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Ancient Science of Life,

Vol No. V. No. 4 April 1986, Pages 216- 227

GEOGRAPHICAL APPROACH TOWARDS THE STUDY OF


HEALTH CARE SYSTEM
B. HYMA*, A. RAMESH & N. L. SUBHADRA IYENGAR
*B. Hyma, Department of Geography, Faculty of Environmental Studies, University of Waterloo,
Waterloo, ONTARIO, Canada, N2L 3 GL.

Department of Geography, University of Madras, Madras 600 005, India.


Received: September 20, 1985

Accepted: December 28, 1985

ABSTRACT: In this study the authors discuss the emerging trends in geography of health and
health care system in detail and analyses the position of geography of Health in India and
abroad.
Themes in Modern Geography:
The Modern Geography, as a science, is
concerned with the rational development
and testing of theories explaining the spatial
diffusion of phenomenas, spatial location
and allocation models, spatio temporal
patterns and process of various characters of
the earth and socio spatial behavior and
perception of people in Geographical space.
Within the scope of Geography of Human
well-being and the essential spatial welfare
analysis, the physical attributes namely
health of man kind has been gaining
increasing importance since 17th century.
The Geographical study of Health System
began during this time.
Geographers contribution in the study of
Health:
The pursuit of physical and mental attributes
and attitudes of man, namely medical
analysis, began as early as 17th century,
under the banner of Medical Geography. In
this area of specialization the credit of
carrying out a pioneering work is conferred

to Prof. A. T. A. Learmonth, (1952), though


the foundation stones were laid by Prof. L.
D. Stamp (1959), in his essay on
Geography of Life and Death. With the
introduction of Learmonths work in
Medical Geography series of Research
works flowed into this discipline b
Geographers like Mcclleland, (1859), Mc
Glashan (1972), May (1956), Pyle (1979),
Phillips (1981), Indrapal (1956 72),
Adams (1889), Rogers (1928 44), Akhtar
(1978 1982), Ramesh (1981 85), Hyma
(1981 85), Daksha (1981 85), Hamston
(1905), Hesterlow (1929, 30, 31),
Nityanandan Pillai (1941), Misra (1970),
Kumaran (1983 85), Banerjee (1974),
Braden (1975) and to name a many more.
During the early phases of 17th Century
geographers mainly concentrated on the
adverse influence of climatic and other
natural elements on human health. To cite a
few examples, the out-standing works have
been carried out by Hoffman in the period
between 1746 1750. In the early 18th

Pages 216- 227

century the focus was on identification of


areas of coincidence of natural elements like
Topography, Soil, Climatic and Biotic
organisms with diseases. The noteable
works in this aspects are of Mcclleland
(1859), Adams (1889), Hamston (1905). In
the late 18th and early 19th centuries
attention was oriented towards the
assessment of cultural elements on the life
pattern and health of people by the
renowned geographers namely Rowntree
and Seebohm (1901), Hesterlow (1930),
Kutschenreuter (1959), Wilner and Walkey
(1963), Sargent and Barr (1965), Goldsmith
and Perkins (1967). Along with this came
the works on analysis of influence of
environmental repercurssions and resulting
health hazards by Goldsmith and Landen
(1968), Fonaroff (1968), Leave and Seskin
(1970), Gosh (1971), Ellis, Dixit, Girt,
Auliciems and Lincoln (1973), Gosh and
Agarwal (1974), Stanley and Albers, Dare,
Melinda Meade (1976), Vornov, Feachem,
Mc Garry, Muna Duncon, Amin,
Worthington. Faridd, Mehta, Weiss, Ripert
and Ekobo and Palmer (1977), Giggs
(1979), Wood, Kuman, Singh and Margaret
Lawrence (1980), Singh (1981). In the later
periods of advancement, the assessment and
analysis of location efficiency and socio
spatial perception and behaviour of
providers and users (Medical personal and
patients) about medical services in particular
areas, dominated the Research interest
among Sukhdev (1981), Strassburger
(1973), Shivaramaya (1938), Shinde (1980),
Ramesh, c. (1981), Nityananda Pillai
91941), Mahadev and Thangamani (1981),
Kumaran and Jayapal (1981), Job (1981),
Jayachandra (1981), Hesterlow (1930, 31,
32), Bladen, (1976), Bhatnagar, Sakuntala
(1981), Akhtar (1981).
Some of the
Locational Theories, Models and Laws
propounded by urban, social geographers
were applied to test the locational Hierarchy
and peoples perception and ideas specially

