Morris David Morris's Physical Quality of Life Index (1979) combines:

Calorie intake, housing and employment

Crime, pollution and congestion

Income per head, schooling and life expectancy at birth

Assertion (A): John Snow's 1854 map of cholera deaths in Soho, London, is regarded as a founding work of medical geography. Reason (R): By mapping the deaths around the Broad Street pump, Snow linked the disease to contaminated water. Choose the correct option.

Both A and R are true, and R is the correct explanation of A

Both A and R are true, but R is not the correct explanation of A

The three-tier structure of India's public health-care system — primary, secondary and tertiary — goes back to the recommendations of:

The National Health Policy, 2017

Cultural and Social Geography: Culture, Cultural Ecology and Diffusion, Social Well-being, Social Groups in India, Disease Ecology, Nutrition and Health Care

Unit VII has two halves, and this chapter takes the first, cultural and social geography. The document runs from the concept of culture, cultural complexes, areas and regions, cultural heritage, cultural ecology and cultural convergence, through social structure and processes, social well-being and quality of life, and social exclusion, to the spatial distribution of social groups in India (tribe, caste, religion and language), environment and human health, disease ecology, nutritional status (its aetiological conditions, classification and spatial and seasonal patterns, with special reference to India), health-care planning and policies in India, and medical tourism in India. NET Sociology treats caste, tribe and religion as social institutions; this chapter treats them as spatial distributions, and adds the medical geography that sociology does not cover.

1. Culture, cultural complexes and regions, heritage, cultural ecology and convergence

Culture, in E.B. Tylor's classic definition (1871), is "that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society" — learned, shared and transmitted, not inherited biologically. Geography's distinctive contribution came from Carl Sauer and the Berkeley school. In "The Morphology of Landscape" (1925) Sauer wrote that "culture is the agent, the natural area is the medium, the cultural landscape the result", turning attention from environmental control to the way human groups transform the land. The smallest unit of culture is a culture trait; a cluster of functionally related traits is a culture complex — Melville Herskovits's "cattle complex" of East Africa (1926), in which cattle carry economic, social and ritual meaning, is the standard example. The area over which a complex prevails is a culture area or culture region; a larger grouping of regions is a culture realm; the source areas of major innovations are culture hearths — Mesopotamia, the Nile, the Indus, the Huang He, Mesoamerica and the Andes.

Cultural heritage is tangible (monuments, sites, landscapes) or intangible (practices, performances, knowledge). UNESCO's World Heritage Convention (1972) protects the first and its Convention for the Safeguarding of the Intangible Cultural Heritage (2003) the second; the Kumbh Mela (2017), Durga Puja in Kolkata (2021) and Garba of Gujarat (2023) are among India's inscriptions on the intangible list. Cultural ecology, founded by the anthropologist Julian Steward (Theory of Culture Change, 1955), studies how a society's culture core — its subsistence technology, work organisation and settlement — adapts to its environment, and argued for multilinear rather than single-track cultural evolution. Cultural convergence is the growing similarity of cultures through contact, trade, technology and media — the "convergence thesis" of Clark Kerr and colleagues (1960) held that industrialism pushes societies towards a common form — while divergence is their separation. Culture spreads by diffusion, which Torsten Hägerstrand (1953) modelled for innovations in Sweden: contagious (neighbourhood) diffusion spreads outward from the source like a wave, hierarchical diffusion jumps down an urban hierarchy from large cities to small, and relocation diffusion moves with migrants.

2. Social structure, well-being, quality of life and exclusion; social groups in India

Welfare geography grew out of the radical turn of the early 1970s. David M. Smith (The Geography of Social Well-Being in the United States, 1973) framed its question as "who gets what, where, and how", and measured social well-being through territorial social indicators of income, housing, health, education, crime and participation. Composite measures of quality of life followed: Morris David Morris's Physical Quality of Life Index (PQLI, 1979) averages three indices, each scaled 0 to 100 — life expectancy at age one, infant mortality and basic literacy — so that a country with indices of 60, 70 and 80 has PQLI = (60 + 70 + 80) ÷ 3 = 70; the UNDP's Human Development Index (1990) replaced it in wide use. Social exclusion — a term popularised by René Lenoir's Les Exclus (1974) — describes the denial of full participation through poverty, discrimination and lack of access, and it has a geography of segregated neighbourhoods, remote hamlets and disconnected regions.

