As clarified in the preface to this book, its subtitle, Geographical Connections, can be interpreted both in terms of the connections or flows that occur in geographic space and the relations between the environmental and social factors that shape disease incidence and unequal health. Two earlier chapters have dealt separately with the mobilities of populations and material goods, and I turn now to the spread – but also the incidence – of infectious disease. Of course, the movements of materials, people and pathogens are all interrelated.

The emergence of a new coronavirus in late 2019/early 2020 has, as Cambridge geographer Matthew Gandy predicted in 2008, brought into the sharpest focus the impact of a new disease (Covid-19), and I consider here, briefly, the origins and wider determinants of the infection. I devote most of my attention to the differential impacts on (and within) nation states, particularly in the Global South, as well as inequities in how the disease has been managed through vaccination. Discussions of global vaccine availability and equity take us back to issues of global governance discussed in Chapter 4.

A key theme in the spread of the virus (SARS-CoV-2) that has transmitted Covid-19 relates to the networks of transmission through international movement, and I consider how changing patterns of air travel have enabled the spatial spread of infections – including newer strains of influenza. But I also consider other emerging and re-emerging infections, including an earlier coronavirus (SARS), as well as Ebola, for which mobilities across borders were less related to air travel but, rather, to road and track. The late Paul Farmer argued, in his last book, that the failure to deal with Ebola can in part be traced back to colonial exploitation and injustice. As he puts it, in west Africa “disease containment was a priority but care was not” (Farmer 2020). Much the same was true about Covid-19 in many parts of the world.

Earlier he was also careful (Farmer et al. 2013) to make the point that empirical research on disease requires not merely comparisons between countries but detailed data collection on local and regional variations in incidence.

My focus here is on the extraction and movement of materials that are either healthdamaging or whose transfer across geographic space results in potential harm. To that end, I concentrate on: mineral extraction; the transfer of waste, especially plastics; and arms transfers. These are linkages or commodity chains that all involve movement, including the extraction of materials from the ground, the transport of these and, ultimately, the disposal of waste products associated with extraction or with the residue of consumer products. Inevitably, those living near extraction or waste sites, or living alongside the routes along which materials are transported, incur environmental penalties or injustice (Box 6.1). Although many of these transfers can result in harm, in some cases there might be benefits; for example, the extraction of precious minerals may offer employment to those engaged in extraction and movement (although, as we see shortly, costs invariably outweigh benefits). Some may benefit, but others reap no rewards and incur harm.

Mineral extraction and global health

In Chapter 2 I explored some dimensions of health inequalities in Mozambique. Others are reflected in mining. Among the mining projects in Mozambique is the Montepuez open-pit ruby mine in Cabo Delgado, started by the major company Gemfields in 2011. Its impact on population health (along with that of other mines in sub-Saharan Africa) has been studied by Leuenberger et al. (2021). In focus group discussions, people reported their lives being threatened if they attempted to scavenge the mine tailings. Others reported ill health resulting from population mixing. For example, one person complained about the importation of diseases from those coming to work in the ruby mine: “Now these people from outside who come with their diseases come here and contaminate us without knowing the reason why the diseases are increasing more and more” (quoted in Leuenberger et al. 2021). The authors also report health effects linked to pollution and food insecurity. Despite attempts by the company to improve living and working conditions, the overall view on health was negative.

The previous chapter considered the impact that mineral extraction, waste mobilities and arms transfers are having on environmental quality as well as human health. These impacts are transmitted through the air and via water courses. The present chapter considers this pollution, and its consequences for human health, in much greater detail. However, although there is a truly vast literature on air pollution, water quality and their health impacts across the globe, attention here is focused primarily on how these impacts are felt unequally in different places, concentrating – as elsewhere in the book – on places in the Global South. Much of the literature on air and water pollution and health is epidemiological; although some of that research is touched on here, the emphasis is more on the political economy/ecology of air and water quality. Even though this is a generalization, it is invariably the case that those bearing the greatest burden of air pollution are also those in the poorest of households: a clear example of environmental injustice or inequity.

To give a brief indication of the scale of the problem, Fuller et al. (2022) suggest that pollution (of both air and water) is responsible for about 9 million deaths every year, an increase of 7 per cent since 2015 and more than 66 per cent since 2000. They write that “little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe” (Fuller et al. 2022: e535, emphasis added), and note that there are synergistic effects with climate change and loss of biodiversity. Air and water pollution are demonstrably planetary threats, with causes and impacts on human health cutting across national boundaries and therefore requiring international attention.

The political economy of pollution

The hypothesis of a pollution “haven” was introduced in the previous chapter with reference to waste, but is equally relevant in a discussion of air and water pollution. To recap, a haven effect means that firms in high-income countries seek to locate production offshore in low-and middle-income countries, where environmental standards may be weaker; any risk of pollution gets transferred abroad.

