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Location in the Context of Health and Healthcare: Scope and
Impact
Health, as defined in the World
Health Organisation’s Constitution, is "a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity." Health is seen as more than just the absence of disease,
and depends upon a complex suite of factors, with location taking the lead. A
location is more than just a position within a spatial frame (e.g., on the
surface of the Earth or within the human body). Different locations on Earth are
usually associated with different profiles: physical, biological, environmental,
economic, social, cultural and possibly even spiritual profiles, that do affect
and are affected by health, disease and healthcare.
Many factors come into play and have to be studied in this
context, e.g., the geographies of infecting agents (micro-organisms and
parasites) and their intermediate hosts if any, geographies of industrial
pollution and toxic spills, of nutrition, disability, poverty, ageing, racism,
or crime to name a few. (See also "Landscape Epidemiology" below.) However, research into the geography of health is
sometimes constrained by a lack of readily available data; in many cases health
geography research entails time-consuming and expensive gathering of original
data.
Beyond Geo-Locations
(N.B.: Geo = Earth)
 Even
within the human body, the location of a bacterial infection (organ or body
system affected), for example, can be very critical in determining, in addition
to the type of the infecting bacteria, the choice of the antibiotic(s) to treat
it. Bacteria that are susceptible to a certain antibiotic in vitro might
not be affected by the same antibiotic in
vivo. This can occur if this antibiotic for some reason, e.g., related to
its chemical structure, cannot penetrate the specific location (site) of the
infection, e.g., the prostate or brain, even when adequate therapeutic levels of
the antibiotic are present in the bloodstream. Here again, location (within the
human body) is playing a key role in determining the treatment and outcome of an
illness.
See also:
"Landscape Epidemiology" below.
Some Examples
(On how location matters and carries with it other factors into play)
The body weight of infants at birth is one readily available
piece of data, and the relationship between low birth-weight and maternal and
child health is a continuing line of research. In New York City, Sara
McLafferty and Barbara Tempalski have studied the spatial distribution of
low birth-weight infants and identified areas in which low birth-weight
increased sharply during the 1980s. Their results indicated that the rise in low
birth-weight was closely linked to women's declining economic status, inadequate
insurance coverage and prenatal care, as well as the spread of crack/cocaine. Dr. Sara McLafferty
and colleagues have also examined the "Spatial Clustering of Breast Cancer in West Islip, New
York."
In Sudbury, Canada, J.
Roger Pitblado et al have recently published (December 1998) the results
of a 2.5-year prospective cohort study they did to examine the influence of
health beliefs of pregnant adolescents on health behaviours and birth outcomes,
with low birth-weight as the key outcome measure. The influence of social,
economic and physical characteristics of pregnant adolescents on birth outcomes
as well as regional variations have also been examined.
 SEDAC
(Socioeconomic Data and Applications Centre), part of by CIESIN (Centre for
International Earth Science Information Network at Columbia University, US), has
prepared an overview on Human Health and Global Climate Change. In recent years
there has been an explosion of concern about our deteriorating environment, and
the consequences for human health. In particular, health researchers,
physicians, policymakers, and the general public are becoming increasingly
concerned that environmental degradation caused by human activities could
translate into serious, long-term health effects for human populations. Topics
important to human health and global environmental change are described in the
overview, include loss of biodiversity, malnutrition, population growth, and
urbanisation. CIESIN has also prepared a detailed overview on the association
between Ozone layer depletion, ultraviolet radiation and melanoma.
Landscape Epidemiology
 Landscape
epidemiology involves the identification of geographical areas where disease is
transmitted and considers the interactions and associations between elements of
the physical and cultural environments. First expressed by the Russian
epidemiologist Pavlovsky in 1966, the theory behind landscape epidemiology is
that by knowing the vegetation and geologic conditions necessary for the
maintenance of specific pathogens in nature, one can use the landscape to
identify and predict (i.e., to model) the spatial and temporal distribution of
disease risk. Key environmental elements, including elevation, temperature,
rainfall, and humidity, influence the presence, development, activity, and
longevity of pathogens, vectors, zoonotic (animal) reservoirs of infection, and
their interactions with humans (Meade et al, 1988). Vegetation type and
distribution are also influenced by the environmental variables mentioned above,
and can be expressed as landscape elements that can be
sensed
remotely (via satellite systems) and whose relationships can be modelled
spatially.
Landscape epidemiological studies are very useful to public health agencies in their efforts to reduce disease incidence
and allows them to efficiently target limited resources where they are needed most.
The Geography of Healthcare Systems
As mentioned at the beginning of the
previous lecture, it is conventional and useful to divide the geography of
health into two areas:
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The geography of disease and ill-health: describing,
exploring and modelling the spatio-temporal incidence of disease,
cluster/pattern detection, new hypotheses generation, etc.;
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The geography of healthcare systems: delivery of, and
access to suitable health services after determining healthcare needs —
needs assessment and service catchment zones determination. (Gatrell and
Senior, 1999)
As disease and health can vary from place to place and time
to time, so too can (and should be) a society's response to its health needs.
Geographic research into healthcare services can aid in identifying inequities
in health service delivery between classes, peoples and regions, e.g., by
analysing patient access/proximity to available healthcare facilities (travel
time), and in
the efficient allocation and monitoring of scare healthcare resources (i.e.,
needs assesment, and resource planning and management). Allocating
physician/nursing staff by region, assisting in determining the specifications
for new healthcare facilities and also when planning extensions to existing
ones, assisting in taking decisions about where to build new healthcare
facilities, and efficient
routing of ambulance trips are just some examples.
The Centre for the Evaluative Clinical Sciences at Dartmouth Medical School (CECS, US) was
organised in 1989. The faculty now includes researchers in the fields of epidemiology, statistics, economics, medical sociology, medical geography, and clinical practice, among other disciplines. The major goal of research at CECS is the accurate description of the healthcare system in the United Sates, and the pursuit of answers to such questions as,
"What do variations in resources and utilisation mean?" "Is more healthcare always better?" and
"What opportunities exist to reallocate excess capacity to other uses?" CECS produces a
variety of healthcare atlases to help in answering these questions.
The homepage of the Dartmouth Atlas of Health Care is located at http://www.dartmouthatlas.org/
and is worth visiting. (You may also download a locally cached copy of the
"Dartmouth Atlas of Health Care 1998" - PDF.)
Example from "Dartmouth Atlas of Health Care 1998". Thirty-nine percent of the population of the United States lived in areas with one hospital (buff); 15% lived in areas with two hospitals (light orange); 8.4% lived in areas with three hospitals (bright orange); and 37% of the population lived in areas with four or more hospitals within the hospital service area (red).
References:
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Hall W. Just Another Medical Geography Page (Web site). URI:
http://www.geocities.com/Tokyo/Flats/7335/medical_geography.htm
(accessed 6 December 2000)
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Gatrell A and Senior M. Health and health care applications. In Longley
PA, Goodchild MF, Maguire DJ and Rhind DW (Editors). Geographical
Information Systems Volume 2: Management Issues and Applications. New
York: John Wiley & Sons. 1999 (pp. 925-938) [ISBN 0471-33133-3]
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McLafferty S, and Tempalski B. Restructuring and Women's Reproductive Health: Implications for Low Birthweight in New York City.
Geoforum. 1995;25(2): 309-323
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Meade MS, Florin JW, Gesler WM. Medical Geography. New York: The Guilford Press. 1988
[ISBN 0898627818]
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Pavlovsky EN. The natural nidality of transmissible disease (ND Levine, ed.). Urbana: University of Illinois Press. 1966
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