New Zealand Geographer (2007) 63, 135–140 10.1111/j.1745-7939.2007.00101.

Comment
Geographies
Blackwell Publishing
Comment of care Asia

Geographies of care: A commentary

Christine Milligan,1 Sarah Atkinson,2 Mark Skinner3 and Janine Wiles4

1
Institute for Health Research, Lancaster University, England, UK, 2Department
of Geography, Durham University, England, UK, 3Department of Geography,
Trent University, Canada, 4School of Population Health, The University of
Auckland, New Zealand

Within human geography we have seen the
emergence of wide-ranging debate around care
in recent years. In part, the ontological status
of care has been bound up with issues of
ethics, morality, responsibility and social
justice (see, e.g., Harvey 1996; Smith 1998,
2000; Proctor & Smith 1999; Silk 2000; Massey
2004). Within this frame of reference, the
spatiality of care is interpreted as an ethical
issue emerging from the so-called ‘moral crisis’
that threatens contemporary western society
(Smith 2000). Society we are told, has ‘lost its
moral bearings’ (Smith 2000: vii) as it fails to
get to grips with increasing polarization between
rich and poor, growing intolerance to difference
(whether socio-economic, religious or culturally
based) and the pursuit of personal improve-
ment over that of wider society. Geographical
debates around an ethic of care, then, have
been located around issues of difference, bene-
ficence, citizenship, rights and responsibilities.
These debates have considered the ethics of
care across a range of spatial scales stretching
from the global to the highly place-specific.
Clearly these are highly important and
topical issues, but we should not forget that
the discourse of care also holds considerable
meaning for those working within geographies
of health and social welfare. The relationship
between people, place and (health) care, for
example, has been the focus of a number of
recent themed conferences and workshop
sessions in the United States, the United
Kingdom and Canada, as well as journal
articles and books (see, e.g., Milligan 2000,
2001; Williams 2000; Andrews & Phillips 2002;
Conradson 2003a; Parr 2003; Wiles 2003a,b)
and special journal issues (see Social and
Cultural Geography, 2003, 4: 4; Environment
and Planning A 2003, 35: 5). Care has been
interpreted within a relational framework
that examines health, care-giving and the receipt
of care in relation to the places in which it
occurs. This, of course, is a very ‘broad brush’
interpretation of how health geographers have
been engaging with ideas of care. As panellists
at a session on Geographies of Care at the
IGU Towards Healthy Environments Confer-
ence in New Zealand in 2006, the authors of
this commentary sought to unpack in more
detail not only their own position in relation
to their work on care, but also some of the
complexities surrounding care what they felt
to be the key issues for contemporary and future
geographical work. Opening up the debate to
those present identified some additional issues
and potential avenues for future work around
geographies of care. What follows is a sum-
mary of issues arising from this discussion.
Four broad themes are considered in turn.
Place, care and transition
From the latter half of the 20th century onwards,
the implementation of policies focused on
community care and ageing in place in many

Note about the authors: Christine Milligan is Senior Lecturer in Health Research and Associate Dean for Postgraduate
Studies at Lancaster University, England. Sarah Atkinson is Reader in the Department of Geography at Durham
University, England. Mark Skinner is Assistant Professor of Geography at Trent University. Janine Wiles is Lecturer
in the School of Population Health at The University of Auckland.
E-mail: c.milligan@lancaster.ac.uk