Although I am a geographer who has been interested in health issues for 40 years, my research has been almost exclusively focused on countries in the Global North, and even more exclusively on the United Kingdom. More specifically, it has embraced geographical epidemiology – the study of disease and illness in particular places – involving a mix of (usually) quantitative and (sometimes) qualitative methods.

The discipline of health geography, which Susan Elliott and I have sought to summarize in three editions of Geographies of Health (2015), has undergone various shifts in emphasis over the last 30 years or so. I have been led to write this present book in part because of the relative lack of research by geographers on global health. Much of the recent focus in health geography has been on topics that have (for example) explored the health and wellbeing of those living near green spaces and attractive walking environments. Yet, in many parts of the world, walking is less for pleasure and more for access to clean water or escape from violence. I hope here to have addressed key issues that affect those living and working outside Anglo-America and Europe; for sure, I have cast my net wide and have endeavoured to cite literature written by those living and working in regions other than my own.

The subject of global health demands an interdisciplinary perspective. The late Paul Farmer and his colleagues have cited anthropology, sociology, political economy and history as the key disciplines (Farmer et al. 2013). In this book I am adding geography to the mix, recognizing of course that it too draws theory and concepts from those and other disciplines. As Herrick and Reubi suggest in the introduction to their edited collection (2017b: x), “Geography has not yet carved out a disciplinary niche within the diffuse domain that constitutes global health”. I wish to help the inscription, which remains insufficiently “carved”: more than ten years have passed since Brown and Moon's (2012) important commentary on geography and global health, although the brief chapter by Brown and Taylor (2018) in Crooks, Andrews and Pearce's comprehensive Handbook of Health Geography offers a tantalizing taste of a research agenda and other chapters in that collection discuss global health concerns.

It is easy to imagine countries within the Global South as “hearths” of infectious disease, an imaginary that is enabled by graphic stories of Ebola in parts of west Africa. This chapter moves away from such tropes, by focusing initially on non-communicable diseases and the role played in these by markets for alcohol and tobacco. I then turn to matters of gender inequality, revealing how this too shapes health outcomes for women in the Global South.

There is a welcome, and growing, interest in inequality among Indigenous peoples, whether in the Global North or Global South, and this is considered next. The impact of the maltreatment of such peoples and the resulting trauma are felt sharply in particular places, and this trauma transmitted from generation to generation.

The previous chapter painted some broad-brush canvases of health in five countries but said little about the health of people living in particular places. The present chapter addresses some of the inequalities in urban areas. It then considers inequalities in mental health, with a particular focus on children, an area in which – alongside social determinants – exposure to violence is of major concern. Links between place and wellbeing have attracted considerable interest in recent years (witness the new journal Wellbeing, Space and Society), and the interest extends to places in the Global South.

There is a generally accepted view among those researching health inequalities in the Global North that access to health services plays only a minor role in determining these. Established technologies such as geographic information systems (GISs) can help monitor unequal access, while newer ones based on the use of mobile phones can also help. But the same “inverse care law” (those most in need get the poorest access) applies even in the Global South.

Geographies of inequalities in non-communicable diseases

As noted in Chapter 2, Sustainable Development Goal 3 seeks to “[e] nsure healthy lives and promote well-being for all at all ages”; within this, Target 4 aims to “reduce by, onethird, premature mortality from non-communicable diseases through prevention and treatment”.

Appendix 1a: Department of Physical Planning, December 1975 271

Appendix 1b: Department of Physical Planning and Development, 1978 272

Appendix 1c: Department of Physical Planning and Development, 1983 273

Appendix 1d: Department of Planning and Development, 1988 274

Appendix 1e: Department of Planning and Development, 1993 275

Appendix 2: Scottish Borders Council Archive Sources 276

Appendix 3: BRC (Planning & Development Department) Publications 285

Appendix 4: Selected Scottish Office Guidance on Town and Country Planning 288

Appendix 5: BRC (P & D Dept) Industrial Properties (1 January 1988) 295

Appendix 6: SDA Properties in the Borders Region (1 January 1988) 300

INTRODUCTION

Chapter Three examines the growing influence of central government, the Scottish Office, on town and country planning in the Scottish Borders in the 1960s through the issue of the White Paper on the Scottish Economy, the decision to proceed with the Tweedbank Development and the revival of the regional approach to planning with the commissioning of the Central Borders Study. It discusses the local planning authorities’ response to the Scottish Office's initiatives and describes how planning and development became closely intertwined in a bid to stem the long-term depopulation of the region.

Following the introduction by the Labour government of the 1947 Planning Act along with a raft of other pioneering legislation such as the New Towns Act 1946 and the National Parks and Access to the Countryside Act 1949, there followed a period of consolidation in terms of planning legislation with the election of the Conservative government in 1951. During the 1950s, the planning system became centred around development control. Development plans were little more than land use maps and, as the pace of change increased in the early 1960s, they become increasingly out of date and of diminishing value in determining the future direction of growth and development.

