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The present evolution of geography of health is highlighted through a selection of recent publications. Some current research trends are listed, such as disease ecology in a changing environment, geography of AIDS, urbanization, epidemiological transition, health care delivery. The most salient future perspectives are pointed out.
While complementary and alternative medicine (CAM) research has benefited from a range of social scientific perspectives, geographical contributions have been only slowly forthcoming. In this context, this paper illuminates the possibilities for CAM researchers to develop dedicated geographical perspectives. Some fundamental changes in the empirical and theoretical foci of medical/health geography are outlined, from a concern with mapping services and diseases in macro-space to investigating the dynamic between health and place. Highlighted are some important relational dynamics among CAM providers, patients/consumers and places of treatment and some general issues that could benefit from a geographical analysis. The concurrent research agenda is located across the sub-disciplinary strata of human geography.
This paper introduces the following theme section on Geographies of Intellectual Disability. It outlines the historiography of geographical work on intellectual disability, noting in particular the contributions of Wolpert (Transactions of the Institute of British Geographers 5 (1980) 391) and Hall and Kearns (Health and Place 7 (2001) 237), before tracing claims made about both the 'institutional' and 'deinstitutional' eras in the changing geographies confronting and experienced by intellectually disabled people. This account, highlighting the tendency for such people to remain 'outside the participatory mainstream' in almost all circumstances, offers along the way an introduction to the four contributions that follow.
PURPOSE: Comparing radiation therapy utilization rates (RTUR) to those predicted by best evidence is a useful measure of the equity and accessibility of service delivery. In this study the RTUR for melanoma was established for British Columbia, Canada, and compared with the rate suggested by the evidence. Demographic variables, specifically age, gender, and geography that influenced the RTUR were examined with a view to identifying methods of improving underutilization. METHODS AND MATERIALS: The RTUR in the management of malignant melanoma was taken from British Columbia Cancer registry data for 1986 to 1998. Variations in utilization based on age, gender, health authority, stage of disease, and referral patterns were analyzed. RESULTS: An RTUR of 11% was identified. This was consistent over time. Referral rates decreased between 1986 and 1998. RT is used mostly for later stage disease. Males were more likely to receive RT than females, related to later stage of disease in men. Referral rates decreased, but RTUR for referred cases increased, in health authorities that did not have a cancer center. CONCLUSIONS: Use of RT is influenced by age and by stage of disease. Overall RTUR in British Columbia is lower than suggested by best evidence. Referral patterns are influenced by geography. RTUR was higher in males, consistent with a different pattern of disease in males compared with females.
Our investigation of the geography of fall injuries considers the relationship between injury prevention and contextual approaches to health research. We use a geographic information system (GIS) to describe the pattern of emergency department reported falls of the elderly in the Capital Health Region, an administrative health area in Alberta, Canada. We used empirical Bayes estimates to obtain a geographic measure of fall incidence over the study area and a cluster detection statistic to measure the presence of a significant spatial cluster in the region. Inner-city Edmonton had the highest incidence of risk, suburban Edmonton the lowest, and surrounding rural regions and smaller communities had more moderate fall incidence. We argue that descriptive geography can enhance the effectiveness of injury prevention programs by identifying zones of high risk, even when the individual-level and contextual factors that explain the underlying patterns are unknown.
In this paper, we study the geography of publications in clinical cancer research from 1995 to 1999. A Medline search was performed to retrieve papers in clinical oncology reporting phase I, II and III studies published between 1995 and 1999. Only studies reporting antiblastic chemotherapy have been considered, either alone or in combination with other treatments. For each country, the total number of papers, the total Impact Factor (IF), and the mean IF were determined. Similar calculations were performed to compare the European Union versus North America. 3142 papers were identified. The United States ranks first by number of papers (37.7% share), followed by Italy (9.8%), the United Kingdom (8.5%) and Japan (6.9%). Investigators at European institutions published a higher number of papers compared with their North American colleagues (1362 versus 1288). Still the mean IF of North American papers is higher than the papers with a European address (3.54 versus 3.14). The majority of phase I studies were performed in North America, while most of phase III studies were performed in Europe. These results provide information on the geography of clinical cancer research worldwide, which may reflect the human and economic resources involved in this field.
