the Kinnaird Hall in Dundee. He emphasised that, far from being “a grim fanatic with a passion for patriotic conquest”, the typical Polar explorer is “a hero with the heart of a boy”, with a quick sense of humour and boundless reserves of optimism. He emphasised the lighter moments of Scott’s expedition, and revealed that some of the sledge dogs had been brought to Britain and were now being idolised as celebrities. Evans impressed his audience with his modesty and complete lack of melodrama, and he seems to have won the heart of at least one of the journalists present. “Commander Evans is himself a perfect example of the modern Viking. Of medium height, square-shouldered, clean of feature and limb, he conveys at once an impression of both resolution and nonchalance. His blue eyes, with long dark lashes, flash with a boyish love of adventure. His smile is warm enough to melt the heart of an iceberg. His dark head is flung back a little, and he walks the platform as though it were the deck of a battleship he was proud to command.” The next evening Evans was once more a guest of the RSGS, but this time in Edinburgh, where he was presented with the Society’s Livingstone Medal. With touching sincerity, Evans revealed that the award was of priceless value to him, because nine years earlier, in 1904, it had been conferred on his late leader – Captain Robert Falcon Scott.

FURTHER READING South With Scott by Admiral E R G R Evans


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On top of the bottom of the world Luke Robertson

Late in the evening of 13 January 2016, but with the sun still shining high in the summer sky, I took the last few aching steps to reach the South Pole in Antarctica. I had just become the first Scot, the youngest Brit, and the second-youngest in history to ski solo, unsupported and unassisted over 730 miles of snow and ice to reach ninety degrees South. Following 39 consecutive days on my feet, I was physically and mentally exhausted and very relieved to have finally reached the bottom of the world.

“These periods of ill health turned out to be the ideal psychological preparation for a solo trip to Antarctica.”

The last five days – the final ‘push to the Pole’ – had been particularly tough. Down to my very last bag of trail mix, I had burned almost all my fuel and had shed around 25% of my initial body weight. Completing the last degree, a stretch of 70 miles, in two punishing sessions had visibly taken its toll. Due to the severity of the conditions, I had the beginnings of frostbite to various parts of my body and, despite wearing a down-filled skirt to prevent the condition, the beginnings of ‘polar thigh’ were apparent on the inside of my legs. I had hoped that my experience of recovering from brain surgery only two years prior in 2014, and the memories of having a pacemaker fitted in 2008, meant that I would have the mental strength to overcome any psychological doubts. I trusted that the endurance events, the strength training, and the training expeditions to Norway and Greenland would mean I was physically strong enough to see this challenge through. In reality though, despite feeling prepared, I did not know for sure whether this would be the case. These experiences of poor health meant I have become quite accustomed to facing the unexpected. Among other lessons, these taught me to think calmly and logically when confronting challenging situations. Little did I know at the time, but these periods of ill health turned out to be the ideal psychological preparation for a solo trip to Antarctica. Whenever I found myself struggling, I would often recall how lucky I was to be in this position; that I was healthy and well enough to even be able to take on this challenge. Aside from dealing with the inherent difficulties of travelling solo in such an environment – the wind, the temperature, the hunger and the exhaustion – I had significant communication issues to overcome. My batteries and solar panels did not acclimatise quite as well to these unique conditions as I’d planned, and they failed, barely a third of the way into the expedition. This hiccup with technology did mean, however, that communication to the outside world had to be kept to a minimum, and each evening my heart would skip a few beats as I waited for the flashing light to appear at the top of the satellite headset to confirm it was ready for action. By the end, I was down to only one bar of battery on my final backup battery. But despite the journey being carried out alone and the lack of communication, at no point did I feel lonely. The logistics, the fundraising for Marie Curie, and ultimately the safe and successful conclusion to the expedition had been the culmination of an incredible amount of effort from a number of friends and family members. In particular my fiancée, Hazel, was a rock throughout, and her unwavering support and determination were

the key factors in the success of the trip. I was told by others that there might be points throughout the trip when it would seem like the long hours of sledge-pulling would never end, but that when finished, it would seem like it was over all too quick. Never was a truer word spoken. The expedition surpassed all expectations in every way possible. It had certainly been more challenging, but also far more enjoyable, than I could have imagined. Above all, it had been more of an experience than I could ever have hoped for. Since returning home, I have been taking advantage of those little life luxuries that I will never take for granted again. I’m also aiming to share my experiences of overcoming challenges, and hope to inspire others to keep getting out that metaphorical tent every single day. We all go through testing times in our lives and we all have goals we want to achieve. Not everyone needs (or will want!) to go through brain surgery or ski to the South Pole, but we all have the ability to take that first step in doing what we want to do and surprise ourselves as to how far we can go. I would like to say a huge thank-you to everyone who backed my Due South 2015 Expedition, and a special thanks to the Royal Scottish Geographical Society for the support offered. The memories have already far outweighed any physical suffering.

