See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/342346381

Medical Geography _ Concepts, Techniques and Approaches

Chapter · June 2020

CITATIONS READS

0 5,356

1 author:

Ifeoma Evan Uzoma

University of Uyo
15 PUBLICATIONS   1 CITATION   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Urban Water Supply View project

Human Geography - Concepts, approaches and trends View project

All content following this page was uploaded by Ifeoma Evan Uzoma on 21 June 2020.

The user has requested enhancement of the downloaded file.

139

CHAPTER 07
MEDICAL GEOGRAPHY: Concepts, Approaches and
Techniques
Uzoma, E. I

Abstract

Medical Geography as a field of study is dependent on the major traditions of Geography. As a sub-
discipline of Human Geography, Medical Geography deals with human-environment interactions and
the influence these interactions have on public health. It focuses on the geographic aspects of health,
healthcare and disease. What distinguishes Medical Geography from the discipline of Human
Geography as a whole is its thematic focus, not its methods or theoretical grounding. It uses the
concepts of Geography to investigate a variety of health related topics. This chapter focuses on the
fundamentals of Medical Geography, its objectives, approaches and models. It also addresses the
ecology and diffusion of diseases and the place of technology (Geographical Information System and
Remote Sensing) in the study of Medical Geography. The challenges of Geographical Information
System in health care are also discussed.

Introduction
Geography as a discipline is made up of four major traditions vis a viz; the area studies
tradition, spatial tradition, earth science tradition and the man-land (man-environment)
traditions (Burton, 1920). Medical Geography has two major traditions, both sharing the
special geographic methodologies of mapping and regionalizing (Meade, 1986). The first
tradition is concerned with man-land (or in today's terminology human-environmental)
relations. It has evolved from "environmental determinism"(hot, wet climates cause lethargy
and poor health) to "possibilism” in which the environment sets the ultimate constraints (one
cannot get mosquito- transmitted diseases at 15000 feet elevation) but interacting cultural
forms are varied, to a "cultural ecology" in which human existence is inextricably interwoven
with the biosphere (Meade and Emch, 2010). The dimension of medical geography that
developed from this tradition is concerned with such things as the malarial consequences of
converting rain forest into agricultural land for population resettlement.
The second tradition is concerned with spatial analysis or the explanation for variation over
the earth's surface of almost anything (Latham, 1963). The trend over time has been from
describing to explaining to, recently, optimizing locational decisions on the basis of the
explanation. In medical geography this tradition has resulted in studies of phenomena as
varied as the distribution of mortality, hospitals, and herbal remedies. The explanation has
sometimes drawn upon the man-land tradition, but more often has rested on aggregate,
ecological associations.
In the last three decades, Human Geography as a discipline has witnessed a revolution
which has extended its boundaries. Geographers are applying new concepts and research
methods to approach more complex issues. One of the growing fields in human geography is
139

Medical Geography or the study and application of geography concepts and techniques to
health related problems (Valencius, 2000; Ajaegbu, 1992) and this area is rooted in the man-
environment and spatial traditions of Geography. The pivotal point in the course of Medical
Geography came in 1850 when the renowned English physician John Snow, pioneered the
idea that ecological phenomena can be cartographically matched to health events, correlating
cases of cholera to water supply structures within London using maps (Newson, 2006). Snow
was simply applying the concepts of Geography to control a disease based directly on the
results of a spatial analysis. Because his work showed for the first time that Geography can
play a primary rather than supportive role in the explanation of many diseases, he (John
Snow) is considered the father of Medical Geography (Barret, 1996).
This chapter sets out to shed more light on what Medical Geography is all about, the
fundamentals of Medical Geography, its objectives, approaches and models. It also addresses
the ecology and diffusion of diseases and the place of technology (Geographical Information
System and Remote Sensing) in the study of Medical Geography. The challenges of
Geographical Information System in health care are also discussed.

What then is Medical Geography?

Medical geography as an aspect of human geography has been given different definitions by
different authors and the definitions are based on perspectives of authors. A few of the
definitions are noted in this paper;
Medical Geography is a sub-discipline of Geography which deals with human-environment
interactions and the influence these interactions have on public health. It focuses on the
geographic aspects of health, healthcare and disease. What distinguishes Medical Geography
from the discipline of Geography as a whole is its thematic focus, not its methods or
theoretical grounding. It uses the concepts of Geography to investigate a variety of health
related topics (Meade and Emch, 2013). It has also being defined severally by different
writers. It has being defined as an area of Geography that incorporates geographic techniques
into the studying of health around the world and also the spread of diseases (Lang, 2000).
Jacques May (1952), a founding father of Medical Geography defined medical geography as:
the study of the distribution of manifested and potential diseases over the earth’s surface and
of factors which contribute to disease (pathogens) followed by the study of the correlations
which may exist between these and the environmental factors. Hall (2000) defined medical
geography as the branch of human geography that deals with geographic aspect of health
(status) and health care systems. He defined it as the application of geographic information,
perspectives and methods to the study of health, disease and health care. Another writer,
Briney (2008) defined Medical Geography as the branch of medical research that
incorporates geographic techniques into the study of health around the world and the spread
of diseases. In addition, Medical Geography is a field that studies the impact of climate on an
individual’s health and the distribution of health services. Rosenberg (2009) described
Medical Geography as a field of Geography that studies the geographic distribution of
diseases (including epidemics and pandemics), illness, death and healthcare.