pertaining to distance factor, and particular


services like family planning techniques,
public health care units, some of the
renowned works in this area are from Shan
and Bashu, Menter (1969), Girt, Weiss and
Geenlick, Noble, Lanontangue, Bellotic and
Wechsler (1971), Hodgart, Knox, Shonick
(1978), Robert Krishnan, Kumaran (1983).
With the introduction of the WHOs concept
of Health For All by 2000 A.D. and a
search for An alternative System of Health
Care, the geographers have extended their
study towards Medical Pluralism and have
made successful attempts to assess and
analyze the Sociospatial behavior and
attitudes of providers and users of different
systems of medicine and also the projects on
Comprehensive development
through
Health Care. Contributions did come from
Hyma, Ramesh, Daksha, Bhardwaj, Home,
David Phillips (1979 1985). In the entire
course of progress of development of theme
of medical geography, the techniques of
cartography, quantitative analysis with the
most advanced computer programmes have
had equal research appreciation (Mc
Glashan, 1972, Pyle 1979, Bimolkantipal
1985, Hopps 1969).
Perspectives and concept of Geography of
Health and Health Care:
The
commission
on
International
Geographical Union defined Medical
Geography in the year 1952 as the study of
Geographical factors concerned with the
cause and effect of health and diseases
Realizing the narrowness of such a
definition, in 1976, the IGU (International
Geographical Union) in Moscow, abolished
the 24 years of old term of Medical
Geography and adopted a much broader
perspective of Geography of Health and
Health Care. In which case, unlike the
earlier works, the focus was not just on

Pages 216- 227

assessment of distribution of pattern of


disease occurrence and spread, and medical
services, but on analysis of causes and
consequences of such a kind of distribution
and the associated socio spatial attributes
through analysis of locational efficiency,
socio spatial perception and behaviour of
providers and users of health care services.
Approaches and Techniques:

Geographers adopt five main approaches


and techniques to test the pattern of
occurrence, spread and distribution of
diseases and location of health care services
in a region. The most commonly applied
approaches and techniques are : (1) Medical
Cartography (Phillips 1981, Robert 1984),
(2) Ecological Associate Approach (Robert
1984), (3) Diffusion studies (Robert), (4)
Locational Analysis (Robert) and (5) Spatio
Temporal, Social and Behavioural Studies.

1. Medical Cartography:
In the early stages, the studies in Medical
Geography, both by Geographers and

Medical personals began with the task of


map making. During the period of 1800s

Pages 216- 227

maps were used as an important tool of


analysis. The cartographic technique for
expression of analysis still holds good and
especially so with improved quantitative
technique of computer analysis. The maps
is most general cases clearly identifies both
Homogenous and Heterogenes areas, and it
also points out those areas of the world
where plans and programmes liken to Health
Sector are in urgent need. The works of
Aiken, Mcclleland, and Hopps have
established the importance of this technique
to Health Studies. Hopps in his work of
1969 has stressed on the significance of
computerized mapping in Geographical
studies on Health.
2. Ecological Approach:
Two main branches of study developed
under this approach namely disease ecology
and disease geogenes.
The Ecological
Associative studies concentrated on spatial
context of Epidemiological studies, the
influences of topographic, climatic, biotic
and socio-economic cycles and their
influences
on
health
of
people,
environmental repercussion and associated
health hazards (Mcclleland, 1859), Adams
1889, Hesterlow, Scomer, Man, Sergent,
Fonarff and Justaz (1900 to 1983), Ashley
and Dixit (1983).
3. Diffusion Studies:
This approach was mostly adopted in the
earlier centuries to study the occurrence and
spread of disease contagion in the

environment with migrants, especially


during (colonialism and in the later phases
to assess) the diffusion and adoption of
Health care innovations in the Geographical
space, especially pertaining to Family
Planning programmes. The well established
works are of Rogers (1944), Noble, Lanague
Bellotic and Wechsler (1971), Weiss,
Greenlick, Knox (1978), Hodgart (1978),
Etton (1982), and Robert (1983).
4. Locational Analysis:
Contemporary research works have stressed
on the locational theories and models to
evaluate the locational theories and models
to evaluate the locational theories and
distribution of Health care services in a
region. The locational models of gravity are
all applied to study the location of Hospitals,
mobile services, public health units. The
works of Robert (1944), Kumaran (1983)
and Krishnamurthy (1984) are an important
contributions to this aspect.
5. Spatio-Temporal Social and Behavioural
Approach
This is the most recently applied approach to
assess the perception, attitudes and attributes
of both users and non-users of health-care
services of a region.
Almost all
Geographers working on Medical pluration
and Location Allocation Model of Health
care services, like, Hyma, Ramesh,
Bhardwaj, Daksha, Kumaran (1981 85)
Suchirita (1981) and others have applied this
approach for study.