22 SUMMER 2016

Inequalities in mental health: geographical perspectives Professor Sarah Curtis, Professor Emeritus, Department of Geography, Durham University; Dawn Everington, Scottish Longitudinal Study, University of Edinburgh; Dr Claire Niedzwiedz, Centre for Research on Environment, Society and Health, University of Edinburgh When discussing health inequalities, it is important to consider mental as well as physical health. Mental health issues affect a large proportion of the population in countries around the globe. For example, NHS Health Scotland reported that ~15% of the adult Scotland population who participated in the Scottish Health Survey reported common mental health problems in response to the General Health Questionnaire.

that urban planning and development and local community policies may contribute in positive ways to mental (and physical) health and help to reduce health inequalities in our society. NHS Scotland is attending seriously to these issues and has developed policies and indicators to address mental health inequalities. Research can often help to inform these efforts. Health geographers are working, for example, to measure and map inequalities in mental health, and show how they are associated with ‘environmental determinants’, in order to identify the areas where intervention may be most necessary and urgent and to assess which are the most ‘powerful’ environmental and social determinants of mental health. The graph shows how the risk of reporting a mental illness among people living in Scotland in 2011 increases as the level of deprivation in their neighbourhood increases. Information on reported mental illness was summarised across data collected from more than 150,000 adults who are anonymously represented in the Scottish Longitudinal Study (a large-scale linkage study created using data from administrative and statistical sources). For those living in the most deprived areas the likelihood of reporting mental illness is almost three times that found among people in the least deprived areas (after adjusting for sex, age, family composition and economic position). This suggests that living in a deprived area may present an extra risk for mental illness, in addition to personal characteristics.

“Our mental (and physical) health can be influenced by the material, social and symbolic aspects of our environment.”

The pattern of mental disorders is socially uneven, and people in more disadvantaged groups tend to be more likely to suffer from problems with their mental health. The places where we live are important for mental health inequalities, as well as individual and family factors.

There is a growing interest in what makes for good mental health and well-being since, according to the WHO, mental health should not only be considered as the absence of disease, but rather as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Information on health inequalities is collected in population surveys, mental health service records or data on mortality attributable to mental health problems. Other research draws on in-depth studies of individual experience. The research demonstrates inequalities in mental health and well-being, across a number of social dimensions such as gender, ethnicity and income. While personal and family factors are important for these differences in mental health, various aspects of places are important for mental health inequalities. For example, the literature on ‘therapeutic landscapes’ explores how our mental (and physical) health can be influenced by the material, social and symbolic aspects of our environment. A number of studies by geographers in Scotland (and elsewhere) have shown that mental health can benefit from ‘salutogenic’ material aspects of the environment, such as visually attractive and comfortable buildings and greenspace which may feel ‘natural’ and ‘safe’, and where the economic situation is favourable, with good access to jobs, services and other resources. Mental health is generally better in places where we have a sense of ‘belonging’, and supportive links with others in the community. We may also benefit from places which are symbolically important, such as places of worship, memorials, and public buildings that represent positive aspects of our society. A sense of feeling ‘at home’ in the place where we live is also important. If the places we inhabit lack these salutogenic features, this may be damaging for our mental health. Environmental conditions in terms of greenspace accessibility and quality, built environment, economic and social conditions, vary from one area to another, and these environmental inequalities are likely to contribute to inequalities in mental well-being, mental health disorders, and use of mental health services (with associated variations in cost to health and social care services). Geographers are increasingly working with partners in non-academic agencies to develop planning strategies that are sensitive to the idea of ‘place shaping for health’, so

Our ongoing research is also examining how mental health may change over time, as socio-economic or physical environmental conditions change. We are involved in new research concerned to identify ‘what works’ to improve mental health and well-being at the community level, as well as for individuals. Given the high, and growing, frequency of common mental health disorders within the general population and large societal costs, this research is timely and important.

Geographical inequalities in risk of reporting a mental illness, showing how risk increases as area deprivation score increases. Carstairs Deprivation Indicator combines information on different aspects of deprivation in small geographical areas across Scotland, based on data from the 2011 population census. Source: Scottish Longitudinal Study. Census output is Crown copyright.

FURTHER READING Good Mental Health for All (2015) NHS Health

Scotland (

Professor Curtis is the author of Space, Place and Mental Health (Ashgate, August 2010).