From the definitions given above, Medical Geography can be defined as the discipline that
looks holistically at the geography of disease and healthcare and its relationship within space
and time. It deals with the human – environment interactions and the influence these
interactions have on public health. There are basically two branches of Medical Geography:
139

one examines the geographical factors which contribute to ill-health and disease
(Geographical Epidemiology). It can also be called the Geography of disease and ill health,
involving the descriptive research quantifying disease frequencies and distributions and
analytic research which is concerned with finding out what characteristics make a population
or individual susceptible to disease. This requires an understanding of Epidemiology.
Whereas the other deals with the geographical factors influencing the provision of and access
to health services (Geography of health care), facility location, accessibility and utilization.
This requires the use of spatial analysis.

Fundamentals of Medical Geography

Just as in every other discipline, there are guiding principles which serve as ground work of
the system. The basic fundamentals of Medical Geography include:
1. Place: Geography is naturally about space and place. Here, we look at the specifics of
particular localities in which health or ill - health is experienced, risk factors are
negotiated, and services organized and utilized (Meade, Florin and Gesler, 1998).
Places matter because it is a chief determining factor in the health and well being of a
people, the type of health problems found in an area and solutions necessary. One area
in which this approach has been significant is in exploring the relationship between
neighbourhood, socio - economic status and measures of health status and risk factors
(Mayer, 2010).
2. Health: Health refers to a state in which an individual is perfectly adapted to his
environment. It is according to the World Health Organization (1948) “a state of
complete physical, mental and social well-being and not merely the absence of
disease or infirmity”. They considered health as the level of functional or metabolic
efficiency of a living being, usually meaning to be free from illness, injury and pain.
Since good health is much more than an absence of disease, it involves a state of
equilibrium between humans and the physical, biological and social environment,
compatible with full functional activity (Last, 1987). Medical Geography focuses on
the health of communities and populations rather than on the health of individuals and
it is measured by factors such as availability of safe drinking water, environmental
sanitation, disease ecology, immunization rate, nutrition etc.
3. Well being: this is a state of being healthy especially with regards to landscapes and
environment (Williams, 2010).
Place, health and well being therefore forms the fundamentals of studying medical geography
within this context.

Objectives of Medical Geography

There are different objectives which Medical Geography as a discipline intends to achieve.
These objectives are rooted in the spatial and man-environment traditions of Geography and
they include the following;
1. The focus of medical Geography is on the geographical patterns of health and
diseases from the view point of the populations rather than the individuals.
2. Medical Geography seeks to improve our understanding of the various factors which
affect the health of the population and hence individuals. It also enhances the concept
and ideas we have about health and diseases and also enhances the final outcome of
health care.
139

3. Medical Geography helps researchers to understand the power of mapping their study
data (diseases) and understand the significance of place in understanding health and
disease.
4. Medical Geography also aims to provide an understanding of health problems and
improve the health of people worldwide based on the various geographic factors
influencing them.
5. Medical Geography facilitates a critical understanding of health, disease, illness and
society; promotes an understanding of how Geography as a discipline contributes to
the understanding of health and health care provision and improves understanding of
the impact of ecological and population change on health. It is a course that aims at
utilizing maps to examine the spatial patterns of disease and risk factors that may
contribute to disease and also to introduce some of the major contemporary issues in
global health.
6. It aims to elucidate the causes and patterns of diseases. It also tries to predict the
occurrence of the major infestations in order to enhance their prevention.

Interdisciplinary Nature of Medical Geography

Medical Geography uses the techniques and concept of the discipline of Geography to
investigate health related topics. One of the predominant concepts of Geography as a science
is that it examines relationships between people and their environment in holistic terms. In
the particular sub discipline of Medical Geography, the focus is upon this interactions that
bear specifically upon human health within a variety of cultural systems and a diverse
biosphere. Another concept of Geography is cooperation with other fields to bring about
developments. The medical personnel brings the skills for prevention, diagnosis and
treatment, but an understanding of why and how a disease spreads rests at the core of modern
Medical Geography with its concern for spatial structure.
Medical Geography is an integrative and multidisciplinary subject incorporating
contributions from a wide range of specialties such as Epidemiology, Public Health, Statistics
(to make efficient use of data and draw appropriate conclusions), Biology (to understand
disease process), Engineering (exposure assessment), Geographical Information Systems (to
map disease spread) and Climatology etc.

