December 2013

See on Scoop.itMedical GIS Guide

Brian Altonen‘s insight:

One of the hardest parts of studying historical medical geography is the time it takes to find your documentation.  Maps are figures, usually included as addenda of figures to published writings.  This means they are poorly indexed.


Chances are, for every 100 or more articles I have read, reviewed and/or hunted down in the 19th century medical journals, only one or two percent will have decent geographical illustrations about disease.  The majority of books and articles of such value in Google Books lack the map due to the nature of its inclusion, normally as a pocketed insert or a fold out.   So it is usually important that either a decent copy be found in hardcopy form, or that interlibrary loan services be used to obtain a photo of the map and/or the book/article itself. generally fairs better with the illustrations, spending the time needed to include these in the variety of electronic forms of the documents that they provide.  


The above maps from the 1890 Census are detailed fairly extensively at my page


The point however being made here is that by reviewing historical maps we develop insights into how to better interpret the maps of disease we produce today.  


The above maps are from my use of the Census maps to analyze what was becoming one of the poorest parts of the country–Appalachia.  Even with large area choropleth mapping, we can still see where latitude, aspect (east vs. west face of the mountains), large scale area-specific landuse patterns (Coastal, vs. Great Lakes, vs. South, vs. Great Plains) and even population density (the early NY-to-Ohio, north to Boston, south to Washington DC megalopolis then developing).


For example East versus West had little to do with impacting how croup could be spread, whereas north vs. south and population density appear to play a major role in Scarlet Fever activities.  Stillborn deliveries occur no matter where you reside.  Enteric fever, from contaminated dairy products mostly, is more a southern phenomenon.   Heart Disease and Old Age have higher rates on the east side of Appalachia (the megalopolis, with developed towns and cities).


This same method of looking at major geographic features i nrespect to disease and disease maps can provide us with important insights into the value of spatially presenting you public health and epidemiological findings.  Programs that lack these valuable spatial techniques and insights into their findings are not going to provide us with as much value as a GIS study of the same important topics.


For more examples of how the maps of the past can help current spatial health researchers, epidemiologists and medical geographers, go to my blogsite on this topic at or visit my Pinterest page, where some of the more interesting examples of my findings are posted.


The five boards in Pinterest which review this work are as follows:

See on Scoop.itEpisurveillance

July 1973. From page 72 of “The Future Society: Aspects of America in the years 2000″ American Academy of Political and Social Science annual meeting. “Health Challenges of the Future” lecture by George E. Ehrlich.

Brian Altonen‘s insight:

A little more than 40 years ago, George E. Ehrlich gave a lecture at Temple University on July  of 1973 entitled “Health Challenges of the Future”.   This lecture was part of the annual meeting of the American Academy of Political and Social Science devoted to “The Future Society: Aspects of America in the years 2000.”

Then Professor of Medicine at the Temple University School of Medicine, Ehrlich predicted the depersonalization of medicine which the computer might result in.


However, we are falling short of one of his visions about the direction in which the field of medicine was heading due to the invention of the computer.


Ehrlich thought that by 2000 we would be fully engaged in making the best use of the computer and the storage of patient records, thereby create tremendous improvements in people and population health.  He speculated that with the computer, diagnoses could be made more rapidly, lab orders and clinical testing could be automated, with the results generated and then posted in a timely manner, and that we could therefore understand the best options for care we had available to us, all in a very short time.


Ehrlich’s major concern with these technological advancements was the further reduction of the human contribution that could ensue–a reduction of interactions that normally occurred between patients and care givers.


Unfortunately, many of today’s practitioners, allied healthcare givers, and patients agree with Ehrlich’s last statement.


Even more unfortunate however, the failure of the system to more quickly and more effectively make the best use of its technology to provide patients with more health care value for their money.


This latter failure has nothing to do with the technology itself, only with those responsible for the best use of that technology–those responsible for employing it within the health care system with the best long term interests in mind.


George Ehrlich could not foresee the increasing split that has occurred between the rich and poor since the 1970s.   But he would probably agree and be incredibly surprised to see how that, in spite of technological achievements and advancements, the human side of providing care and making care accessible has not changed in more than forty years.


The recent resistance to change and improvements in healthcare, are a repeat of these same events unforeseen by Ehrlich.  The ongoing resistance to change due to financial managers and CFOs of these systems offers little explanation for the tremendous acceptance these companies have for their lack of progress during the past 40 years.


The failure of insurance companies to implement EFFECTIVE, cost savings population health analytics programs into their systems is an example of what Ehrlich refers to with his criticisms.


Conformity is not always to our benefit when it comes to  healthcare.  The attached quality of life and financial benefits of receiving more effective care are opportunities missed due to poor management and the corporations’ resitance to change.


Ref:  George E. Ehrlich, (Publ. in The Annals of the American Academy of Political and Social Sciences, Vol. 408, July 1973, pp. 70-82.)

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