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Rural mental health in Scotland Professor Hester Parr and Professor Chris Philo, School of Geographical and Earth Sciences, University of Glasgow

Imagine you are feeling deeply anxious. You need help and think perhaps you should go to a GP and ask some advice. The nearest surgery is eight miles down a single-track road and you might bump into neighbours you are avoiding these days. There is no-one locally you trust enough to share your problems with. You worry about the gossip that circulated about the local lad in the next valley when he saw a community psychiatric nurse. Such a scenario was common in findings from research funded by the UK ESRC on Social geographies of rural mental health: experiencing inclusion and exclusion. This research, undertaken 15 years ago in the Scottish Highlands, revealed diverse facets of rurality and mental health such as: a distinctive history of beliefs and behaviours around psychological difficulty; social stigma to mental health problems; and the challenge of connecting with distant or scattered others/collectives working progressively in the mental health sector. These challenges remain today, impacting not just Scotland but also other rural areas, nationally and internationally. Geographical research opens the ‘black box’ of factors influencing rural mental health, partly by hearing what matters to those living with mental health problems in rural areas, pre- and post-diagnosis. We learn that their experience can be shaped by harsh climate, hard-to-reach services, fear of local ‘gossip’ and surveillance, and a wider cultural reticence about revealing emotional distress. The status as ‘local’ or ‘incomer’ also influences whether neighbourly assistance might be sought. Indeed, a person with known mental health problems may perceive themselves as ‘socially included’ or ‘socially excluded’ in relation to the following factors: • length of rural residence: ‘local’ or ‘incomer’ status affects whether rural residents feel trusting of neighbours and local services and providers; • rural social connectedness: ‘locals’ may have a greater density of supportive local networks in times of mental illhealth; • service access and engagement: ‘locals’ may be more reluctant than ‘incomers’ to be seen to access formal mental health services. Although terms such as ‘local’ and ‘incomer’ are problematic, they signal that not everyone in rural and remote Scotland experiences mental health problems in the same way. How do these mental health concerns and experiences fit with wider realities around health inequalities? Scotland has a population of just over five million, mostly living in the urbanised Central Belt, but the rural cohort still comprises about 29% of the population. Geographical variations in

mortality are arguably greater in Scotland than elsewhere in the UK, with a range of interdisciplinary studies pointing to higher death rates in urban than in rural areas (particularly for cancer and heart disease). These characteristics relate to estimates that one in six people who live in poverty in Scotland occupy rural areas. In providing health services for these areas, the Scottish Government states that it takes account of rurality, remoteness and deprivation in weighting allocations of spending and service provision, although debates arise about how best this weighting might be done. Working groups have reviewed rural and remote health/health care, using tools such as the clinical peripherality indicators to map which NHS boards have remote and rural areas within their boundaries. Access to care is only one issue facing rural and remote areas and contributing to inequalities, however, and others include staffing levels, demographic profiles and basic infrastructures. All these factors implicate health equalities and outcomes.

“Geographical research opens the ‘black box’ of factors influencing rural mental health.”

What innovations exist in the field of rural mental health in Scotland to counter this familiar story of inequalities? The Scottish Association for Mental Health in 2012 found in surveys that 20% of people in Scotland did not know where to go for help if they were experiencing a mental health problem. NGOs like the Highland Users Group (HUG,, established since the mid-1990s, play an important role in connecting individuals in rural and remote areas. Such organisations can campaign on stigma in rural areas and work with young people in challenging engrained cultural attitudes silencing the experience of psychological difficulties. The 13 branches of HUG across the Scottish Highlands, for example, provide current service users with a forum for shared experiences and finding common ground for change. Political, professional and public understanding of the experience of rural mental health problems is a key starting-point for addressing health inequalities. In 2015 the Scottish Government laid out what kind of research matters for development of mental health policy, noting that it is keen to consider new evidence-based models of prevention, treatment and service delivery. These models should ensure integrated approaches to the physical and mental health needs of the population, together with reducing stigma as a barrier to accessing services. Fine-grained understanding of the socio-cultural geographies underlying ‘what works where’ in mental health is critical to this responsive mode of engagement.

24 SUMMER 2016

Tobacco and alcohol retailing in Scotland: implications for hea

Dr Niamh Shortt and Professor Jamie Pearce, Centre for Research on Environment, Society and Health, School of Geosciences, Univers