Applications of Medical Geography

Medical Geography is used in mapping and studying the spatial distribution of diseases.
Maps are created to show historic outbreak of diseases and the source areas of diseases. For
example, the Atlas of the United States mortality was used to look at a wide range of health
factors such as instances of cancer, asthma etc and the importance of population growth in
relation to disease spread.
Travel agencies use such information to advice on the distribution of diseases
worldwide so they can learn about the different vaccines needed to travel to such places. This
no doubt aids the reduction or/ stop the spread of disease through migration.
Medical Geography is applied in the production of the World Health Organization
Global Health Atlas which is used to gather information about the distribution of the world’s
139

disease in an attempt to find patterns and trends of transmission, help monitor the spread of
the diseases, help check the impact of the diseases and possibly find cures. The Global Health
Atlas can also be used by medical professionals, researchers and other interested persons to
gather data about the distribution of the world.

Disease Ecology
The geographic distribution of disease is neither random nor uniform. Rather, diseases vary
spatially. Diseases that are always present (endemic) in certain locations are often completely
missing in others. For example, while malaria is endemic in tropical Africa, it is rare in
Western Europe. Similarly, diseases that are globally present, such as pandemic HIV/AIDS,
vary spatially in prevalence and severity of impact due to spatial differences in access to
health care, immunity, sexual behaviours, and other factors. For example, due to poverty and
other factors, sub – Saharan Africa has been more severely impacted by HIV/AIDS than any
other world region. A person’s risk of exposure to infection varies with their social context,
including sexual contacts and behaviour, and genetic factors including current health and
nutrition status and immunity.
The disease ecology framework provides an explanation for this uneven geographic
distribution of diseases. In its most basic form, the framework argues that any disease may be
attributable to three sets of factors – genetics, environment, and behaviour. Genetics refers to
biological characteristics of people, environment to the geographic context in which people
live, and behaviour to people’s choices, activities, and interactions. These factors play out
differently in different places, giving rise to distinct ecologies of disease.

Disease ecology is the interaction of the behavioural ecology of hosts with the biology of
pathogens, as it relates to the impact of diseases on population. Disease ecology has been
commonly understood to include features of the environment, population, and culture in the
explanation of patterns of disease, in answer to the questions of “why is this disease here?”
or “why is this disease in places like this? Disease ecology deals with the relationship
between disease and the geographical environment in which it occurs.

It is the study of underlying principles that influence the spatio-temporal patterns of diseases.
Incidence, spatial distribution and timing of diseases reflect the interactions of populations
with each other. Diseases may be environmental (i.e. caused by things like toxins, air, water,
cancers, environmental shortages such as famine), or infectious (i.e. caused by pathogens). It
also looks at how physical factors including climate and weather, soil composition, and water
composition affect the spread of disease in an environment. The study of disease ecology
hopes to achieve the following objectives;
A. To develop an understanding of the relationships between diseases and environments
B. To develop an understanding of the interactions among pathogens, hosts or receptors
and the environment.
C. To make it possible to prevent change in the infectivity and virulence of organisms
that threatens human health at population level.
D. To explore the impact of environmental change on disease etiology, vectors and toxic
organism.
139

E. To develop new approaches to surveillance and monitoring.

F. Improving models of host-pathogen ecology.
Disease ecology focuses on understanding how diseases spread through and impact host
population, and how hosts, pathogens and their environments react and evolve in response to
one another. It is a rapidly expanding discipline that draws on the strength and merges the
ideas of ecology, geography, microbiology, mathematics, medicine, genetics, immunology,
and epidemiology, biomedical, agricultural, veterinary and environmental sciences to study
the interaction of the behaviour and ecology of hosts with the biology of pathogens, as it
relates to the impact of diseases on populations i.e. the study of how hosts and pathogens
interact in populations, communities and even entire ecosystems. It also helps to better
understand how climate and environment affects the interaction between hosts and pathogens.
Here, the link between the ecology of organisms and their ecosystems are established by
providing mechanisms for predicting the consequences of human induced land use changes
for the spread and evolution of infectious agents.
The ecology of infectious disease explores relationship between parasitic, bacterial,
and viral infectious diseases, their human and animal hosts, and their environments react and
evolve in response to one another. Common themes here include factors responsible for the
emergence and re-emergence and persistence of diseases within animal and human
population, the factors contributing to their spread, and the impact of environmental
disturbance on these dynamics. The ecology of infectious disease is an important aspect that
combines field studies and epidemiology to understand interactions among human hosts,
vectors and pathogens and to better forecast risk.
An important principle of disease ecology is that population, society and both the physical
and biological environments are in dynamic equilibrium. Significant enough stress on this
equilibrium can produce cascading effects on any of the aforementioned components. The
human-environment relationship, if disturbed enough by major changes in land use,
migration, population pressure, or other stressors can show significant mal-adaptation, as
manifested by the appearance or diffusion of new diseases. Much historical work has
demonstrated the effects on both Europe and the Americas of the early widespread contact of
the European explorers (e.g., Crosby, 1972, 1986; McNeill, 1976; Whitmore, 1991; Denevan,
1992). Other more contemporary manifestations of disequilibrium include the tremendous
increase in the incidence of schistosomiasis following the construction of the Aswan Dam,
and the increase in schistosomiasis, malaria and other infectious diseases following the Volta
River project in Africa. Examples from other continents include increases in malaria
following land clearance for rubber plantations in Malaysia, increases in vectored diseases
with the construction of transportation routes in Brazil, and the appearance of Lyme disease
in the United States following the reforestation of peri-urban areas in the northeast. The
reforestation occurred as previously agricultural areas were brought into residential and even
commercial usage, thus increasing the proximity of humans and deer. Deer are important in
the transmission of Lyme disease, serving as the main link between the rodent reservoirs of
Lyme disease and humans. The increased proximity also increased the contact between
people and deer ticks. Since deer are edge dwellers, transmission of disease between the
animal reservoir and humans via the deer ticks increased by changes in land use patterns.
Despite the human toll taken by the AIDS pandemic, the major lesson to be learned from the
pandemic is that the assumption that infectious diseases are a phenomenon of the past, largely
restricted as major health threats to developing countries, and that ``international health''
consists of the study of problem of developing countries, are all erroneous. HIV/AIDS is
139