Group (Census 2011)	Share and pattern
Scheduled Tribes	8.6 per cent (about 104 million). Highest shares in the north-east and islands (Lakshadweep and Mizoram above 94 per cent); largest numbers in the central tribal belt — Madhya Pradesh, Maharashtra, Odisha, Rajasthan, Gujarat, Jharkhand, Chhattisgarh; the Bhils and Gonds are the largest tribes
Scheduled Castes	16.6 per cent (about 201 million). Highest share in Punjab (about 32 per cent), largest number in Uttar Pradesh; concentrated in the fertile, densely settled plains and low in the tribal north-east
Religion	Hindus 79.8, Muslims 14.2, Christians 2.3, Sikhs 1.7, Buddhists 0.7, Jains 0.4 per cent. Muslim majorities in Lakshadweep and the then state of Jammu and Kashmir; Christian majorities in Nagaland, Mizoram and Meghalaya; a Sikh majority in Punjab
Language	22 scheduled languages. Language families: Indo-Aryan (about 78 per cent of speakers), Dravidian (about 20 per cent), Austro-Asiatic and Tibeto-Burman (about 1 per cent each). Hindi is the mother tongue of about 44 per cent, followed by Bengali, Marathi, Telugu and Tamil

3. Environment and human health, disease ecology and nutritional status

Medical geography dates its founding image to John Snow's map of cholera deaths in London's Soho in 1854, which located the source at the Broad Street pump and linked the disease to contaminated water before germs were understood. Disease ecology, systematised by Jacques May (The Ecology of Human Disease, 1958), studies the interaction of the agent (the pathogen), the host (people, with their immunity, nutrition and behaviour) and the environment (physical, biological and social) that brings them together; in India A.T.A. Learmonth mapped malaria and other diseases in this tradition. Vector-borne diseases follow the geography of their vectors: malaria (Anopheles mosquitoes) in forested, hilly and tribal districts of central and eastern India and the north-east; dengue (Aedes aegypti) in growing cities with stored water; kala-azar (visceral leishmaniasis, carried by the sandfly Phlebotomus argentipes) in Bihar, Jharkhand, West Bengal and eastern Uttar Pradesh; Japanese encephalitis (Culex mosquitoes breeding in paddy fields) in eastern Uttar Pradesh and Assam. Abdel Omran's theory of the epidemiological transition (1971) describes three ages: pestilence and famine, receding pandemics, and degenerative and man-made diseases — the non-communicable diseases (heart disease, diabetes, cancer) that now cause most deaths in India alongside a persistent burden of infection.

Nutritional status has three aetiological (causal) conditions: undernutrition (inadequate energy and protein, compounded by infection), micronutrient deficiency (iron deficiency causing anaemia; iodine deficiency causing goitre, historically in the sub-Himalayan "goitre belt"; vitamin A deficiency) and overnutrition (overweight and obesity) — together the "double burden". Child undernutrition is classified by anthropometry against WHO standards: stunting (low height-for-age, reflecting chronic undernutrition), wasting (low weight-for-height, acute undernutrition) and underweight (low weight-for-age, a composite), each defined as more than two standard deviations below the reference median; older schemes by Gomez and Waterlow used percentages of the reference. NFHS-5 (2019–21) found 35.5 per cent of Indian children under five stunted, 19.3 per cent wasted and 32.1 per cent underweight, and 57 per cent of women aged 15–49 anaemic; stunting is highest in Meghalaya and Bihar and lowest in Kerala, Goa and Sikkim. The seasonal pattern is marked: the lean months before the kharif harvest, which coincide with the monsoon peak of diarrhoea and malaria, are the worst for child nutrition.

4. Health-care planning and policies in India, and medical tourism

India's health-care planning began with the Bhore Committee (1946), which proposed a three-tier system of primary health centres, secondary and tertiary care that still shapes the network. Population norms decide location: a sub-centre for 5,000 people (3,000 in hilly and tribal areas), a primary health centre for 30,000 (20,000) and a community health centre for 1,20,000 (80,000) — a geographical rule that makes access in sparsely peopled terrain a matter of distance as much as of numbers. National Health Policies were adopted in 1983, 2002 and 2017, the last targeting public health spending of 2.5 per cent of GDP by 2025. The National Rural Health Mission (2005), merged into the National Health Mission (2013), introduced the village-level ASHA worker. Ayushman Bharat (2018) has two arms: Health and Wellness Centres (now Ayushman Arogya Mandirs) for comprehensive primary care, and PM-JAY, a hospital insurance scheme covering up to ₹5 lakh per family per year.