The consumption of tobacco and alcohol continues to pose significant public health challenges. Tobacco- and alcoholrelated illnesses are thought to account for 12.5% of all deaths globally, and in Scotland one in every five deaths is attributable to smoking compared to one in 20 attributable to alcohol. Tobacco and alcohol consumption is also an important factor in understanding health inequalities. In Scotland, more socially disadvantaged populations are more likely to smoke, report heavier drinking, and die from tobacco- or alcohol-related causes. At the Centre for Research on Environment, Society and Health (CRESH) we have been working with colleagues at Action on Smoking and Health (Scotland) and Alcohol Focus Scotland to investigate some key geographical factors affecting smoking and drinking amongst adults and adolescents. In particular we have explored the supply and availability of alcohol and tobacco products in neighbourhoods across Scotland, and the implications for inequalities in smoking and drinking patterns. We have collected data on the location of every tobacco and alcohol retailer across Scotland and used this information to develop neighbourhood density measures (the mapped data can be seen at This geographical data has then been combined with health information on mortality, hospitalisations and adult and adolescent behaviours (from the Scottish Schools Adolescent Lifestyle and Substance Use Survey and Scottish Health Survey). Amongst the findings we have demonstrated that: • the density of tobacco and alcohol outlets are comparatively high in the majority of neighbourhoods in Scotland; • Scotland’s most deprived neighbourhoods have the highest availability of both tobacco and alcohol outlets. The average density of alcohol and tobacco outlets is twice as high in the fifth most deprived neighbourhoods in Scotland compared to the fifth least deprived neighbourhoods; • neighbourhoods with higher availability of alcohol outlets have higher alcohol-related deaths and hospitalisations. For example, residents of neighbourhoods with the highest availability of alcohol outlets were more than twice as likely to die an alcohol-related death than those with the fewest outlets; • teenagers living in neighbourhoods with higher availability of tobacco are more likely to be regular smokers, or even to have experimented with smoking; • adults in these neighbourhoods have both a higher chance of being a smoker and a lower chance of giving up smoking. Why are these findings important for public health policy? The results suggest that the availability of these products matters for Scotland’s health, and that their greater availability in more deprived areas may be contributing to Scotland’s persistent health inequalities. The distribution of retail outlets puts the most vulnerable and disadvantaged populations in harm’s way. The findings demonstrate the need to address this challenge, and for governments to see the retail environment as a lever by which they might tackle poor health and reduce inequalities. Addressing alcohol- and tobacco-related harm is a key priority for policy makers in Scotland and elsewhere. In the case of tobacco, the Scottish Government has prioritised ‘Creating

a Tobacco-Free Generation’ and earmarked 2034 as the year in which Scotland’s smoking prevalence will have dropped to 5%. Such laudable and ambitious plans will need a wideranging and ambitious strategy. This will involve measures that alter the norms and attitudes towards unhealthy products such as alcohol and tobacco, and include reducing the availability of these products. At present there are eight times more tobacco outlets in Scotland than there are pharmacies. It is easier to buy poison than medicine in this country. This is not an environment that will create a tobaccofree generation. Within both tobacco and alcohol control there has been an increased recognition of the potential of supply-side interventions. Indeed the World Health Organization’s Europe Action Plan recognises both hours of sale and regulating the density of outlets as policy options. Findings from the CRESH team support such moves and suggest that tackling harm from tobacco and alcohol consumption and related health inequalities will require control over where, when and how easily alcohol and tobacco are available. This means greater local scrutiny of alcohol licence applications for example, and, in the longer-term, reducing how readily available these products are. Perhaps it is time to begin prioritising public health over business interests?


25 Geographer14-


alth and inequalities

sity of Edinburgh

“It is easier to buy poison than medicine in this country.�

26 SUMMER 2016

Transform Scotland’s Inter-City Express campaign John Webster, Volunteer Research Assistant, Transform Scotland

Our Inter-City Express campaign aims to transform rail travel in Scotland over the next 15 years, bringing all seven of Scotland’s cities closer together with a safe, civilised and sustainable mode of transport that is fit for the 21st century. The Inverness-Perth Highland Main Line railway has just celebrated its 150th anniversary – and there is much that the Victorians would still recognise. Two-thirds of this key 118mile route is just single track, which limits capacity, slows journey times and undermines reliability – and the line is still not electrified. Journey times on key inter-urban corridors such as Edinburgh/Glasgow-Aberdeen and Edinburgh/ Glasgow-Inverness are often uncompetitive with car travel because of the lack of real investment in rail infrastructure over many years. For example, in 1895 the fastest EdinburghDundee journey time was 57 minutes, while in 2012 the fastest trip was 64 minutes. The fastest Edinburgh-Perth journey in 1895 took 65 minutes, while in 2012 the fastest time was 76 minutes. In 2016, very little further progress has been made.

Ladybank, which has left the rail journey from Edinburgh to Perth slower than was possible 100 years ago. A new direct rail link between Edinburgh and Perth would slash journey times between Edinburgh and the north by 35 minutes and create a once-in-a-lifetime opportunity to make Perth station the crossroads of the rail network north of the Central Belt. The vastly under-utilised station site could realise its untapped potential as a catalyst for urban regeneration, as well as transport connectivity. Transform Scotland cannot achieve these ambitions alone. We continue to engage with businesses, transport groups and third sector organisations to make the case to the Scottish Government for equal and fair treatment for rail with road within the transport budget.