prototypical of emerging and resurgent infectious diseases, which the medical and public
health communities now acknowledge to be a hitherto unappreciated reality and a severe
threat to worldwide public health. Many geographers have analyzed the spatial and ecological
patterns and issues of HIV/AIDS (e.g. Shannon and Pyle, 1989; Shannon et al., 1990; Gould,
1993).

Models and Approaches to Medical Geography

Models have been described as representations of real life situations (Harvey, 1969). There
three basic models that are used in Medical geography and they include, environmental
models, spatial- temporal models and behavioural models. Medical Geography also uses
three major approaches and methods in its work which are tied to the spatial and man-
environment traditions. These three approaches determine how and where Medical
Geography is applied or made useful.

Environmental or Ecological Models

These are models that try to explain the occurrence of the incidence of disease on the basis of
environmental associations and causations. Disease regions and the extent to which they are
associated with or make for the flourishing of specific germs and diseases are recognized on
the basis of physical characteristics and ecological combinations. These models identify
patterns and differences in disease by the prevalent disease types, disease incidence, health
conditions/level, morbidity and mortality levels etc. The models studies different types and
levels of environment e.g. physical environment (relief, vegetation, climate soils etc),
socioeconomic environment (population, settlement densities, education levels, occupation,
income etc) and it also studies disease vectors in the environment (water borne disease, air
borne disease, insect borne disease), atmospheric hazards, seasonality of disease incidence,
disease of poverty, occupational disease etc

Spatial- Temporal Models

These models aim at understanding or explaining the implication of space, distances and
time, regarding to the spread of diseases. They are concerned about the spatial processes
involved in the spread and flow patterns of diseases, the journey to medical institutions and
utilization of health facilities. They also look at the importance of flow patterns (movement
and migration) in bringing about the spatial patterns of disease. It also looks at why
environmental factors can explain the presence of a disease in a place but cannot explain the
extent of its spread and how vectors adapt to an environment. Examples of such models are
the distance decay model (Meade, 1986). These models also explain the extent to which
distance from health facilities explain peoples use of health facilities or the extent to which
disease are cured. The distance may be in terms of route, time, effort, cost or money cost over
space, or social distance as they exist between disease vectors and human host, human host
and the population at risk, disease and endemic areas and patients and sources of medical
care.

Behavioural Models
These models are concerned with the actual behaviours involved in the vector-host agent
relationships in the occurrence of diseases. These models try to explain the adaptive
behaviour of the vector, the behaviour of human population at risk and the response of
patients to medical care.
139

