Elsevier

Health & Place

Volume 53, September 2018, Pages 264-267
Health & Place

Commentary
Connecting qualitative research on exercise and environment to public health agendas requires an equity lens

https://doi.org/10.1016/j.healthplace.2017.09.005Get rights and content

Highlights

  • Geographies of physical activity have been critiqued for environmental determinism.

  • Qualitative research on exercise and environment offers a potential antidote to this.

  • To effectively inform public health agendas, qualitative research must centre equity.

  • Public health critique and critical praxis are mutually necessary to affect change.

  • Creative methods can help connect qualitative research to public health agendas.

Abstract

In this commentary, I respond to the special section in Health & Place (vol. 46) on “Exercise and environment: new qualitative work to link popular practice and public health” edited by Hitchings and Latham. I argue that if qualitative research is to effectively inform public health policy and practice it cannot ignore the fact that physical activity participation is inequitable. Without building in a critical equity lens, geographers risk perpetuating the “inequality paradox”—that is, the potential for population health interventions to inadvertently exacerbate health inequalities. Related to this, I challenge the editors’ assumption that geographers’ critiques of public health approaches to physical activity and our applied efforts to foster physical activity participation are mutually exclusive endeavours. Rather, I argue they are mutually necessary within a social justice agenda. Finally, I close this commentary by offering ways forward for qualitative research on exercise and environment to connect with public health agendas and inform interventions.

Introduction

Writing in the pages of the critical geography journal Antipode almost thirty years ago, John Mohan (1989) reviewed four medical geography textbooks and arrived at the prognosis that “medical geography requires radical surgery” (p. 176). Although citing critical potential in two of the texts, Mohan concluded that they were substantively lacking in prescriptions for progressive change, constrained in their scope by their empiricist persuasion, privileging of aggregate data and large spatial units, and inattention to difference and first-hand experience. Some of the very limitations raised by Mohan—a dearth of qualitative methods and experiential data, inadequate consideration of gender and other axes of social difference, and narrow focus on conventional Western medicine—were cornerstones of the early medical geography sub-disciplinary identity debates of the 1990s which pushed the field toward a more inclusive medical and health geography (Dorn et al., 2010; Kearns, 1993; Kearns, 1995). Recent critiques have cautioned that geographies of physical activity may be falling into similarly determinist traps that characterized early medical geography (Andrews et al., 2012b, Blacksher and Lovasi, 2012, Colls and Evans, 2014, Rosenberg, 2016). The recent Health & Place special issue on qualitative research on exercise and environment, edited by Hitchings and Latham, offers a potential antidote to this, but I contend it does not go far enough. Responding to this special issue, in this commentary I illustrate why.

In their introduction, Hitchings and Latham (2017a) offer five themes via which qualitative research on exercise and environment can connect with public health agendas: (1) varied nature of environments; (2) differentiation from sport; (3) sociality; (4) pleasure; and (5) changing practices; however, they overlook one cross-cutting ingredient to affecting change: equity. I argue that if qualitative research is to effectively inform public health policy and practice it cannot ignore the fact that physical activity participation is inequitable. I do not dispute the value of the areas Hitchings and Latham identify, but rather caution that without building in a critical equity lens, geographers risk perpetuating the “inequality paradox”1—that is, the potential for population health interventions to inadvertently exacerbate health inequalities (Frohlich and Potvin, 2008). Related to this, I challenge the authors’ assumption that geographers’ critiques of public health approaches to physical activity and our applied efforts to foster physical activity participation are mutually exclusive endeavours. Rather, I argue they are mutually necessary within a social justice agenda. Finally, I close this commentary by offering ways forward for qualitative research on exercise and environment to connect with public health agendas and inform interventions.

Section snippets

Putting an equity lens on exercise and environment

Being against (medicalised and individualised) exercise and appreciating the potential for it to become a poisoned elixir (rather than medicine) shifts priorities and opens up new possibilities. The solution is simple, but not easy: reducing inactivity and inequality. Refusing inequitable intervention enables the promotion of exercise to meaningfully influence the lives and health of marginalised and excluded people and reduce related inequalities. (Williams and Gibson, 2017, p. 13)

Physical

Critique versus critical praxis

To excavate these aspects of inequities requires critique; yet, Hitchings and Latham (2017a) claim that “efforts to increase activity” are somehow at odds with how “so much social science activity is taken up in critique” (p. 304). This draws an unhelpful line between the roles of critique and critical praxis, which I argue undercuts the aim of connecting qualitative evidence with public health agendas. Parr (2004) distinguishes between critical thinking, which can reveal channels to praxis,

Getting creative for change

To be for practice, and to promote physical activity as social justice and public service, we must move beyond typical academic research to other types of scholarship. (Gill, 2011, p. 311)

Qualitative methods in health geography have been conceived as having the potential to bring previously neglected perspectives and everyday life experiences into the policy arena (Dyck, 1999). While Hitchings and Latham advocate for more than cultural critique to connect with public health agendas, they stop

Conclusion

There is potential to connect qualitative research with public health agendas, as showcased in Hitchings and Latham's special issue on exercise and environment. In this commentary, however, I have argued that doing so requires an equity lens—or we risk perpetuating social inequalities in physical activity participation. I demonstrated that rather than dismissing critique in connecting qualitative research with public health, we can benefit from embracing critique and critical praxis as integral

Funding

None.

Acknowledgements

Thank you to Gavin Andrews and Mark Rosenberg for comments on earlier versions of this paper.

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