The Scottish Government is planning a range of modest improvements to rail services to and from Aberdeen and Inverness, but the timescale for implementation stretches as far away as 2030. However, road expenditure of no less than £3bn on the dualling of the A9 is planned for before 2025, with another £3bn now being proposed for the A96 by 2030. These massive public investments will of course generate increased car and lorry traffic, and undermine rail’s ability to compete – unless train journey times are dramatically improved. That means creating a fit-for-purpose electrified and doubletracked railway. These vital improvements would transform rail’s capacity and capability for both passengers and freight. If dualling is good enough for road, it’s good enough for rail too. An initial cost estimate for the double tracking and electrification of the Highland Main Line is around £1bn, a fraction of planned road expenditure. So why are roads given such priority at a time when climate change demands a vast reduction in vehicle emissions? The proposals put forward by Transform Scotland in Inter-City Express would revolutionise rail travel. Key features of the proposals are to: • double and electrify the largely single-track Inverness-Perth railway; • upgrade and electrify the Aberdeen-Inverness railway, and the connection between Aberdeen and the Central Belt; • build and electrify a new direct rail link between Perth and Edinburgh; • create a new Inter-City rail hub at Perth station. Getting freight off the A9 is another key objective. The Highland Main Line already handles significant freight flows, but given more investment in rail, hundreds more trucks could be taken off the A9 daily. This would undoubtedly reduce the toll of road accidents on this road and reduce the need for government spending to repair damage done to road surfaces. The direct rail route between Edinburgh and Perth via Dunfermline, Kinross and Glenfarg was closed in 1970 to make way for the M90 motorway. Most trains now run via

Inter-City Express is a joint campaign set up by Transform Scotland, Rail Freight Group, Capital Rail Action Group, Friends of the Far North Line, and the Scottish Association for Public Transport.

“If dualling is good enough for road, it’s good enough for rail too.”


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Deeper Than Indigo: Tracing Thomas Machell, forgotten explorer Dr Jenny Balfour Paul, Institute of Arab and Islamic Studies, University of Exeter

When Jenny Balfour Paul came across the remarkable illustrated journals of Victorian traveller Thomas Machell in the British Library, she found her own life to have striking echoes of his, not least travels to and within India and an indigo career. Retracing his journeys took her to remote parts of the Middle East, Asia and Polynesia, often in her own footsteps too. Machell of Crackenthorpe, born in 1824, left home in his teens to travel East. He witnessed important historical events, including the ‘First Opium War’ and ‘Indian Mutiny’, working as a sailor and on indigo and coffee plantations in India’s Raj heartlands. He also followed the Indus to the North-West Frontier and took passage under an Arab alias with Muslim merchants trading between Calcutta and Suez, a voyage Balfour Paul retraced by container ship in 2010. This extract, from Kissing the Crescent and the Cross, relates adventures in Muscat.

“We had a splendid adventure in the central desert and its Eden-like date gardens.”

party retreated in a huff back to the waiting plane and immediately took off for Sharjah, abandoning me as a lost cause, which suited me fine. Though penniless, I found my way into Muscat city, cadged some funds, and made contact with Gigi Crocker, a weaver, living in Salalah, with whom I had been corresponding. She drove six hundred miles in her jeep to meet me in Nizwa oasis and we had a splendid adventure in the central desert and its Eden-like date gardens, with Gigi’s Bedouin friends and Oman’s last indigo farmers and dyers. I eventually returned to UK having borrowed money for the airfare from a trusting Omani banker. Looking back, the whole escapade had a Thomas-like edge.