Spatial Diffusion of Diseases

Disease diffusion refers to the spread of disease from its source into new areas (Cromley and
McLafferty, 2002). The diffusion of infectious disease moves both through population and
over space (Meeade and Emch, 2013).
It is well documented that the incidence of disease is likely to be affected by distance so that
places closer to the source of a disease is likely to have higher incidence (Pyle, 1979).
However, in a globalised world, increasingly connected by an integrated transport
communication system there is also strong evidence to suggest that disease can spread
quickly via roads at the national scale and airports at regional and global scale.
Spatial diffusion has, of course, been of tremendous interest to geographers and
epidemiologists for centuries. Recent changes in travel patterns have altered the human
ecology of infectious disease. A well-known characteristic of contemporary society is the
increasing speed with which individuals and transportation vehicles traverse the earth. This is
illustrated by the diffusion of new influenza strains, as discussed previously. One estimate is
that approximately one million people travel internationally each day, and one million people
travel from developed to developing countries (and vice versa) per week (Garrett, 1996).
Thus, if somebody contracts a disease on one continent, it could be transmitted to the
population on another continent by the next day. The rates and patterns of diffusion depend
on the mode of transmission. With respiratory viruses, such as influenza, where viral
replication takes place on the epithelial cells of the respiratory tract, and then the virus is
transmitted via the airborne route, diffusion is rapid. The particular diffusion patterns are
determined largely by understanding the origins and destinations of human travellers. Where
spatial interaction is more intense, the likelihood of spatial diffusion is greater. This is
particularly significant for rapidly diffusing diseases with high attack rates such as influenza.
Travel and migration have been established as the main reason for the diffusion of
HIV/AIDS, but the spread of AIDS has been much slower than that of influenza, since
transmission is more difficult, and requires participation in specific behaviours (Quinn,
1995).
Disease diffusion is the spread of diseases through different agents such as water, air
wind etc. diseases can be diffused in six different ways and they include:
a. By expansion diffusion – the disease may intensify in the originating region and then
diffuses outwards to new areas (Hornsby, 2000; Pyle, 1979). Expansion occurs when
a disease spreads from one source place to another. In this expansion process, the
disease often intensifies, in the originating region. As the disease expands into new
areas it is likely to weaken. This type of diffusion was recognised in the recent Lassa
Fever virus that had its source in Borno state, Nigeria.

b. Relocation diffusion – here, the diseases leave the originating areas and migrate to new
areas (Hornsby, 2000). Relocation diffusion is a spatial spread process, whereby the
disease leaves the areas in which it originated as it moves into new areas. An example of
relocation of disease can be seen in the migration of disease carriers, whether it be a
migrant with HIV or measles. The spread of cholera in Haiti in 2010, which killed 6000
people was thought to be brought into the country by aid workers from Nepal in the
emergency response to the earthquake (The British Geographer, 2014).
139

c. Mixed diffusion: It can be through a combination of expansion and relocation diffusion or

a combination of contagious, hierarchical and network diffusion as in the case of
HIV/AIDS (Cromley and McLafferty, 2002; Hornsby and Kathleen, 2000).
d. Network Diffusion: Network diffusion occurs when a disease spreads via transportation
and social networks (Cromley and McLafferty, 2002). It reflects the geographical and
social structuring of human interaction. A good example of a disease to explain this path
of diffusion is HIV. We can see how HIV is spread along important transport routes such
as those countries with a developed road network in Africa and also within social (sexual)
networks. A second example would be the recent H1N1 flu virus that quickly went global
via the aviation network of flights and major international airports.
e. Contagious or radial Diffusion: Contagious diffusion is disease diffusion which depends
on direct contact with individuals who have been infected (Hornsby, 2000). The process
is strongly influenced by distance because nearby individuals or regions have a much
higher probability of contact than remote individuals or regions.
f. Hierarchical Diffusion: Hierarchical spread involves the spread of disease through an
ordered sequence of classes or places (Hornsby, 2000), for example from large cities to
remote villages. Cascade diffusion is a term used to describe a process assumed to be
downwards from larger to smaller centres. For example, the spread of disease from one
large city to smaller towns and then into peripheral villages. This hierarchical spread can
also be seen with HIV in regard to social status and sexual habits. HIV spreads is
contained at first among a few carriers with high status and high concurrency of sexual
relations (Hornsby and Kathleen, 2000). The disease is spread first to people with
medium status and medium level of sexual concurrency. Finally the disease may then
spread from the second tier of carriers to people with lower status and lower sexual
concurrency.
g. Reversed Hierarchical diffusion pattern: according to Altonen (2014), socio-economics
and social inequality play a role in disease diffusion within densely populated areas, with
certain diseases impacting the poor due to their population health features, local sanitation
and environmental health related features.

Trends in Technology and Medical Geography

Geographical Information Systems (G.I.S) and Medical Geography
Geographical Information Systems are computer based sets of procedures that capture, store,
manipulate, edit, retrieve, analyze, model and display data with spatial characteristics
(Aronoff, 1989). In all applications that use the GIS, one of the most valuable is in the area of
health research. Medical Geography has embraced GIS as a remarkable tool for
understanding how health is related to space, in forms such as uncovering disease distribution
to the allocation of health resources across communities (Cromley and McLafferty, 2002).
GIS is an excellent tool used to identify spatial patterns and core areas of disease
transmission. Disease maps can distinguish the low and high risk areas, as well as physical
and socio-cultural factors that contribute to the causation of disease (Rytkonen, 2004).

