INTRODUCTION TO MEDICAL GEOGRAPHY: ITS NATURE

Geography is basically concerned with question about places and their description. Medical
Geography deals with medical phenomena in relation to place and seeks to identify the particular
assemblage of health and related phenomena. Environmental conditions are undoubtedly casual
factors affecting both human health and diseases. Thus status of the environment is often the
status of the health of the community. Therefore understanding environmental aspects are very
basic. Health has been defined as a state of complete physical, mental, social and spiritual well -
being and not merely the absence of diseases. It has been also recognized that, health is a
function not only of medical care but a part of over-all integrated development of society. It is
affected by socio-economic status, family composition, customs, beliefs, and life styles. In fact
health influences man's all activities and shapes his destiny. The awareness that diseases may
have a connection with the geographical environment may be traced back to an ancient period in
human history. A record of such awareness comes from Hippocrates who lived in 4th century
B.C. Hippocrates gave much importance to geographical aspects of a place where an individual
wishes to settle.

There are several disciplines, which help in the study of health of mankind, in one form
or another and Geopgraphy is one of them. A systematic study of the spatial distribution of
diseases and health and their causes come which the field of Medical Geography’, which is a
branch of Geography. Studies in Medical Geography depict the:

 state of health of the population in a particular area or region

 Points out the effects of physio-geogrpahical, social, industrial and economic factors on
the general health of the people living in that area.

Despite the invention of several curative and therapeutics measures, the incidence of diseases has
not shown a downward trend and reflects the lack of preventive measures undertaken so far.
Health is always the outcome of environmental quality and quality of life. Understanding of
spatial pattern of diseases and health care delivery is of great importance to the healthy society.
Hence, it attempts to study the role of environment in determining the human health on one hand
and health care delivery system on the other

AN EMERGING RESEARCH DICIPLAINE

Medical Geography is a recent branch of geography. It attempts to prove the environmental

effects on the health of mankind, it unfolds the local or regional variations of environmental
conditions.

A simple definition of medical geography is, “that it is the study of areal or spatial pattern of
diseases". This study often emerges from mapping. The map may be used as an analytical tool to
break up a disease process into separate components, which may be employed in the explanation.

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The term medical geography was first used by medical workers who prepared maps and atlases
showing the distribution of diseases as important tools of analysis. The I.G.U. (1952) in
Washington congress defined Medical Geography as the study of geographical factors
concerned with cause and effect of health and diseases.

Encyclopedia Britannica defines medical Geography as study, "Dealing with geographic

arrangement of diseases and with the factors relevant to the incidence".

In Dr.C.M.How's opinion that, it is an interdisciplinary field of study concerned with areal

variation of diseases incidence as expressed by mortality or morbidity indices with possible
cause-effects relationship and with the elements of physical, biological and socio-cultural
environment in space.

Learmonth defines medical geography as the "Study of areal distribution patterns of human
diseases, preferably viewed dynamically rather than statistically, normally involving knowledge
of the ethnology of diseases, especially through medical ecology, it is the study of the web or
relationship of a diseases complex with its physical and social environment."

McGlanshan noted that the task of a medical geographer includes the preparation and collection
of data and its mapping in order to represent the presence (or absence) of certain diseases and to
apply objective statistical tests of distribution to assess whether or not the pattern is likely to
have occurred by chance and also to measure the degree of correspondence between disease and
other spatially varying factors, and then to apply tests to decide whether any spatial association
could be an causative factor. Thus, it can be said in a general term that medical Geography is
defined as the study of spatial distribution of health, ill health and disease, as determined by the
natural and cultural milieu of human being.

