The British Columbia Atlas of Wellness
November 4, 2013
Review By Neil Hanlon
Maps and atlases have acquired a mystique in the lore of public health since the publication of Dr. John Snow’s famous cholera map of London in the mid-nineteenth century. Somewhere along the way, a notion emerged that mapping disease events had led to major breakthroughs in understanding and containing communicable disease transmission. In practice, maps have rarely, if ever, achieved such heroic feats. More often they are employed, and at times manipulated, to make a point. Such was the case with Snow’s map, which did not appear in his original and groundbreaking study of cholera but, instead, was added to the second edition in 1854 to reinforce his contention that cholera is a water-borne disease. In any case, maps have since become popular tools of communication for health practitioners, planners, and researchers, and atlases of disease and health outcomes continue to appear on a regular basis.
British Columbia has been the setting of a number of health atlases over the past two decades. These collections have now moved well beyond a preoccupation with illness and mortality to include such topics as the distribution of health care personnel and resources, variations in service utilization, and the mapping of social conditions known to influence health outcomes. Noteworthy examples include the two editions of The BC Health Atlas, which successfully integrate epidemiological methods, community health concepts, and cartographic techniques (McGrail and Schaub 2002; McGrail, Schaub, and Black 2004).
Into this crowded landscape enters the first edition of The British Columbia Atlas of Wellness. The work is co-edited by Leslie Foster, a veteran of the BC health atlas scene, and Peter Keller, who is internationally renowned for his work in cartography and geographic information systems. With contributions from a wide range of scholars and consultants, the Atlas contains more than 270 maps and over 120 indicators of wellness. Chapter 1 outlines the goals of the Atlas and its origins as the progeny of the provincial government’s ActNow BC initiative. Chapter 2 summarizes various definitions and dimensions of wellness from the literature. Chapter 3 offers information about data sources, tips for interpreting the maps and measures, and the obligatory cautionary notes about the data and mapping techniques employed. Chapter 4 provides an overview of diverse socio-demographic and physical geographic characteristics across the province. Maps of wellness indicators, the main attraction, are presented in the seven sections of Chapter 5, comprising approximately 150 of the book’s 235 pages. The final chapter combines a number of the indicators in a series of summary maps intended to benchmark areas achieving “best wellness” (209) results.
The maps themselves are highly legible, technically sound, but by no means dazzling. All are printed in colour, although the choice of palette, ranging from forest green, representing the most positive results, to a clay red at the other end of the spectrum, may not appeal to everyone. Most employ Health Service Delivery Areas (HSDAS), the major administrative sub-units of the province’s regional health boards, as the basic geographic unit of analysis. This selection was made primarily to enable the use of data from the 2005 cycle of Statistic Canada’s Canadian Community Health Survey, whose sample sizes are too small to permit a more local level of analysis. While such a choice is understandable, the HSDAS are a tad large to serve as a basis for discussion about local-level action to promote wellness.
The Atlas provides a checklist menu of literature on the concept of wellness rather than a critical synthesis, and no operational definition to guide the work is offered. In fact, there are some glaring discrepancies between the wellness dimensions listed in Chapter 2 and the indicators chosen to be mapped in Chapter 5. Why, for instance, are there no indicators of spiritual, occupational, and environmental wellness? In terms of the indicators selected, I felt there was too much emphasis on what public health practitioners refer to as modifiable health risks, such as smoking, diet, and exercise behaviour. This is clearly in deference to the priorities of the ActNow BC initiative, but I would prefer to see indicators chosen to meet conceptual criteria rather than policy direction. In this regard, the maps of “assets and determinants” (51-93) and “wellness outcomes” (185-208) were the most relevant to the subject at hand, and were effective in meeting the goal of providing readers with “food for thought to imagine the more dynamic aspects of everyday life that so profoundly shape the health and wellness experiences of populations” (19).
I found apparent contradictions in some of the results to be as intriguing as the cumulative summaries presented in Chapter 6. It was interesting, for instance, that non-metropolitan areas scored highest in measures of wellness determinants, such as social support, and sense of belongingness to the local community; yet many of these non-metropolitan areas scored the lowest in terms of wellness outcomes, such as being free of barriers to activities both inside and outside the home, and overall health utility. Perhaps consideration of, and discussion about, these and other findings will spur future advances in research, practice, and policy.
Overall, and in spite of its shortcomings and compromises, this work is a nice complement to earlier atlases of health and disease in British Columbia. The content is highly accessible to the non-expert, and a conscientious reader should be able to make reasonable and cautious interpretations of the material, thanks to the helpful introductions and summaries provided. The Atlas is thus well positioned to serve as a platform for discussion about community-level wellness promotion, as it was intended to be. The book’s affordable price of forty dollars and its availability for free download on the internet further reinforce the sincerity of this effort. While there are no life-saving discoveries to be found here, there is plenty of challenging information that may well lead to breakthrough dialogue and action.
McGrail, K., and P. Schaub. 2002. The British Columbia Health Atlas, 1st ed. Vancouver: Centre for Health Services and Policy Research, University of British Columbia.
McGrail, K., P. Schaub, and C. Black. 2004. The British Columbia Health Atlas, 2nd ed. Vancouver: Centre for Health Services and Policy Research, University of British Columbia.