Application of GIS in Medical Geography

139

The use of GIS within health may be categorised into three distinctive areas of health
and they are; epidemiology, healthcare and health research. Epidemiology is the study of the
occurrence of disease, especially in relation to environmental features. This is an area in
which traditional analytical tools of GIS are employed a great deal. The use of GIS in health
is concerned with such factors such as hospital and clinic placement, accessibility to these
and other services contributing to the health of people. Due to the ability of the GIS to
combine data from many sources, for identification and mapping of environmental factors
associated with disease vectors, GIS is particularly suited for disease surveillance and
monitoring. It can also be used to monitor water borne disease, environmental health,
modelling exposure and quantifying lead hazards in an environment.
Geographic Information systems can also be applied in the area of identifying and
predicting spread patterns of diseases and those patterns used to curb future patterns of
disease spread. It is one of the useful tools in mapping and analyzing the spatial distribution
of diseases. It aid and assists in health research, health education, planning, monitoring and
evaluation of health programmes that are meant to control and eradicate certain life
threatening diseases and epidemics.
Geographic Information systems (GIS) can also be used to quantify the associations between
the disease risk variables e.g. vectors, pathogen and reservoir host abundance and distribution
and environmental variables.
Organizations that collect substantial data for decision making purpose are often
characterized as being “data rich” but “information poor”. Maps and mapping tools can be
very useful for each transfer in converting locally collected data into useful information. GIS
is also used to improve data collection in the field (for example, for rapid health assessment
or mortality surveys).
Geographic Information systems (GIS) and Remote Sensing (RS) technologies are being used
increasingly to study the spatial and temporal pattern of diseases in the environment. It can be
used to complement conventional ecological monitoring and modelling techniques and
provide means to portray complex relationship in the ecology of diseases. In addition, the use
of Geographic Information systems (GIS) and Remote Sensing (RS) technologies to identify
environmental feature allows the determination of risk factors and delineation of areas of risk,
permitting more rational allocation of resources for cot effective control.
Geographic Information systems (GIS) and Remote Sensing (RS) technologies are powerful
resources for community health for many reasons including their ability to integrate data
from many sources to produce new information and their inherent visualization (mapping)
functions, which can promote creative problem solving sound decisions with lasting impact
on people’s lives.
GIS has become another major tool for public health professionals to track the status and
distribution of health indicators. GIS software like MAP INFO and EPI MAP are utilized to
map out spatial distribution of various diseases and its variation over space and in time. Maps
are used for decision making and designing health policies.
GIS is used to analyze both temporally and spatially complex datasets in geographical health
research e.g. demographic, political, environmental, ecological, topographical, hydrological,
land-use, public infrastructure, transportation, climatic, health infrastructure and
epidemiological data. (Kannel et al 2001). Indeed, GIS has been used to capture, map,
transform and analyze data for use in disease atlases; to model disease in relation to
139

environmental variables; to predict the effect of density-related factors in disease distribution

and to focus and drive infection control programs by identifying the areas of endemic
diseases and population at risk.
GIS also offers analogous analytical capacities and can additionally offer useful spatial
selection and buffering tools (Kistemann et al. 2002 ). Applications are extensive and include
such possibilities as identifying zones of potential risk for diseases like asthma (Maantay
2005 ).

GIS tools are widely used in analyses of health and health care, allowing, for example, the
identification of catchment areas for health care facilities or zones of contagion for infectious
diseases or pollution impact zones around hazardous facilities such as incinerators or major
roadways (Cromley and McLafferty 2002 ). Maps representing the associations between
health outcomes and environmental characteristics can easily be generated, providing a
platform for statistical analysis of spatial associations.

Case Studies

• Using GIS to document the emergence and geographic spread of Barmah forest virus
in Australia (Tong et al, 2005).

• Modelling the temporal-spatial distribution of Dengue fever outbreak in Puerto Rico

(Morrison et al, 1998).

• Analysing health impact of water sources in diarrhoea in Nigeria (Njemanze et al,

1999).

• Modelling the spatial distribution of Immunisation services in Akwa Ibom, Nigeria

(Uzoma, 2017)

Remote Sensing (RS) and Medical Geography

Remote Sensing (RS) is the small or large scale acquisition of data on an object or
phenomenon by the use of recording or real time sensing devices that are not in physical or
direct contact with the object or phenomenon being studied (Campbell, 2002) e.g.
observation satellite, weather buoys etc. In Medical Geography, when such problem such as
the identification of endemic areas of disease, the estimation of population at risk and the
assessment of environmental information in areas that lack baseline data or cannot be
accessed arise, the use of Remote Sensing in conjunction with GIS provides an effective and
efficient method of data capture.

