Geography of health: some trends and perspectives

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.

Coronary heart disease rates within a small urban area in Belgium

STUDY OBJECTIVE

To identify geographical differences in coronary heart disease (CHD) attack rates in a small urban area and to relate these to indicators of socioeconomic class.

DESIGN

CHD attack rates were calculated from data of the Ghent MONICA myocardial infarct register for the period 1983-87. The city of Ghent is subdivided into 201 sectors based on morphological, and socioeconomic characteristics. During the national census of 1981, the main determinants of residential differentiation were measured. These sector variables were linked with the CHD attack rates.

PATIENTS

All residents of the city aged 25-69 years are prospectively followed with regard to heart attacks. Between 1982 and 1987, 1728 suffered an acute heart attack according to MONICA criteria.

MAIN RESULTS

Significant (p < 0.05) differences in age and sex standarised attack rates were observed between city sectors. These differences were related to an index of socioeconomic status.

CONCLUSION

Within a small urban area, significant geographical differences occur in CHD attack rates and these are related to socioeconomic status.

Method for the classification of countries according to health-related indicators

A taxonomic approach using cluster analysis and principal component analysis has grouped the countries of the world in eight clusters, in an initial attempt to propose a worldwide spatial classification based on the following health-related indicators: (a) those directly related to the health status of the population; (b) those measuring the provision of health care; (c) those linked to population characteristics; and (d) those reflecting economic parameters. The cartographic representation was based on demographic maps which display the area of each country in proportion to its population size.

Problems of cancer mapping

Some problems are general to disease mapping; others are specific to the cartography of cancer. Drawing a map involves the choice of projection, the indication of scale, the ranking of data and classification in categories, and the selection of an appropriate mapping technique. Specific problems are related to data gathering of cancer morbidity and mortality and to the representation of rates. Difficulties arise when comparing cancer maps.