Medical tourism — travel across borders for treatment — has grown rapidly in India on the basis of low cost (a fraction of Western prices for cardiac surgery, transplants and orthopaedics), internationally accredited private hospitals (JCI and NABH), English-speaking doctors, short waiting times and AYUSH traditions such as Kerala's Ayurveda. The main hubs are Chennai (often called India's health capital), Delhi–NCR, Mumbai, Bengaluru, Hyderabad and Kerala; patients come chiefly from Bangladesh, the Middle East, Afghanistan, the Maldives and Africa. The government introduced an e-medical visa and promotes the sector under the "Heal in India" initiative. Its geography raises a welfare question the first section anticipated: advanced care concentrated in metropolitan corporate hospitals for foreign and affluent patients, while rural districts fall short of the Bhore norms.

🧠 Three anthropometric words, three time-scales

Stunting (height-for-age) is the long story — months or years of deprivation. Wasting (weight-for-height) is the recent story — an illness or a bad season. Underweight (weight-for-age) mixes the two and cannot tell them apart, which is why policy has shifted towards reporting stunting and wasting separately.

Key takeaways

Tylor defined culture (1871); Sauer (1925): culture the agent, the natural area the medium, the cultural landscape the result; traits form complexes (Herskovits's cattle complex), complexes form culture areas and realms, innovations begin in culture hearths.
Steward's cultural ecology (1955): the culture core adapts to environment; Hägerstrand (1953): contagious, hierarchical and relocation diffusion; convergence brings cultures together, divergence separates them.
Smith (1973): who gets what, where and how; PQLI (1979) averages life expectancy at one, infant mortality and literacy; India 2011: ST 8.6 per cent, SC 16.6 per cent (highest share Punjab), Christian majorities in Nagaland, Mizoram and Meghalaya.
Snow (1854) founded medical geography; May (1958) framed agent, host and environment; vectors map diseases (kala-azar and the sandfly in Bihar); Omran (1971): the epidemiological transition to degenerative diseases.
NFHS-5: 35.5 per cent of under-fives stunted, 57 per cent of women anaemic; Bhore Committee (1946) three tiers; NHP 2017, NHM, Ayushman Bharat (2018); medical tourism concentrates in Chennai, Delhi–NCR and other metros.

Practice questions (12)

Attempt each one before opening the answer. Every explanation names the tempting wrong option as well as the right one, because that is where marks are lost.