Spatial Techniques Useful in the Study of Health

Mapping disease is now a common practice, perhaps even a banal practice. It has been
facilitated by developments in software capabilities including geographic information
systems (GIS) and internet mapping systems such as Google Earth, advances in geocoding,
and increases in data availability.
139

There are various spatial techniques that can also aid the study of the geography of health and
they include;
a. Spatial Analysis: it is a geographic research tool used to compare the spatial
distribution of a set of features. Spatial analysis is used in identifying the spread of
contagious disease, both by agencies responsible for surveillance, by those who are
developing predictive models, and by those who are describing recent epidemic
patterns. These patterns or distribution can help identify and quantify the underlying
cause of such patterns. In health research, spatial analysis is used to detect and
quantify patterns of disease epidemiology that may be an insight into the disease
epidemiology, detect clusters of health events that may demonstrate significant areas
of either high or low disease risk and assess why clusters exist where they do. It
identifies the where of spatial patterns. Example, Spatial analysis was used for
forecasting the progress of the HIV epidemic in the1990s.
b. Multivariate spatial statistical modelling of disease process: spatial autocorrelation
is quantified in spatial analysis through the use of spatial statistics. Spatial statistics
are used to detect patterns of spatial autocorrelation that represent the high or low
disease clusters. It a GIS technique which enables the evaluation of potentially true
disease outbreak and a more effective allocation of sparse resources towards their
containment and prevention.
c. Mapping – it helps in visualizing disease spread, understanding the direction and
pattern of spread and aid resource allocation. By identifying spatial patterns, one can
sometimes also identify a series of associated environmental or population factors that
co - vary at the same scale. This is useful both for exploring possible associations in
order to test individual - level risks, and, ultimately, cause, as well as identifying areas
of risk that may be targeted for intervention.
d. Spatial autocorrelation: It is a concept based on the idea that observations that are
located close to each other are influenced by each other and not distributed in space
and time by random chance alone (Meade and Erickson, 2000). Positive
autocorrelation occurs when events of similar values are adjacent to each other while
negative autocorrelation occurs when high values are located adjacent low values. It is
a technique used for assessment of the correlation of a disease with reference to its
spatial location and its attribute and spatial features.
e. Local indicators of spatial association (LISA) statistics: it is a technique used to
identify influential and risk location in spatial association analysis. It is also used in
the location of hotspot zones.
f. Hotspot analysis: hotspots are concentrations of incidents within a limited
geographic area that appear over time. When dealing with health events, hotpots are
indicative of a particular area or environment that is particularly prone to disease.
Hotspot analysis can be used to show the spatial dimension of an epidemic i.e. to
show the areas where certain diseases are clustered. Health prevention can therefore
target effort to these areas knowing that they will achieve a positive result in reducing
disease with limited resources. Several types of hotspot analysis includes;
• Point-location (it identifies areas with the most number of hotspots)

• Hierarchical cluster detection (grouping incidents by Nearest Neighbour

Index)

• Partitioning (assigns point into groups for clusters detection)

• Density (identifies clusters based on concentrations of incidents)

139

• Clumping (it is similar to partitioning but it allows for overlap of cluster

membership)

• Risk based clustering (detects clusters based on an underlying risk variable

such as population, socio-economics, property values etc)
g. Density analysis: it involves the integration of spatial and non spatial data into the
GIS database. The data helps to analyse the factor that are responsible for the
distribution pattern of a disease and its concentration.
h. Weighted overlay analysis: it is a technique used to apply a common scale of values
to diverse dataset to create an integrated analysis. It also includes the use of
modelling, spatial interpolation and extrapolation, and GIS to estimate exposure to
potential and known risks.
i. Cluster analysis: The purpose of cluster analysis is to identify locations, magnitudes,
shapes of statistically significant patterns of events. It also helps in the generation of
significant explanation about the processes that produced the pattern events (causation
and potential risk factors. it is a technique used to show if the pattern of distribution is
clustered, dispersed or random. It also shows the feature similarity on both feature
locations and feature values simultaneously. The advantage of detecting clusters I that
it helps to identify spatial patterns that are unique and different than what could be
expected in the absence of the phenomenon being studied i.e. clustering is a measure
of an area’s abnormality relative to an expectation.
j. Distance Analysis: The Distance Analysis calculates the statistics based not only on
location of points but on the distance between the points. Because it is used to identify
the degree of clustering of points, it is sometimes called a local or ‘second order’
analysis. Examples of distance analysis include Nearest Neighbour Index (NNI) and
Ripley’s k-statistics. Ripley K- statistics provides a test of autocorrelation for every
distance from each observed event.
k. Dot - point analysis - The analysis of dot - points is often used to track down unusual
concentrations of cases across space. These concentrations can be tested by various
criteria: their geometrical pattern, their association with the distribution of the
population or other associated factors, their linkage with previous cases, or sources of
contagion.
Other techniques include the following; geographical smoothers, empirical Bayes
methods, correlation, and regression further enhanced the utility of mapping and pointed
in new directions.