Pages 216- 227

Sources and Methods of Data Collection


in Geographical Research on Health
System Analysis:
The methods by which and the sources from
where the data is collected varies depending
on the objectives of the study and in turn on
the variables selected for verification of
occurrences in the Geographical space. But
in al cases the collected information on
various aspect from all possible sources is
oriented towards geographical location.
Sources of Data: As in all fields of scientific
research the information is procured from
three main sources.
Variables and Sources
procuring of information:

selected

for

As mentioned before the sources of


information especially secondary, depends
on the variables and in turn on the objective
with which the study is conducted. To cite
few examples For a research on spatial
distribution of mortality by cause, for any
required region the records on death from
the Health Department of Corporation in
case of urban areas, the taluk, panchyat or
block offices for rural areas; is taken into
consideration. Besides all other variables,

the place of death, the residential addresses


of the diseased and the cause of death are
more important, for geographical analysis.
In addition to these other demographic,
social and economic details as available and
required can be recorded.
In a similar way to spatially analyze the
distribution of Health services and identify
sufficiency
and
deficiency
regions
information on variables like Health services
centre Medical Equipments, amenities,
bed strength; laboratories, chemists and
pharmaceuticals and medical personnels
can be collected with their locational
address, of work.
The same can be
correlated with Demographic, Socio
Economic and Health status of the people in
a region through quantitative technique and
plotted on the map in the respective
divisions. Most conveniently administrative
blocks and further super imposed on
demographic, socio economic and health
status maps.
For locational analysis or Health service
centre, the perception, attitudes, attributes
and behavior of both the providers namely
doctors and users patients and general
population, about the location namely

Pages 216- 227

and allocation of health service centres,


(iii) Spatio temporal pattern and
process of diseases and health care
services and (iv) Socio spatial
behavioural approach to assess the
attitudes and attributes of people towards
Modern Health System and Traditional
Medicine.

distances in terms of geographic, social,


economic and the pros and cons of such a
location is assessed through questionnaire
survey in concerned areas.
Reliability of Health Data:
The main task of Geographical Research
pertaining to Health or to any related aspect
is the gathering of relevant and necessary
information, qualitative, quantitative and
cartographic exposition on spatial form. It is
without doubt that geographers face
enormous problems, as the data on required
ground is not available. Hence geographers
are left with the task of manipulating the
available data on regional level.
Problems of using Computers
mapping of Health Data:

for

Though the geographers of health system


have also made an attempted of introducing
have also made a attempt of introducing the
advanced technique of computer analysis for
mapping of health data, due to the nonavailability of authentic and required data
bank on health in proper; various problems
are met with.
Emerging Trends in Geography of Health
and Health Care:
Contemporary geographers also engaged in
the task of findings out and applying new
techniques and approaches for spatial
analysis of Health services and also for
spatial pattern of consumer distribution by
findings solutions to questions like who
gets what, where and when.
1. Recent trends in the Approaches to
Geography of Health and Health care:
The modern geographers of health
studies apply approaches such as (i)
Spatial Diffusion, (ii) Spatial location

2. Advanced Technique to assess the health


system in the Geographical Study of
Health Science: To assess the health
data, numerous statistical techniques like
multi correlation, factorial analysis,
nearest neighbour technique, linear
programmes on computers have been
applied by the Geographers. Along with
quantitative and cartographic techniques
locational models like gravity model
explaining distances decay analogy,
Rank size rule to assess the
hierarchical distribution of health service
centres, are applied to test the location
and allocation of health care services in
relation to the need factor. With the
rapid progress of technique and
approach for the study of health system,
Geographers as Regional Planners have
a great role to play in the science of
health studies. This is especially so with
the introduction of WHOs inter
disciplinary research for Integrated
health care delivery system to attain the
goal of health for All by the year 2000
A. D.
3. Position of Geography of Health in India
and Abroad : Though the geographical
studies on health began as early as 17th
century in the world, in India it dates
back only to the latter half of nineteenth
century. (Ramesh, 1983). Most of the
techniques and approaches that are
applied by Indian Geographers are
similar to the ones applied by their
counterparts
in
Western
World.

Pages 216- 227

Unfortunately though there is an


increasing interest among Indian
Geographers to study the health system,
due to the absence and non-reliability of
date back especially pertaining to vital
statistics, environmental data / and other
health data at micro level. The works of

geographers is highly limited to a micro


level only. With the introduction of
reliable data bank, it will open up with
a wide spectrum of study and deal with
down to earth problems; but till then it is
a rich potential mine to explore and
process for the welfare of man kind.

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