© 2007 The Authors

Journal compilation © 2007 The New Zealand Geographical Society Inc. Published by Blackwell Publishers Ltd.
136
advanced capitalist countries has acted to shift
the main site of care for vulnerable people
from the institution to the home. One
significant strand of work within geographies
of care has thus been concerned not only exam-
ine how this shift in the location of care has
impacted on the places in which that care
occurs, but also how care-recipients and care-
givers (both formal and informal) are affected
by this shift. Work in this vein has addressed
the blurring of the boundaries between formal
and informal care-giving, the shifting power
relationships that occur between lay, profes-
sional and paid care givers and care recipients
within these new settings, as well as changes
in the meaning and nature of home (e.g.
Williams 1996; England 2000; Twigg 2000; Milligan
2001, 2006; Wiles 2003a,b). Home is not the
only locus of care-giving. Geographers have
also examined how care is manifest and dif-
ferentially experienced within a range of set-
tings such as hospitals, hospices, care homes as
well as other voluntary and community-based
settings (e.g. Andrews & Phillips 2002; Brown
2003; Conradson 2003b; Milligan 2005). Here,
researchers have been concerned to not only
build on earlier medical geographical concerns
with why variations in access and availability
to services occur within and between places,
but also to examine how care, as both an affec-
tive and a physical entity, shifts and changes
within and across these settings with implica-
tions for who cares and the form that care
takes. Geographers working broadly within
this theme have also engaged with the notion
of ‘therapeutic landscapes’ (Gesler 1992) in
relation to the design of care settings, people’s
relationship with particular parts of the city,
voluntary and community settings such as drop-
in centres, rural areas, retreats and palliative
care settings (e.g. Parr 1999; Kearns & Barnett
2003; Parr & Philo 2003; Andrews 2004; Gesler
et al. 2004; Conradson 2005). Other work has
considered the impact of transitions in the
place of care – particularly in relation to care-
givers and older people (Milligan 2006).
Defining who cares and where
A second strand of work around geographies
of care has focused on how variations in
cultural norms and assumptions between places
© 2007 The Authors
Journal compilation © The New Zealand Geographical Society 2007.
C. Milligan et al.
impacts on who cares and where that care
takes place. Inevitably there is some overlap
with the first theme, but distinctive elements
of this work have included a focus on the
gendered nature of care and care responsibilities.
Feminist work in this field, for example, has
addressed the changing relationship between
care, women, home and work – whether in
domestic or institutional settings (Dyck 1995,
1998; Young 1996; Cloutier-Fisher & Joseph
2000; Dyck et al. 2005). It also addresses the
shift to community based care in many advanced
capitalist countries and the subsequent down-
loading of care from the state to local/volun-
tary organizations and families (Milligan 2001;
Skinner & Rosenberg 2006). Work in this vein
has been concerned to address: (i) the rela-
tionship between formal and informal care
providers, noting how this is effecting a blurring
of the boundaries between formal and informal
care and the tasks performed; and (ii) how
care support is sought and negotiated (Milligan
2000; Twigg 2000). Family and voluntary
carers (and to some extent private organizations)
are now undertaking many of the care tasks
formerly provided by the statutory sector.
Work focusing on the shift from formal care-
givers to informal volunteer caregivers in rural
places has also highlighted the need to better
understand how they experience and transform
the processes and outcomes of health care
restructuring (Barnett & Barnett 2006; Skinner
& Rosenberg 2006). Such work has argued
that the true casualties of healthcare restructur-
ing are caregivers – particularly elderly people
and women.
In discussion it was also noted that, to date,
much of the work around care has tended to
treat groups as too homogenous. Hence there
is a need for greater recognition of the diversity
within and between social groups, and to
consider the implications for our understandings
of who cares, why and how. Such recognition
is especially important when working with
minoritized, cultural or socio-economic groups,
particularly given that statutory providers
often fail to recognize adequately cultural
difference around what constitutes appropriate
forms of care. The importance of understanding
both socio-cultural and personal difference
was noted, with language barriers, different
expectations of care, and more general socio-
 Geographies of care
cultural aspects of identity all seen as impor-
tant factors. Different expectations and norms
in relation to care-giving and how this may
be manifesting through different needs or
mechanisms for giving or delivering care were
also highlighted. One area in which such insights
are being implemented is in nascent work on
child carers – in both developed and developing
countries (Robson 2000, 2006).
Finally, geographers are beginning to engage
with two additional issues in relation to who
cares. First, work is starting to emerge around
the impact of remote care technologies and
domotics (i.e. care technologies designed for
the home) in an effort to understand not only
how these new technologies are changing the
nature of care but also who cares and where
that care takes place (Milligan et al. 2006).
Second, geographers are extending our under-
standing of the diverse ways in which social
relations are maintained across geographical
distance (e.g. Faist 2000; Conradson & Latham
2005). The professional contributions of migrant
doctors and nurses are just one example of the
intersections between transnational mobility
and practices of care, whether expressed in
formal healthcare, hospice or home settings.
The practice of care across distance, in terms
of the maintenance of relational connections
between transnational migrants and friends
and family in their places of origin, is an
important topic for research.
Place and the performance of care
Within this strand of work geographers have
been concerned to examine the affective