Challenges of using GIS in Healthcare

Challenges involved in incorporating GIS application into the decision making process within
the health sector include a lack of financial resource for software acquisition and training of
non specialist to use such tools.
Another challenge is in terms of mapping latency (delay between stimulus and response)
periods, allowing for population mobility, ensuring the quality of information, and
recognising confounding (puzzling or mixed up) factors. Lack of geographically detailed data
is particularly problematic in countries with little tradition of public health, such as Nigeria,
and also in the less developed world.
139

Conclusion
Medical Geography is one of the oldest existing branch of Geography which has helped
extend the traditions of Geography to the frontiers of health and healthcare. Just like any
other field of study, there are constant changes and improvements in the applications,
approaches, models and technology used in the study of Medical Geography. In these
changes and improvements lies the future of this branch of Geography.

References
Ajaegbu, H.J. (1992). Orientations for Nigerian Geography in The 1980’s: the Need for Medical
Geographical Studies. In Ayeni, B. And Faniran, A. (eds): Geographical Perspectives on
Nigeria’s Development. The Nigerian Geographical Association, Nigeria. Pp 167-179

Altonen, B (2014). 1960-Pyles’s Disease Diffusion and Migration Patterns. Public Health, Medicine
and History.

Barret, F.A (1996). Daniel Drake’s Medical Geography. Social Science and Medicine, 42(6), 791-800.

Briney, A. (2008). Medical Geography in www.about.com (website).

Brown, T., McLafferty, S. and Moon, G. (eds). A Companion to Health and Medical Geography.
Wiley-Blackwell publishers. Pp 1-637

Hall W. (2000): Just Another Medical Page (Web site).URI:

http://www.geocities.com/tokyo/flats/7335/medical_geography.htm

Hornsby, K. (2000). “Spatial Diffusion: Conceptualizations and Formalizations.” National Center for
Geographic Information and Analysis and Department of Spatial Information Science and
Engineering, University of Maine, 2000:

Hancock, T. and Perkins, F. ( 1985 ) The mandate of health: a conceptual model and teaching tool .
Health Promotion 24(1)8 – 10 .

Kickbusch, I. ( 1989 ) Approaches to an ecological base for public health . Health Promotion 4(1)265
–8.

Lalonde, M. ( 1974 ) A New Perspective on the Health of Canadians. Government of Canada.

Lang L. (2000): GIS for Health Organizations. California: ESRI Press. [ISBN 1-879102-65-X]

Last, J.M.(1987): Public Health and Human Ecology. Apple and Lange, Connecticut.

Latham, J.P (1963) “Methodology for an Instrumental Geographic Analysis,” Annals of the
Association of American Geographers, 53(2):194–209.

Mayer, J.D (2010). Medical Geography. In: Tim Brown, Sara McLafferty, and Graham Moon (eds). A
Companion to Health and Medical Geography. Wiley-Blackwell publishers. Pp 33-35

Meade, M.S and Emch, M (2010). Medical Geography. Third edition The Guilford Press, New York.

Meade, M.S, Florin, J.W and Gesler, W.M (1998): Medical Geography. The Guilford Press, New
York.
 139

Meade, M.S (1986). Geographic Analysis of Disease and Care. Ann. Rev. Public Health. 1986. 7:313-
35

Meyer, J. D. (1982): Relations between Two Traditions of Medical Geography. Progress in Human
Geography. 6:216-230

Newson, S.W.B (2006): Pioneers in Infection Control: John Snow, Henry Whitehead, the Broad
Street Pump and the Beginnings of Geographical Epidemiology. Journal of Hospital Infection.
64(3), 210-216.

Oppong, J.R. and Harold, A. (2010). Disease, Ecology and Environment. In: Tim Brown, Sara
McLafferty, and Graham Moon (eds). A Companion to Health and Medical Geography. Wiley-
Blackwell publishers. Pp 237

Pyle, Gerald F. “Studies of Disease Diffusion.” Applied Medical Geography. V.H. Winston and Sons,
Washington, D.C., 1979: pp. 123-163

Rosenberg, M.W. (1998): Medical Geography or Health Geography? Populations, Peoples and Places.
International Journal of Population Geography, 4:211-226.

Rytkonen, M. (2004). Not all Maps are Equal: GIS and Spatial Analysis in Epidemiology.
International Journal of Circumpolar Health. 63(1)

The British Geographer (2014). The Spread of Disease and its Management. The Gography of Health.

Williams, A.M. (2010).Therapeutic Landscapes as Health Promoting Places In: Tim Brown, Sara
McLafferty, and Graham Moon (eds). A Companion to Health and Medical Geography. Wiley-
Blackwell publishers. Pp 207

Uzoma, E.I (2017). An Analysis of the Utilisation of the Expanded Programme on Immunisation
(EPI) in Akwa Ibom State, Nigeria. An Unpublished PhD Thesis in the Department of
Geography and Natural Resources Management, University of Uyo, Nigeria.

Valencius, C.B (2000). Histories of Medical Geography. Cambridge Journal of Medical History.
20(1):3-28

View publication stats