Critical Realist Approach To Geography And Health

Geographic studies on health care and wellbeing have often been divisive. Some researchers have primarily been devoted to health structures, examining correlates and predictors or describing patterns in data using sophisticated statistical techniques (Aday & Andersen, 1974; Buor, 2003; Wilson & Rosenberg, 2004); whereas others have focused on psychosocial elements and/or the cognized environment and how they influence or inform the patterns of health care access, usage and behavior (Parr & Philo, 2003; Parr, Philo & Burns, 2004). The task for most emerging health geographers and researchers including myself has been to merge these dichotomized approaches to health studies and social science at large (Hartshorne & Clark, 1962; Lawson & Staeheli,
This critical realist worldview argues that phenomena in the real world that we study as researchers are structured and possess causal powers and liabilities (Sayer, 2015). Expanding on the unobservable structures of reality, critical realist acknowledge two types of such aspect of reality: capitalist or other structures and the forces of power; and structures formed from experiences and conceptions “in people’s heads”, which are often the basis for actions (Holt-Jensen, 2009). Critical realism thus embraces the hermeneutical dimension of reality and recognizes the influence it can have on behavior and the wider social structures we observe as geographers (Sayer, 2000, 2015). In applying this concept to health studies or any phenomenal inquiry in geography, critical realism enables us to incorporate human meaning and experiences in our study, thus examining the influence of these on the observed health structures or health care usage patterns we observed in the “big data” (Bergin, Wells & Owen, 2008; Clark, Lissel & Davis, 2008). In other words, the double inclusiveness of critical realism, offers health researchers and geographers a leeway between positivist’s reductionist approach and constructivist’s relativist approach in health studies and geography in general (Wainwright & Forbes, 2000; Danermark et al. 2002 cited by Bergin, Wells & Owen, 2008; Holt-Jensen 2009; Sayer,