- Email: [email protected]
A medical view of medical geography
Sot.SC;.Med. Vol.26,No. 6,p. 675,1988 Pergamon Press
plc. Printed
in Great Britain
LETTER TO THE EDITOR A MEDICAL
VIEW OF MEDICAL
GEOGRAPHY
Dear Sir, AI1 academic disciplines make some contribution to the study of human health. And just as war is too important to be left to the generals, health care is too important to be left solely to health professionals. The application of geographical techniques to the study of medical problems has a long history. Medical mapping has provided useful spatial descriptions of mortality and morbidity patterns, and given occasional pointers to possible aetiological factors. Over the last 15 years geographers have also undertaken studies of health care provision. However, while observing that medical geographical publications have increased at an almost exponential rate over the last 20 years, Giggs [l] notes that medical geography is still very much a minority subject even among geographers and, by implication, has made little impact on health professionals. He states, for example, that there are no geographers among the authors of the 92 chapters in the Oxford Textbook of Public Health [2]. A major reason for this may be that geographers and medical research workers read few of each others publications. Although they may often use the same data sources for research, e.g. mortality statistics, census reports, they publish their findings in different bodies of literature. A quick count of the references of the 8 articles by British geographers at a 1985 medical geography symposium [3], showed that of the total (208) only 13 came from the major medical journals (British Medical Journal and Lancer). A further 8 references came from journals that may be read by community physicians [4] [Journal of Epidemiology and Community Health (4), Public Health (2), International Journal of Epidemiology (1) Community Medicine (l)]. While geographers appear to make little use of medical journals, medical researchers also appear to ignore the geographical literature. The 1984 British Medical Bulletin [5] on “The Geography of Disease” listed 26 authors, only one of whom had a geography degree. Its 17 articles contained a total of 745 references but less than half a dozen were from geographical journals. Most were from medical and epidemiological journals; only two papers cited the works of Professor Melvyn Howe, perhaps the leading geographer on this subject. It is true that these examples relate to the British scene. The situation may be different in the United States and elsewhere. However, if our observations are generally valid they are important for two reasons. Firstly, geography as an academic discipline would be enhanced if its contribution to disease mapping and health service planning were more widely recognised by health professionals. Secondly, while the academic study of medical geography is of intrinsic interest, it is also of potential value to students who may wish to work in the health field. It is worth remembering that the British National Health Service is the biggest employer in Western Europe. To teach and research the subject, however, we believe that some medical input is important, firstly in the areas of understanding basic pathology and medical procedures and secondly, in interpreting and evaluating the medical literature. From the students’ point of view to have studied biology at a higher level in secondary school would be advantageous although not essential. In conclusion, we would emphasise that these comments are meant to be constructive, not critical. We believe that medical geography is a subject that has much to contribute to the medical literature and to the development of good health services. Canterbury & Thanet Health Authority/ Health Services Research Unit, University of Kent, England
HUGH F. THOMAS BSc MSc MB ChB MIEH, SANDRA
Registrar in Community Medicine E. LIMEMTANIMRCS LRCP MB BS MFCM, District Medical Officer
REFERENCES 1. Giggs J. A. Introduction of 1985 Nottingham Medical Geography Symposium. Sot. Sci. Med. 23, 913-918, 1986. 2. Oxford Textbook of Public Health, 4 Vols. Various authors. OUP, Oxford, 1985. 3. Papers presented at the 1985 Nottingham Medical Geography Symposium. Sot. Sci. Med. 23(IO), 911-I 117, 1986. 4. Eskin F. Journals read by community physicians: result of a national survey. Commun. Med. 2, 307-311, 1980. 5. Sir Richard Doll (Ed.) Geography of diseases. Br. med. Bull. 40, 307408, 1984.
675
plc. Printed
in Great Britain
LETTER TO THE EDITOR A MEDICAL
VIEW OF MEDICAL
GEOGRAPHY
Dear Sir, AI1 academic disciplines make some contribution to the study of human health. And just as war is too important to be left to the generals, health care is too important to be left solely to health professionals. The application of geographical techniques to the study of medical problems has a long history. Medical mapping has provided useful spatial descriptions of mortality and morbidity patterns, and given occasional pointers to possible aetiological factors. Over the last 15 years geographers have also undertaken studies of health care provision. However, while observing that medical geographical publications have increased at an almost exponential rate over the last 20 years, Giggs [l] notes that medical geography is still very much a minority subject even among geographers and, by implication, has made little impact on health professionals. He states, for example, that there are no geographers among the authors of the 92 chapters in the Oxford Textbook of Public Health [2]. A major reason for this may be that geographers and medical research workers read few of each others publications. Although they may often use the same data sources for research, e.g. mortality statistics, census reports, they publish their findings in different bodies of literature. A quick count of the references of the 8 articles by British geographers at a 1985 medical geography symposium [3], showed that of the total (208) only 13 came from the major medical journals (British Medical Journal and Lancer). A further 8 references came from journals that may be read by community physicians [4] [Journal of Epidemiology and Community Health (4), Public Health (2), International Journal of Epidemiology (1) Community Medicine (l)]. While geographers appear to make little use of medical journals, medical researchers also appear to ignore the geographical literature. The 1984 British Medical Bulletin [5] on “The Geography of Disease” listed 26 authors, only one of whom had a geography degree. Its 17 articles contained a total of 745 references but less than half a dozen were from geographical journals. Most were from medical and epidemiological journals; only two papers cited the works of Professor Melvyn Howe, perhaps the leading geographer on this subject. It is true that these examples relate to the British scene. The situation may be different in the United States and elsewhere. However, if our observations are generally valid they are important for two reasons. Firstly, geography as an academic discipline would be enhanced if its contribution to disease mapping and health service planning were more widely recognised by health professionals. Secondly, while the academic study of medical geography is of intrinsic interest, it is also of potential value to students who may wish to work in the health field. It is worth remembering that the British National Health Service is the biggest employer in Western Europe. To teach and research the subject, however, we believe that some medical input is important, firstly in the areas of understanding basic pathology and medical procedures and secondly, in interpreting and evaluating the medical literature. From the students’ point of view to have studied biology at a higher level in secondary school would be advantageous although not essential. In conclusion, we would emphasise that these comments are meant to be constructive, not critical. We believe that medical geography is a subject that has much to contribute to the medical literature and to the development of good health services. Canterbury & Thanet Health Authority/ Health Services Research Unit, University of Kent, England
HUGH F. THOMAS BSc MSc MB ChB MIEH, SANDRA
Registrar in Community Medicine E. LIMEMTANIMRCS LRCP MB BS MFCM, District Medical Officer
REFERENCES 1. Giggs J. A. Introduction of 1985 Nottingham Medical Geography Symposium. Sot. Sci. Med. 23, 913-918, 1986. 2. Oxford Textbook of Public Health, 4 Vols. Various authors. OUP, Oxford, 1985. 3. Papers presented at the 1985 Nottingham Medical Geography Symposium. Sot. Sci. Med. 23(IO), 911-I 117, 1986. 4. Eskin F. Journals read by community physicians: result of a national survey. Commun. Med. 2, 307-311, 1980. 5. Sir Richard Doll (Ed.) Geography of diseases. Br. med. Bull. 40, 307408, 1984.
675