Practicing health geography in 2017 IMGS 2017 Editorial.

This commentary is an introduction the special issue of Social Science and medicine composed of pieces of work presented at the International Medical Geography Symposium (IMGS) held in Angers, France in July 2017. Every two years, the symposium brings together health geographers and others interested in applying a spatial approach to their research to share findings and form new ideas about the progress of this exciting sub-discipline. 279 delegates from 30 countries attended this symposium hosted only for the second time outside the Anglo-Canadian-American triangle.

A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses.

Buruli ulcer is a neglected tropical disease caused by M. ulcerans, an environmental mycobacterium. This cutaneous infectious disease affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. Stagnant open bodies of surface water and slow-running streams are the only risk factor identified in Africa, and there is no human-to-human transmission. Appropriate and effective prevention strategies are required for populations living in endemic areas. Based on a multidisciplinary approach in an area in which Buruli ulcer is endemic in South Benin, we investigated the link between all human-environment interactions relating to unprotected water and behaviors associated with Buruli ulcer risk likely to affect incidence rates. We characterised the sources of water as well as water bodies and streams used by communities, by conducting a prospective case-control study directly coupled with geographic field observations, spatial analysis, and the detection of M. ulcerans in the environment. A full list of the free surface waters used for domestic activities was generated for a set of 34 villages, and several types of human behaviour associated with a higher risk of transmission were identified: (i) prolonged walking in water to reach cultivated fields, (ii) collecting water, (iii) and swimming. Combining the results of the different analyses identified the risk factor most strongly associated with Buruli ulcer was the frequency of contact with unprotected and natural water, particularly in regularly flooded or irrigated lowlands. We confirm that the use of clean water from drilled wells confers protection against Buruli ulcer. These specific and refined results provide a broader scope for the design of an appropriate preventive strategy including certain practices or infrastructures observed during our field investigations. This strategy could be improved by the addition of knowledge about irrigation practices and agricultural work in low-lying areas.

Effect of well drilling on Buruli ulcer incidence in Benin: a case-control, quantitative survey.

BACKGROUND: Buruli ulcer is the third most common mycobacterial disease worldwide. The public health burden of this neglected tropical disease is large, particularly in poor areas of west and central Africa. The development of appropriate preventive strategies is hampered by an incomplete understanding of the epidemiology and transmission of the disease. We investigated the effect of the drilling of wells on Buruli ulcer incidence. METHODS: In this case-control, quantitative survey, we obtained field data for Buruli ulcer incidence over a 10-year period from a specialised centre that collected data for the Ouémé and Plateau departments in Benin, and data for well drilling from the Ministry of Energy, Water and Mines in Benin. The coordinates of the wells drilled were obtained during site visits. A case-control study was then done to investigate the role of well water use in protecting against Buruli ulcer. FINDINGS: We found a strong inverse correlation between the incidence of Buruli ulcer and the number of new wells drilled in the Bonou municipality (r2=0·8818). A case-control study (106 cases and 212 controls) showed that regular use of the water from the wells for washing, bathing, drinking, or cooking was protective against Buruli ulcer (adjusted odds ratio 0·1, 95% CI 0·04-0·44; p=0·0012). INTERPRETATION: This study opens up new possibilities for developing an effective yet affordable policy to fight the disease on a substantial geographical scale. Our study shows that providing access to protected water is an efficient and feasable way to reduce the incidence of Buruli ulcer. FUNDING: Fondation Francaise Raoul Follereau, French National Institute of Health and Medical Research, and Région Pays de Loire.

Parallel worlds? French and anglophone perspectives on health geography.

In this short commentary, we address the following question: setting aside the issue of translation, do health geographers in France speak the same language as their English-speaking counterparts in various parts of the world? Specifically, do they have comparable empirical, theoretical and political concerns? We briefly survey the 'states of knowledge' in both fields for points of difference and similarity. We devote particular attention to the diverse contexts in which health geography is practiced. Our overarching goal is not to oppose two 'blocks'; nor is it to produce syntheses of two bodies of work. Rather, we seek to identify the diverse contexts in which geographic knowledge of health issues is produced, and to encourage reflection on what these mean for current and future collaboration across linguistic boundaries. We contend that meaningful Anglo-French comparative work will need to be particularly attentive to takes on theory that is 'the same, but different', to alternative spatial lenses (territory vs. place), and to sometimes sharply distinct perspectives on social difference.

Local Experiences in Community Health: Examples from Canada, Brazil and Mali, and an Experiment in France.

This paper presents the findings of international research with an original approach anchored in health geography, which illustrates the importance of place as a dimension in community health. The aim of the research is to identify the success factors in the processes used to build community health initiatives at the local level. The study is based on interviews encoded and analysed using the framework of the grounded theory. Three main themes-the place, the community and healthcare supply-and two cross-cutting issues referring to 18 explanatory dimensions are identified. These findings are then put to the test in France through an action research approach. Overall, the work suggest avenues to enable the transferability of successful elements of community health initiatives.

Health geography's voluntary turn: a view from western France.

This paper examines the potential for prevailing Anglo-American perspectives on voluntarism to inform understanding of health and social care internationally. Focusing on the économie sociale et solidaire and its involvement in the secteur médico-social in France, it evaluates the transferability of a theorization about the evolving role of voluntary organizations and volunteers for the purpose of interpreting research on service provision in ageing communities. A case study of local associations is analyzed to uncover their emergence within evolving spaces of care, how they facilitate adjustment and create opportunities for resistance to the dual challenges of ageing and restructuring as well as the complexity underlying their multifaceted responses. The findings contribute to understanding the link between voluntarism, health and place, and address calls to expand the international scope of health geography within the 'voluntary turn' in health policy and research.