The natural environment, in which a person lives and settles, becomes the major cause for a
pattern of diseases from which he suffers. Thus the systematic study of the spatial distribution of
disease with reference to the environment, in which the affected person lives, forms the main
concept of the study of medical geography. In Order to show this inter-relationship, medical
geography studies the distribution; and the influence of geographical factors, such as landforms,
soil, climate, vegetation, flora and fauna and microorganisms, on the life of man. In the process
of the development of medical geography, there emerged a totally new study area, namely,
health care geography. This happened in the year 1960 when medical geographers felt that it is
not a disease ecology, which has to be studied, but the spatial organization of health institutions
in an area also plays significant role. Thus at present medical geography comprises of two
aspects, one relating to the diseases ecology, and the other to health care. In fact, the impact
of health care institutions on the morbidity and mortality rates is adventure-fascinating area for
further research in medical geography, particularly in the developing and under developing
world.

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Scope of Medical Geography
Aim of medical geography is to find out the causal relationship of diseases and also to identify
and narrow down the factors responsible. According to Dr.McGlashan, medical Geographer's
tasks are to prepare and collect disease data and to map it. Therefore the medical geography of a
region presents a holistic picture of the area or regional patterns and associations.
R.W.Armstrong (1983) said that Geography is the study of place and Medical Geography is the
study of health and medical characteristics of places.

Its objective is to understand the geographical variation in conditions of health and illness.
A.T.A Learmonth said that, Medical Geography is the study of patterns of similarities and
difference in the occurance of diseases between areas (1985).

Medical geography is a recent branch of geography arising out of a common interest

between geography and medicine. It has been widely recognized only in the last three decayed.
Medical Geography has multi faced approach towards understanding aspects of human health
problems.

Health care geography started to flourish in the 1980s. The internal structure of health geography
as a science is depicted in Figure. We can see
that medical geography, with its longer pedigree, has a wider range of areas of research. New
research trends, such as the emergence of an environmental-ecological approach, may serve
the revival of the contents and the views of this discipline. Medical geography is the area that
is most closely related to natural sciences and to physical geography as such, and yet it is
rather closer to medicine than geography. Health care geography is a relatively new area and
it has a sociological and economic approach in terms of its subjects. Its internal structure and
its new areas of research are not as elaborate as that of medical geography and its subjects are
more interwoven as well. Health care geography is closely related to human geography and
there are many geographers among its experts. However, it is apparent that these two
disciplines complement each other well regarding their contents and approaches, and as both
are included in health geography this phrase seems fitting for this independent area of science.

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Beyond describing the ordinary topics of the subject the study intends to familiarize
with the current global environmental processes that influence the health of the
population as well as their consequences. The preventative facilities and opportunities that are
crucial in the shaping of health conscious behaviors are also introduced (medical and wellness
tourism, healthy diet etc.). The importance and possibilities of cooperation and collaboration
in order to improve the quality of life and life prospects are also discussed in the course
material.

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The scope of medical geography is to study the:

 spatial pattern of occurrence of diseases

 with cause and effect relationship with space
 to examine distribution and utilization of Health care facilities that are normally
available in the area of study.

Health is also accountable interns of access to community, primary health centers. Thus access to
health care services is also addressed as a part of the study.

Late 60’s: inclusions of health care aspects gave a new dimension to the subject.

Early 70's: the application of statistical models has developed in both diseases ecology and
health care researches and adoptions of behavioral approach have strengthened it.

Then interest rise in socio economic, political dimensions of health and diseases then came
political epidemiology and traditional medicine.

A systematic study of spatial distribution of disease and their causes and health care facilities
comes in the border of the scope of medical geography. Medical geography attempts to study
the:

 Environmental effects on human health

 To map the environmental conditions that explains the spatial aspects of health and
diseases,
 To analyze the availability of the health care facilities to the needy.