He leaves Muscat on New Year’s Eve 1847 in self-imposed discomfort. On learning that the wind is in the wrong direction for sailing north up the Persian Gulf he has decided instead “to go round by the Red Sea.” He writes: “I suppose we shall get to Suez in about two months ‘Inshallah’. It will be a very interesting trip and I shall have a good opportunity to improve my Arabic.” He has just boarded a baghla At last, on 22nd December, the type of dhow that he describes as “a vile Arabian headland of Ras el Hed is high-sterned antique looking craft that sighted, but the ship is becalmed appeared to have been built on the model and off-course. Thomas is grumpy on of everything that should be avoided.” Christmas Eve but at last a breeze He continues: “The mosquitoes were very springs up and the Hamoody makes troublesome thanks to the dates with Muscat harbour. which the Futel Khair was partly loaded the Once ashore, he keeps up his oriental rest of her cargo consisting of Tobacco disguise, enjoying an English officer’s from Shiraz and rugs and beautiful surprise when this long-bearded Arab carpets from Bushire. She was so suddenly addresses him in perfect lumber’d up that there was not space for English. Thomas is impressed by Entering Muscat harbour by dhow in 1847. © TM/British Library a fisherman’s walk which as all the world Muscat, sketching the harbour around knows is only ‘three strides and overboard’. I moved my traps as three sides of a page. When I went there myself I wrote: “Muscat close aft as possible (there was no place for me below decks) and must have been enchanting in the past but the old buildings as the night closed in I rolled myself up in my horse blanket and are being bulldozed and replaced in a wink by hideous concrete with my weapons at hand I lay down to sleep with one eye open villas.” “I wandered about the place,” writes Tom, “took a peep and the other shut.” into the palace diwan where the Imam’s son was holding court, had a look at the dilapidated forts and the place down which they pitch their criminals which smashes them to pieces, a Portuguese invention.” He notes the popularity of the Imam, “who lives mainly in Zanzibar,” the well stocked bazaar and the importance of the port with its “continual interchange of goods – Cloths, Rice and Spices from India and China Coffee Dates and Salt from Arabia Silks carpets tobacco and spices from Persia and also a great abundance of pearls from the Persian Gulf and slaves from the coast of Africa.” I too enjoyed Oman and its people, and Thomas would be amused to hear why and how I was smuggled into Muscat in 1995. Keen to record Oman’s last indigo dyers, I couldn’t get the obligatory ‘No Objection Certificate’ to enter the country because I was a woman and my reason weird. However, I hitched a lift to next-door Sharjah when its Ruler’s private plane flew to UK to fetch various Exeter University figures, including Glencairn [Jenny’s husband], for a fund-raising trip to Oman. From Sharjah five members of the party got permission to enter Oman, and when they set off for Muscat, again on the Ruler’s plane, I sneaked on board as stowaway. On arrival in Muscat I hung back in dark corners of the airport while the party whizzed off in shiny cars to see the Finance Minister. However, their meeting ended in a row, so the

TM in Arab dress having his hands washed in Alleppy/Alleppuzha in 1847. © TM/British Library

Dr Balfour Paul will be speaking to RSGS audiences in Edinburgh, Glasgow and Kirkcaldy in December 2016. Her book, Deeper Than Indigo, is our Reader Offer this quarter: see back page for details.

Looking south down the Suez Canal from the bridge of CMA-CGM Coral when docked at Port Said in 2010. ©Jenny Balfour Paul

28 SUMMER 2016

Climate change and the scariest graph ever Professor James Curran

Back in the 1990s I used to give many public talks about climate change. Often I would start by being quite blunt that my main purpose was to scare the living daylights out of the audience. Subsequently there’s been a lot of discussion and research about motivation to address climate change and whether it’s better to frighten people or to reassure them that the problem can be fixed. Of course there’s no definitive answer. But I’m still certain, in my own mind, that a bit of fear at the very least puts the electorate in a frame of mind which then allows Governments to take some quite challenging decisions – for example on carbon taxes, roadpricing, increasing fuel bills, or on public investment in a circular economy. We know that solutions to climate change lie roughly half in the realms of personal behaviour and half in Government policy. So, I’ll be blunt again. I think this article is frightening. And, actually, I hope you do as well. When I retired a year ago, I was keen to use the time to look closely at the carbon dioxide (CO2) data, from the Mauna Loa observatory on Hawaii, which have been collected continuously since 1958. These data are the basis of the famous Keeling curve that is credited with stimulating the initial concerns about rising CO2 levels and associated climate change. The data, of course, show rising levels year-on-year due to man-made emissions, but there is an interesting seasonal pattern as well. In the Northern Hemisphere summer, the Mauna Loa CO2 level drops quite significantly as vegetation grows across the vast land mass, only to rebound in autumn/winter as much of the vegetation dies back and biodegrades, releasing some CO2 back into the atmosphere. Some carbon, of course, is also sequestered into woody material, roots and soils. It’s straightforward to apply statistical analysis to these fluctuations and the results appeared in the April 2016 edition of the Royal Meteorological Society’s journal Weather. The seasonal drop is found to behave as shown below:

Personally, I think this is the scariest graph I’ve ever seen. It indicates that the ability of the biosphere to absorb carbon from the atmosphere peaked in 2006 and is now declining. This matters because the biosphere accounts for almost half of the ongoing removal of CO2 from the atmosphere, with the oceans absorbing the remainder. That this might happen at some point in the future has been a feature of the longstanding thinking that ‘positive feedback’ in climate change might occur which, at its extreme, could result in runaway or irreversible climate change. This is the process by which climate change could disturb ecosystems to such an extent that they begin to fail in providing their ecosystem services – one of which is absorbing carbon. This might happen as a result of extreme heatwaves, drought, floods, pests/diseases, or wildfires significantly damaging forests or other natural vegetation and crops, or perhaps also as a result of seasonal CO2 releases from melting permafrost. So far this has only been a hypothesis and thought likely not to happen for another 20 to 30 years. However, this graph indicates that it’s real and already happening. So how much does it matter? Well, a follow-on paper which is about to be published in Weather provides some further analysis which indicates that, already, this decline in biosphere sequestration is equivalent to adding another 30% to emissions. That’s another China added to the global inventory. It may not be so surprising then that atmospheric CO2 seems to be rising faster than ever, just when man-made emissions have plateaued over the past couple of years. So be scared. More than ever this is the time to review personal behaviours and to support Governments, wherever and whenever, in taking the tough decisions which are increasingly and urgently needed.