This paper extends earlier explorations of the use of metaphor in the marketing of the Starship Children's Hospital in Auckland, New Zealand, by examining controversy surrounding the opening of an in-hospital McDonalds fast-food outlet. The golden arches have become a key element of many children's urban geographies and a potent symbol of the corporate colonisation of the New Zealand landscape. In 1997 a minor moral panic ensued when a proposal was unveiled to open a McDonald's restaurant within the Starship. Data collected from media coverage, advertising and interviews with hospital management are analysed to interpret competing discourses around the issue of fast food within a health care setting. We contend that the introduction of a McDonald's franchise has become the hospital's ultimate placial icon, adding ambivalence to the moral geography of health care consumption. We conclude that arguments concerning the unhealthy nature of McDonald's food obscure deeper discourses surrounding the unpalatable character of the health reforms, and a perceived 'Americanisation' of health care in New Zealand.
This paper attempts to examine the effects of deinstitutionalization on a former asylum's human and physical geography, through a case study of St Lawrence's Hospital, Bodmin, UK. It researches the inevitably impermanent geography of an asylum in the process of being 'run down'. The paper includes an empirical account of the rationalization of a former asylum, reconstructing an east to west migration of activities across the site. It deals with St Lawrence's as a 'stigmatized' place unable to escape the mark of its asylum past, and as a place that staff and local people cannot imagine being used for anything other than land uses associated with 'mad people' or other marginal groups in society. The paper deals with how St Lawrence's is regarded by some as a 'community', people who recall with a measure of affection how the asylum used to be a 'home' as well as a 'workplace', a nostalgia which rebounds into suspicion about the dismantling process. Fundamentally, the paper aims to tease out and work through the hopes and fears that now surround the former asylum's environment.
The most important event in human economic history before the industrial revolution was the Neolithic transition from a nomadic hunter-gatherer lifestyle to sedentary agriculture, beginning approximately 10,000 years ago. The transition made possible the human population explosion, the rise of non-food-producing specialists, and the acceleration of technological progress that led eventually to the industrial revolution. But the transition occurred at different times in different regions of the world, with big consequences for the present-day economic conditions of populations indigenous to each region. In this article, we show that differences in biogeographic initial conditions and in geography largely account for the different timings of the Neolithic transition and, thereby, ultimately help account for the 100-fold differences among the prosperity of nations today. The effects of biogeography and geography on the wealth of nations are partly mediated by the quality of present-day institutions but also are partly independent of institutional quality.
BACKGROUND: Findings are compared on geographic variation of incident and late-stage cancers across Connecticut using different areal units for analysis. RESULTS: Few differences in results were found for analyses across areal units. Global clustering of incident prostate and breast cancer cases was apparent regardless of the level of geography used. The test for local clustering found approximately the same locales, populations at risk and estimated effects. However, some discrepancies were uncovered. CONCLUSION: In the absence of conditions calling for surveillance of small area cancer clusters ('hot spots'), the rationale for accepting the burdens of preparing data at levels of geography finer than the census tract may not be compelling.
This article provides an overview of 2001 Census geography systems in England and Wales, concentrating primarily on the creation of output geography. It is important to note that there are significant differences between the systems being implemented in England and Wales and those which apply to Northern Ireland and Scotland. The Northern Ireland system is broadly similar to that described here, whereas the entire data infrastructure and output area design process in Scotland are different.