The Medical Geography has the following six thematic categories on which many researches are
followed:
i. Geography of nutrition
ii. Disease Ecology
iii. Scio-Economic and cultural aspects & health
iv. Health behavior and traditional medicine
v. Health care geography
vi. Geographers and family planning programme

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Place of Medical Geography in Science of Geopgraphy
Health geography is the independent inter- and multidisciplinary area and subdiscipline
of geography. As we can see it in figure it is linked to other sub-disciplines of
geography with particularly close connections to demography and settlement geography as
well as social geography as all parts of human geography, and the development of economics
and the standards of service facilities also influence the health of the population. Therefore in
its research it relies on the figures of economic geography – especially of the food industries as
well as the figures of catering geography. Among the areas of physical geography it is
climatology and hydrology, which describe the phenomena and processes of the atmosphere
and the hydrosphere that significantly determine the human living spaces, as well as pedology
that are in close connection with health geography. This relationship is becoming
increasingly vital due to the excessive environment changing activities of the society as
healthy living space (clean air, adequate quality water etc.) is indispensable for the existence
of a healthy society. Health geography increasingly relies on data provided by various
geographical information systems (GIS) and this leads to stronger links to distance perception.
As the examined phenomena and processes refer to one or more distinct areas of the
geographical space, health geography also needs to cooperate with regional geography.

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Health geography belongs to the field of human geography, however it is closely related
to physical geography concerning its areas and aspects of research. Its approach is both of
regional and general geography. Its most important organisational principles are spatial,
historical and chronological.

Besides having involved connections with many geographical sub-disciplines, health

geography is also linked to other natural and social sciences such as biology, medicine from
the area of natural sciences, information technology from engineering and history, economics
and political studies from the area of social sciences. (Fig. 3.) Due to these multiple links its
research area focuses on problems that are examined and observed by other sciences as well,
with a different approach and aspects that of health geography.
Similarly to its multifold connections health geography has various methods of
investigations ranging from natural scientific methods (observation, modelling, etc.) to
research methods of economics and mathematics-statistics. Questionnaires, interviews and
attitude analysis, which are common research instruments in sociology, are also typical tools
in health geography

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SIGNIFICANCE OF MEDICAL GEOGRAPHY

The study of medical geography or geography of health is important to portray:

 An understanding of prevailing patterns of diseases over locations and time.
 The factors and processes of the growth and variation of diseases related to environment
 dietary status of the people within a spatial unit

These aspects can best be understood by geographers because the key to the nature, occurrence,
prevention and control of diseases lies in the environment. Analysis of the links between the
migration of people and spread of diseases, and environment and health is by its very nature a
spatial problem. Levels of risk and vulnerable vary spatially in response to variation in
environmental conditions, and as a consequence, the health outcome and associated levels of
need and health support vary. Obviously, geographers can make major contributions to help
reduce suffering of human health and increasing longevity if they are able to establish causal
links between specific disease and environment. The curative aspect of disease may well handle
by the people by using medicine but when they need to preventive aspect, they have to go
beyond it
Today, medical geography has a number of applications as well. Since the spatial
distribution of disease is still a large matter of importance though, mapping plays a huge role in
the field. Maps are created to show historic outbreaks of things like the 1918 influenza

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pandemic, for example, or current issues like the index of pain or Google Flu Trends across the
United States. In the pain map example, factors like climate and environment can be considered
to determine why high amounts of pain cluster where they do at any given time.

Other studies have also been conducted to show where the highest outbreaks of certain types of
disease occur. The Center for Disease Control and Prevention (CDC) in the United States, for
instance, uses what they call the Atlas of United States Mortality to look at a wide range of health
factors across the U.S. Data ranges from the spatial distribution of people at different ages to
places with the best and worst air quality.

Subjects such as these are important because they have implications for the population growth of
an area and the instances of health problems such as asthma and lung cancer. Local governments
can then consider these factors when planning their cities and/or determining the best use of city
funds.

The CDC also features a website for traveler’s health. Here, people can get information about the
distribution of disease in countries worldwide and learn about the different vaccines needed to
travel to such places. This application of medical geography is important for reducing or even
stopping the spread of the world’s diseases through travel.

The World Health Organization (WHO) also features health data for the world with its Global
Health Atlas. Here, the public, medical professionals, researchers, and other interested persons
can gather data about the distribution of the world’s diseases in an attempt to find patterns of
transmission and possibly cures to some of the more deadly illnesses such as HIV/AIDS and
various cancers.

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