“The ability of the biosphere to absorb carbon from the atmosphere peaked in 2006 and is now declining.”

James Curran retired as Chief Executive of SEPA in 2015. This research was unpaid and done in his own time. Earlier in his career he gained a doctorate in forest/ atmosphere interactions, and designed and built the weather station on Cairngorm. He is a Chartered Meteorologist.


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Climate targets to make a global difference Mike Robinson, Chief Executive, RSGS

Scotland has undoubtedly set an example of leadership in tackling climate change on the world stage. It introduced the world’s first climate justice fund, however modest, which allocates around £3m of funding per year to projects in developing nations affected by climate change. In 2009, it also enacted the most stringent climate abatement targets in the world, which received unanimous cross-party support, and featured an interim target of reducing emissions by 42% (from 1990 levels) by 2020. In 2010, I was asked to chair the Scottish Parliament’s ShortLife Working Group on Climate Change, in order to resolve the level of the early annual targets after there was disagreement within the chamber. There was a concern that achieving 42% reductions was beyond our reach. However, as announced in June, it does look certain that we will achieve the 42% target after all – and early. This is in part due to changes in the production of energy away from coal, in part due to loss of heavy industry, in part due to wider policy efforts, and in part because the 1990 baseline figure has been more accurately calculated (because of better scientific data). Therefore it’s by circumstance as much as by design. It’s good, but it’s not great. The Scottish Government has a manifesto commitment to bring forward a new Climate Act, which will revise these targets. The existing targets were, after all, agreed with a 2°C threshold in mind. With the 2015 Paris Climate Conference recognising the need to keep temperature rises below 1.5°C, perhaps there is an opportunity both to revise these targets to take account of the new baseline, and to revise the commitments upwards to reflect the need for greater urgency and effort.

create and what infrastructure we invest in. We all have a role to play. I believe there is huge merit in Scotland showing leadership around climate change; after all, the whole world needs to become more sustainable, probably for the first time ever, so there is much to be done, and opportunity in being ahead of the curve. So how can we make the greatest difference globally to this issue?

“There is huge merit in Scotland showing leadership around climate change.”

RSGS has been working with the ECCI, Scottish Government, 2020 Business Group and others to ascertain exactly that – how Scotland can best contribute to global emissions reductions. Through a project called Bitesize we have used the IPCC Fifth Assessment Report to help identify those chunks of effort which Scotland could demonstrate, pilot, inform or directly assist, which will help other nations reduce their emissions, exporting Scottish expertise and international example, and helping deliver on domestic targets. We will convene a meeting later in the year to bring all the various sectors of Scottish society together to discuss how we might begin to take action on these. If we do see strong targets in any new Act, a robust RPP3, a continued commitment to climate justice funding and a series of international ‘Bitesize’ examples, Scotland should be better placed than ever to claim leadership in one of the most defining issues of our generation.

A higher target of 55% or more by 2020 would realign the targets to better reflect this changing baseline. This is expected to be the level required (according to the UKCCC) to achieve the equivalent of the original 42% commitment. Beyond 2020 though, it is a strong 2030 target that would best underline the urgency with which we need to take action. And more stringent 2040 and 2050 targets could reflect the 1.5°C ideal threshold and give an incredible example to the rest of the world to accelerate their ambition. It will be interesting to see how proposed commitments match up to this. Nonetheless, targets are only that, and it is essential that the right policies are put in place to ensure their achievement, if we are to play our part in solving this problem. And more than that, perhaps help lead, guide and advise this global change. This issue is not going to go away, and the bolder we are in confronting it, the sooner we can face up to the future with confidence and help others around the world to do the same. During 2016 the Scottish Government will be working to produce a plan of how to meet these emissions reductions (the Report on Policies and Proposals version 3, or RPP3) which will inform this transition. This should then become the blueprint by which all sectors of society can engage. Of course each of us will also, to a degree, contribute to these targets, one way or the other. The real tests, both personally and nationally, are going to be the decisions we make about how we travel, how we heat our homes, how we produce electricity, how we grow our food, the waste we

This chart, produced by Dr Ed Hawkins, National Centre for Atmospheric Science, University of Reading, is available online as a moving gif ( It depicts average global monthly temperatures since 1850. The trend shows a clear outward spiral (warming trend) ending in the yellow line which indicates a leap in global averages in the six months to April 2016.