"Culture is the agent, the natural area is the medium, the cultural landscape the result" was written by:
1. E.B. Tylor
2. Carl Sauer
3. Julian Steward
4. Torsten Hägerstrand
Show answer
Answer: B — Carl Sauer
The sentence is from Sauer's "The Morphology of Landscape" (1925), the founding text of the Berkeley school of cultural geography. Tylor gave the classic definition of culture, Steward founded cultural ecology, and Hägerstrand modelled diffusion.
The approach that studies how the "culture core" of a society — its subsistence technology and work organisation — adapts to its environment was founded by:
1. Julian Steward
2. Jacques May
3. Melville Herskovits
4. Carl Sauer
Show answer
Answer: A — Julian Steward
Steward's cultural ecology (Theory of Culture Change, 1955) centred on the culture core and multilinear evolution. Herskovits described the East African cattle complex, and May founded disease ecology.
A fashion that appears first in the largest metropolis, then in regional cities and only later in small towns, skipping the countryside in between, is an example of:
1. Contagious diffusion
2. Cultural divergence
3. Relocation diffusion
4. Hierarchical diffusion
Show answer
Answer: D — Hierarchical diffusion
Hierarchical diffusion jumps down the urban hierarchy regardless of distance. Contagious diffusion spreads outward to neighbours like a wave, and relocation diffusion travels with migrating people.
Morris David Morris's Physical Quality of Life Index (1979) combines:
1. Life expectancy at age one, infant mortality and basic literacy
2. Calorie intake, housing and employment
3. Crime, pollution and congestion
4. Income per head, schooling and life expectancy at birth
Show answer
Answer: A — Life expectancy at age one, infant mortality and basic literacy
The PQLI deliberately excludes income and averages three indices scaled 0–100: life expectancy at age one, infant mortality and literacy. Income, schooling and life expectancy at birth are the dimensions of the HDI.
A country scores 60 on the life-expectancy index, 70 on the infant-mortality index and 80 on the literacy index (each on a 0–100 scale). What is its PQLI? Type a number.
Numerical answer — type the value.
Show answer
Answer: 70
The PQLI is the unweighted mean of its three indices: (60 + 70 + 80) ÷ 3 = 210 ÷ 3 = 70.
According to the 2011 census, the state with the highest proportion of Scheduled Castes in its population is:
1. Uttar Pradesh
2. Bihar
3. Punjab
4. Mizoram
Show answer
Answer: C — Punjab
Punjab's population is about 32 per cent Scheduled Caste, the highest share of any state. Uttar Pradesh has the largest number of SC people, and Mizoram has very few, being overwhelmingly Scheduled Tribe.
According to the 2011 census, which of the following states have a Christian majority? Select all that apply.
1. Tripura
2. Meghalaya
3. Nagaland
4. Mizoram
Show answer
Answer: B — Meghalaya; C — Nagaland; D — Mizoram
Nagaland (about 88 per cent), Mizoram (about 87 per cent) and Meghalaya (about 75 per cent) have Christian majorities. Tripura has a Hindu majority of over 80 per cent.
Kala-azar (visceral leishmaniasis), endemic in the eastern Gangetic plains, is transmitted by:
1. The Anopheles mosquito
2. The sandfly Phlebotomus argentipes
3. The Aedes aegypti mosquito
4. Contaminated drinking water
Show answer
Answer: B — The sandfly Phlebotomus argentipes
Kala-azar is carried by the sandfly, which breeds in damp, organic-rich soil around mud houses and cattle sheds, which is why it clusters in poor rural parts of Bihar, Jharkhand, West Bengal and eastern Uttar Pradesh. Anopheles carries malaria and Aedes carries dengue.
In Abdel Omran's theory of the epidemiological transition (1971), the final age is the age of:
1. Vector-borne epidemics
2. Degenerative and man-made diseases
3. Receding pandemics
4. Pestilence and famine
Show answer
Answer: B — Degenerative and man-made diseases
Omran's three ages are pestilence and famine, receding pandemics, and degenerative and man-made diseases, in which chronic non-communicable diseases become the main causes of death. Later writers added further stages such as delayed degenerative disease and emerging infections.
Assertion (A): John Snow's 1854 map of cholera deaths in Soho, London, is regarded as a founding work of medical geography. Reason (R): By mapping the deaths around the Broad Street pump, Snow linked the disease to contaminated water. Choose the correct option.
1. Both A and R are true, and R is the correct explanation of A
2. Both A and R are true, but R is not the correct explanation of A
3. A is true, but R is false
4. A is false, but R is true
Show answer
Answer: A — Both A and R are true, and R is the correct explanation of A
Both are true and R explains A: the map showed deaths clustered around one pump, and the spatial pattern itself was the evidence of a water-borne cause, years before the cholera bacterium was identified.
According to NFHS-5 (2019–21), the proportion of Indian children under five who are stunted is about:
1. 35.5 per cent
2. 19.3 per cent
3. 8.6 per cent
4. 57 per cent
Show answer
Answer: A — 35.5 per cent
NFHS-5 found 35.5 per cent of under-fives stunted (low height-for-age). 19.3 per cent is the wasting figure, and 57 per cent is the share of women aged 15–49 who are anaemic.
The three-tier structure of India's public health-care system — primary, secondary and tertiary — goes back to the recommendations of:
1. The Planning Commission, 1951
2. Ayushman Bharat, 2018
3. The National Health Policy, 2017
4. The Bhore Committee, 1946
Show answer
Answer: D — The Bhore Committee, 1946
Sir Joseph Bhore's Health Survey and Development Committee (1946) laid out the primary health centre and referral structure. The 2017 policy set spending targets, and Ayushman Bharat (2018) added wellness centres and hospital insurance.