stances and material practices which typically
come together in performative expressions
of care. This work engages with both the
emotional geographies literature (e.g. Davidson
et al. 2005), as well as the recent turn to prac-
tice evident across a range of work within the
social sciences (Latham & Conradson 2003).
As such, it has sought to understand the
performative enactment of particular care and
support environments (e.g. Parr 1999; Wiles
2001; Conradson 2003b). Moving beyond dicho-
tomous accounts of places as somehow either
care-full or care-less, these analyses have in-
stead explicitly sought to recognize the uneven
nature of care both as empathetic orientation
137
and material social practice (Parr & Philo
2003). With connections to the therapeutic
landscapes tradition, other work has begun to
explore the significance of designated sites
of retreat as reparative and restorative environ-
ments for the self (Conradson forthcoming).
In turn, such practices reflect the broader
emphasis (and acceptability) of ‘care for the
self’ in contemporary society. One reflection
of this is the degree to which individuals feel
empowered to seek or achieve moments of
stillness within the relatively pressured rhythms
of many work-life arrangements.
The care of bodies: Bodies of care
Within this fourth theme, geographers are
beginning to engage with an expanded notion
of the nature of the place of care for and of the
body. This incorporates a focus on the body
and the ways in which it is treated as a site of
production. There are connections here to the
analytical spheres of the biological, social,
political and moral (Moss & Dyck 1996; Parr
2002). Through this lens, care is viewed as
representing a category through which we might
explore the negotiation of these spheres at
different scales of action (individual, institu-
tional and societal) in the practice and production
of the body. Working within such a framework
may provide a potentially powerful way of
bringing together what are often diffuse or
competing strands of research about our rela-
tionships with the healthy or unhealthy body.
Alongside more commonly framed approaches
to caring and wellbeing, this framework allows
for a wider definition of the relations of care,
including care of the self in terms of hygiene,
social values and fashions, and care of the
dead in terms of both bodies and spirits.
Similarly, an expanded definition of the insti-
tutions of care allows for the inclusion of the
commercialization of care of the body beyond
the public social sectors and an exploration of
emergent new spaces of potential care such as
the internet (Parr 2002).
New directions?
Further discussion at the meeting raised a
number of additional themes and gaps in work
around place and care. First, it was suggested
© 2007 The Authors
Journal compilation © The New Zealand Geographical Society 2007.
138
that the geography of care could (and perhaps
should) extend beyond human boundedness to
consider the relationship between animals,
place and care, whether that be in the home or
beyond. This seam of research might link to
ideas of well-being, and the potentially thera-
peutic relationship between places, non-human
subjects and care. Second, it was pointed out
that with one or two exceptions, much of the
work around geographies of care, to date, has
focused on first world settings. Hence there
is a need for geographers to begin to engage
with ideas around the meaning and experience
of care in developing and other non-industrialized
settings. What we mean by care can differ not
only between different groups and cultures,
but also over time and place. Third, it was
noted that geographers have an important role
to play in policy debates around rights and
responsibilities to care. Within public health,
for example, there are debates to be had about
the extent to which governments have a
responsibility to care for and protect their
citizens – not just in their daily lives, but also in
times of specific tragedies and disasters. There
is also a need to consider what the future care
needs of our populations might be. Given the
global ageing of the population, for example,
there is likely to be a growth in the need for
certain forms of care, such as psycho-geriatric
or dementia care. But there is also a debate to
be had about whether an ageing population
automatically infers a greater need for care, or
whether people will not only live longer but
also healthier lives. Hence care may largely be
an issue for the ‘old old’ (currently 85+). This,
in itself raises important moral and ethical
issues regarding public responsibilities to care
vs. individualism and personal rights. Should
people care, and to what extent does distance
or mobility impact on people’s responsibility
to care (cf. Smith 1998; Silk 2000)? To what
extent is there a need to renew earlier battles
by arguing that the state does need to play a
role in care? Through their attention to the
emplaced dynamics and dimensions of care,
geographers have the ability to offer distinctive
insights to care that can usefully inform both
government and policy debates.
Throughout all of the above runs the important
theme of ethics and care in relation to health
geography. Moral questions are raised about
© 2007 The Authors
Journal compilation © The New Zealand Geographical Society 2007.
C. Milligan et al.
what constitutes good care, whose responsibil-
ity it is to provide that care and where it
should take place. It is interesting that while
issues of rights, responsibilities, citizenship and
difference are common themes running through
both health and moral geographies, to date
there has been only a limited engagement
between these two spheres of work (but see
Popke 2006). This needs to be addressed.
Indeed, geographers working within health
geography would argue for a more sustained
engagement not just with moral geographies,
but also with wider interdisciplinary debates
around issues of morality and care.
Acknowledgements
We would like to acknowledge the contribution
to the discussion of all those present at the
IGU pre-Conference on Towards Healthy
Environments on Waiheke Island, New Zea-
land in 2006. In particular we would like to
acknowledge the ideas put forward by Damian
Collins, Malcolm Cutchin, Robin Kearns and
Mark Rosenberg which are included in the
‘New Directions’ section above.
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