Key purple: 1850 to 1890s blue: 1900s to 1930s green: 1940s to 1980s yellow: 1990s to current


30 SUMMER 2016

River Forth From Source to Sea

Richard Happer and Mark Steward (Amberley Publishing, October 2015)

Some 200 photographs allow the reader to enjoy a virtual journey down the Forth, which packs more interesting historical and geographical attractions into its relatively short length than any other river in Britain. It rises on the eastern slopes of the mighty Ben Lomond, then ambles through the Trossachs, an area of scenic lochs and forests nestling amid crumpled hills. Stirling Castle guards what was for centuries the furthest downstream crossing of the river, a vital nexus between highland and lowland, east and west. After Stirling, the River Forth becomes the Firth of Forth, the most substantial estuary on the east coast of Scotland.

A Natural History of Lighthouses

To Oldly Go

John A Love (Whittles Publishing, September 2015)

Tales of Intrepid Travel by the Over-60s

This book highlights the contribution made by lighthouse keepers to the study of natural history, and ornithology in particular. Much of this is discussed in the words of the keepers themselves, set in the context of lighthouse history. Scotland has an especially rich lighthouse tradition, mainly due to a dynasty of Stevenson engineers with a profound understanding of weather and geology, and indeed natural history, so important in the placing of their lighthouses. Several redundant lighthouse buildings still function as bird observatories, wildlife viewpoints and study centres.

edited by Jennifer Barclay and Adrian Phillips (Bradt Travel Guides, September 2015)

The scandal of our times

Maps That Changed the World

Professor Danny Dorling (Policy Press, March 2013)

John O E Clark (Batsford, February 2016)

In the US and the UK, health inequalities have now reached an extent not seen for over a century. Most people’s health is much better now than then, but the gaps in life expectancy between regions, between cities, and between neighbourhoods within cities now surpass the worst measures over the last 100 years. In almost all other affluent countries, inequalities in health are lower and people live longer. Professor Dorling provided new chapters and updated a wide selection of his influential writings, including international peer-reviewed studies, annotated lectures, newspaper articles, and interview transcripts, to create this accessible, contemporary and authoritative book.

This beautifully illustrated history of cartography features some of the world’s most famous maps, stretching back to a time when cartography was in its infancy and the ‘edge of the world’ was a barrier to exploration. Each map has its own story to tell, be it a Babylonian clay map of the world, an exquisitely engraved 17thcentury Dutch atlas, or a simple colourcoded rail map. Among the ground-breaking examples included are the first maps of the New World, maps that presaged brilliant military campaigns, and those that stretched reality in the name of political propaganda.

Reader Offer - 30% discount & free p+p

Offer ends 30 September 2016

Deeper Than Indigo Tracing Thomas Machell, forgotten explorer Jenny Balfour Paul (Medina Publishing, June 2015) This intriguing odyssey, set on the edges of time, encompasses biography, memoir, detective story, travelogue, history and an enthralling love story. Balfour Paul tracks an elusive young man of the past, to the China Seas, remote islands of Polynesia, India’s plantation lands, and deserts of Arabia. This remarkable tale of East-West connections brings to life the untold story of a spirited outsider at the height of the British Raj. Serendipity, intuition and an enchanting relationship, as well as Balfour Paul’s quest to uncover the missing years of Machell’s life and his aspiration to write ‘a novel in the form of an autobiography’, give this book its magical extra dimension.

Readers of The Geographer can purchase Deeper Than Indigo for only £16 (RRP £22.95) with free UK p&p and a complimentary handmade indigo-dyed bookmark. To order, please visit and enter the code ‘DTIRSGS’ at the checkout, or quote the code in any correspondence if paying by cheque.

RSGS: a better way to see the world Phone 01738 455050 or visit to join the RSGS. Lord John Murray House, 15-19 North Port, Perth, PH1 5LU Charity SC015599

Printed by on Claro Silk 115gsm paper. 100% FSC certified using vegetable-based inks in a 100% chemistry-free process.

Unequal Health

This collection of remarkable tales from ‘Silver Travellers’ brings together contributions (some original, some previously published) from independent-minded souls whose experiences have been entertaining, amusing, thrilling, and even a little irresponsible. Dervla Murphy travelling in Cuba aged 74, Matthew Parris swimming the Thames at 60, and Colin Thubron climbing the last stronghold of the Assassins in his 60s are among the writers recounting their adventures, often defying expectations – and the odds – and going outside their comfort zone to take a less-travelled path in later life.