We have examined, by Southern blotting, the patterns of chromosomal breakpoint locations in 55 cases of Burkitt's lymphoma (BL) with respect to geography and Epstein-Barr virus (EBV) association. We have confirmed the association between chromosome 8 breakpoint and geography: 74% of endemic (eBL) but only 9% of sporadic BL (sBL) had breakpoints outside the HindIII fragment encompassing the c-myc gene (P2 less than .00001). Conversely, not only did 91% of sBL manifest a rearranged HindIII fragment, but at least 56% of these cases, in contrast to 17% of eBL cases, had a breakpoint within the first exon or intron of c-myc (P2 less than .004). Breakpoints outside the switch mu (S mu) region (ie, the HindIII fragment encompassing S mu) on chromosome 14 were twice as common overall (73%) as those within S mu (27%), but in the 15 tumors with S mu breakpoints, 13 (87%) had a rearranged c-myc gene. Breakpoints outside the HindIII fragment encompassing c-myc on chromosome 8 were predominantly associated with non-S mu breakpoints on chromosome 14 (85%) and this was the combination most frequently associated with eBL (65%; 6% of sBL, P2 less than .00001). In sBL, the most frequent breakpoint combination was a rearranged c-myc gene with a non-S mu breakpoint (63%; 13% of eBL). Twenty-eight percent of sBL and 13% of eBL had breakpoints both within c-myc and within S mu. EBV DNA was present in 19 of 20 tumors with breakpoints outside c-myc, in none of 7 with a breakpoint in the immediate 5' region of c-myc, in 4 of 5 tumors with breakpoints in the first exon, and in 7 of 12 tumors with breakpoints in the first intron. These data suggest that the pathogeneses of eBL and sBL differ with regard to the mechanism of c-myc deregulation, and probably also with regard to the state of differentiation of the target cell for malignant transformation. We have formulated a testable hypothesis regarding the potential role of EBV in pathogenesis: that it is required to contribute to the deregulation of c-myc in the presence of some, but not all, types of c-myc damage arising from the chromosomal translocations.
In Africa, the continent most affected by HIV, the geography of the epidemic shows major contrasts. Strong regionalization differentiates both central-east Africa from west Africa and, within the countries, the urban zones from rural ones. Spatial and population factors are important when mapping the geography of the infection. An analysis of the evolution of movements--merchandise as well as populations--of the landlocked countries of the Great Lakes region of Africa leads the author to formulate a hypothesis involving regional considerations.
In a study that sought to understand the ethical concerns of home care and psychiatric nurses, relationship proved to be of central import. Yet the sense of relationship was not limited to, not even primarily, the interpersonal bond that is most commonly understood by relationship. For the nurses in this study, serious ethical concerns originated in those structural aspects of relationship reflecting the social space that patients and nurses occupy. These concerns can be broadly grouped into two categories, spatial vulnerabilities and gendered space. The ethical concerns of spatial vulnerability include poverty, exploitation of patients for institutional gain, homogenization of identity, and the fragmentation of care. Gendered space includes invisibility, instrumentality, and relations to other nurses. Geography may be a useful way to think about the nurse-patient relationship because relationship is itself a spatial term and because geography allows for the dimensionality of scale from the local or intimate to the global or structural. How we organize and structure our social relations is ethically significant.
Medical geography investigates spatial patterns in the distribution of disease occurrence. The origins of the field can be traced to antiquity, but mapping of disease did not appear until the mid-19th century. Maps can reveal distinctive spatial patterns of certain diseases and may suggest environmental correlates. The geographical distribution of many infectious diseases, such as malaria, with well-known ecology are usually easily understood. The etiology of certain chronic non-infectious diseases which exhibit noticeable geographic variation is often complex. A map of cerebrovascular disease mortality rates in Appalachia is used as an example of an application of modern medical geography.
This paper "summarises some of the major changes which have occurred in international migration to, from, and within Asia in the last two decades....A number of theoretical challenges are put forward regarding the complex interrelationships between international population movements, economic development and social change. The employment of systems approaches, neoclassical economic theory, social networks and institutional approaches, and the potential role of population geography in developing a more comprehensive explanation of the changing dynamics of international migration in the region, are discussed. Also considered are the gender dimension in migration, remittance flows and their consequences, and policy issues."
"This paper explores four selected facets of the geography of population in the [U.S.] Midwest that are related to the movement of people: (1) the spread of occupance across the land; (2) the growth of the population of counties once they had been occupied; (3) the distribution of the foreign-born population; and (4) the distribution of retired people who have migrated after they have retired."
"This is the last of three reports discussing major avenues of progress in the alleviation of population geography's poor reputation. The first examined the route of policy-relevant research, the second considered the importance of sound scholarship and, as promised, this report will explore the part that can be played by improved communication and dissemination of our work...."