The early 1960s was a period of great social, cultural, economic and political change; the ‘Swinging Sixties’. The legacies of the Second World War, unrepaired and unfit housing and temporary prefabs, were replaced by burgeoning local authority housing schemes. New styles of architecture, using concrete and steel, became common. The established industries of shipbuilding, iron and steel, coal mining and the textile industry were in irreversible decline. In Scotland, the SHD, which had responsibility for the promotion of Scottish industry and the DHS, which had the responsibility for planning, were replaced by the Scottish Home and Health Department (SHHD) and the Scottish Development Department (SDD), which henceforth had the combined responsibility for planning and economic development. Most contemporary commentators attribute this decision of the Conservative government to the publication of the inquiry into the Scottish economy by the Scottish Council (Development and Industry) in 1961, which urged the creation of a new government department to combine the Scottish Secretary's statutory responsibilities for planning and the promotion of industry.

INTRODUCTION

Prior to 1975, local government in Scotland represented a distinctly Scottish set of institutions. The roots of Scottish local government can be traced back to the royal burghs of the Middle Ages and was one of the items guaranteed in the Treaty of Union in 1707. Prior to 1929, Scottish local government consisted primarily of royal burghs, which were typically small towns or villages that organised trade and basic services within communities, and county councils established in 1889. As the functions of local government expanded, notably during the nineteenth century, the demand for a more systematic structure of local government developed. This resulted in the complex structure of 430 local authorities established in 1929, which consisted of thirty-three county councils and four counties of cities (Edinburgh, Glasgow, Dundee and Aberdeen), twenty-one large burghs, generally those with a population of 20,000 people or more, 176 small burghs and 196 landward district councils. In 1975, there were fifty-seven Scottish local planning authorities, comprising thirty-one counties (two of them joint), twenty-four large burghs and two small burghs, with planning powers under the 1947 Act, ranging in size and character from the City of Glasgow, with over one million people, to the County of Sutherland, with 13,500 people scattered over 2,000 square miles. In the four Border counties of Berwickshire, Peeblesshire, Roxburghshire and Selkirkshire, there were twelve small burghs: Coldstream, Duns, Eyemouth and Lauder in Berwickshire; Innerleithen and Peebles in Peeblesshire, Hawick, Jedburgh, Kelso and Melrose in Roxburghshire; and Galashiels and Selkirk in Selkirkshire. Planning powers were held solely by the four county councils.

By the mid-1960s, the generally held view was that there was a need to reform local government in Scotland. The multiplicity of local authorities, many of them serving small areas and small populations were inefficient. As population had migrated to the towns and cities as a result of the Industrial Revolution and these towns and cities had expanded into the surrounding countryside, boundary anomalies caused friction between neighbouring authorities. Also, given the emerging culture of regional, economic and strategic planning in the 1960s, pressure developed behind the concept of larger, regional local authorities that could improve service provision.

INTRODUCTION

The start of the final decade of the twentieth century saw a number of significant organisational and operational changes amongst Scotland's principal agencies. The establishment of Scottish Homes in 1989 in place of the SSHA and the Housing Corporation, the emergence of Scottish Enterprise (SE) in 1991 and the amalgamation of the CCS with the NCCS in 1992 to form Scottish Natural Heritage (SNH) are just three examples. Scottish Homes was empowered to assist all sectors of the housing market, particularly in areas of ‘tenure deficiencies’. With the abolition of the SSHA in 1989 and the transfer of its functions to Scottish Homes, a strategic development plan was drawn up for the phased development of housing for rent and low-cost home ownership at Tweedbank with the intention of completing development by 1996, and sites for owner-occupied housing were identified. Scottish Homes embarked on an expansion of housing at Tweedbank with a further 400 houses of varying tenure over a six-year programme. Its Rural Policy, published in September 1990, identified four key challenges: increasing the supply of housing in rural areas; tackling poor housing conditions; ensuring affordability and tenant and community involvement. However, Scottish Homes seemed determined to by-pass local authorities despite such bodies having an established organisational infrastructure and local accountability. Instead, emphasis was placed on low-cost home ownership rather than social renting, and local housing agencies with grants for rent or ownership. In the Borders, new housing was provided by Eildon Housing Association and organisations such as Waverley Housing and the Berwickshire Housing Association took over local authority housing responsibilities in the Central Borders and Berwickshire respectively.

Scottish Enterprise (SE) was established in April 1991, an amalgamation of the SDA and the Training Agency, under the Enterprise and New Towns Act 1990. SE thus became responsible for the economic development functions of the SDA; industrial development and job creation and environmental regeneration, and the employment training programmes previously administered by the MSC. There was a marked change in economic development strategy, reflecting the government's view that there had not been sufficient involvement of private business in managing the SDA.