Brian Altonen, MPH, MS

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If you have the time, please participate in this survey on GIS use, with a focus on GIS or Spatial Analysis use in the workplace.  This is for dissertation work on the barriers to GIS implementation by a healthcare and/or managed care system.  The following is the LINK for this survey, at Survey Monkey.   

SURVEY LINK

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I just finished a review of the research processes I am engaged in, for developing a system wide method to evaluate any and all patients, for any kind of metrics, for used in standardized analysis and reporting of patients and measures across the various EMR systems.

I defined (once again) some pretty standard measures that can be taken for a managed care EMR system (listed below). I also compared them with their status when I produced a similar page of this type a year ago [link].

What has happened between now and then is that I developed a series of algorithms that can be used to analyze and map pretty much anything you want in the EMR setting, finalized others generated by this time one year ago, and merged many of the smaller algorithms into a single data pull process, for any standard QOC research project.

My major accomplishments most recently were the development of algorithms that evaluate visits and procedures by patients who have specific diagnoses, versus all patients for a particular population, those that may be used to demonstrate changes in health care processes at the administrative level, focusing on management-cost-time-human resource relationships, and their relationship to actual and potential costs.   These were developed to demonstrate where changes are necessary, and how to evaluate the healthcare outcomes and/or costs related to these changes.

The most important research topics for the next 6 to 12 months regarding grants are: genomics and precision medicine based clinical and lab-related practices, minority health care inequality, socioeconomics and quality of care, epigenomics, rare, congenital and degenerative disease patterns, re-emerging and/or  foreign born disease introduction, the care of an aging HIV patient population with various comorbidities, substance abuse high risk populations, and age, ageing and Alzheimers/Alzheimer’s-like age related disorders.

The application of spatial analysis to many of these projects is still in its exploratory stage, but for those who employ a GIS in these projects, its application may be tested.  Of the nearly 1800 grants reviews, valid for the next 2-3 years, only one made mention of including GIS utilization in the grant submission.  None of the grants that mention “geography” actually refer to the use of any spatial analytics process or system.

The following are the data bases that can be freshly mined and pulled from claims and other raw atomic-table rich systems.

[The year I essentially completed this task during the 7/15-12/16 period is in the brackets. Those with an asterisk underwent some levels of data manipulation, format or content cleaning, reclassification, and/or development including in the algorithms.]

1. Demographics, patient population [7m patients; name; DOB; personal ID; insurance program ID, insurance name, type, company etc.; race, ethnicity (unfortunately often race and ethnicity are entered as one column)]  [2015]
2. Demographics, regional [census based, census block or block-group preferred; last census, most recent year for estimated counts if available] [2015 – ]
3. *Standard Age-Gender [population pyramid level data assemblage for 1, 2, 5 and 10 year increments, for producing population pyramids of demographic features.] [2015]
4. *Standard Race focused interpretation of patient data, including Age-Gender pyramids produced by correlation with Age-Gender dataset. [2016]
5. *Standard Ethnicity-focused interpretaton of patient data, including Age-Gender pyramids.  [Note: Race and Ethnicity often don’t correlate well and produce aberrant groups whene used together.] [2015]
6. *Religion [150 to 10-12] identification and reclassification routines (I have my classification system posted elsewhere in several places, but focus on major religious groups, followed by philosophically defined subgroup types of the minor groups.)  The following method most often used: Catholic, Christian (Trinity, Methodist, Episcopal, Baptist), Christian Derived (Seventh Day, Mormon, some Universalists), Judaic (Torah), Islamic (Koran, Unani, Rastafarian), Cultural (mostly the several Oriental and Indian), Natural Philosophy (Universalists, Quaker, Shaker, or similars), Modern (Practical, Agnostic, Atheistic), Post-Modern (Christian Science, Unity, Transcendentalists, Pagans), Other (Interdenominational), No Data or Unknown.  The first five are classical groups, the remaining may be grouped as Other and Unknown. [2015 – 2016]
7. *Insurer [85] –focuses on Commercial (COM; all the commonly competitors), Medicare (MCR), Medicaid (MCD), combined MCR-MCD, CHP (optional), Metropolitan (MET: large areas may provide a cross population plan where just place of residence defined eligibility), Government (GOV; Fed., State, County, Town insurance plan), Military (MIL), Veteran’s (optional or included with Military), Homeless (HOM), Self-insured (SELF), Union or Contracted Worker Coverage (UNI), Drivers License-accident-related Coverage (DL); Inherited or Annuity-linked coverage (INH), NIOSH-WTC/OSHA/Worker’s Comp coverage (WC), Special Programs (Coal miners, RR or shipping industry etc, SPE). [2016]
8. *Cost (esp. Virtual and True) – Virtual cost is the value of a procedure, event, visit, lab, etc. done on a patient.  Cost lists or “theoretical prices” can be exceptionally lengthy, although not as long as Procedures in general.  They may also be constructed as group costs and later as more detailed costs, by applying averages for true costs across the system, of true costs for subgroups of procedures and other items priced.  True cost is what is charged to payers (patient or insurer).  Virtual cost is an artificial value or estimate assigned to a procedure, as a guess, guestimate, or otherwise calculated value that applies to true life care situations.  Institutional Cost is a cost which is assigned to a process, step or action that uses a systems approach to the analysis; it defines a cost based upon true costs and stresses placed upon the infrastructure for a healthcare system; for example, patients are normally not changed for specific events during a visit, like the price of the educational material provided, or the documentation in writing taken by a nurse using a special reporting sheet, yet each of these count as part of a typical office visit process; in theory the price of the office visit may be divided by the numbers of these non-charged events that occur at a typical visit.  There are more than a million of these “procedures” coded in a detailed system.  The standard is to not change patients for these individual procedures because they are considered part of the service. [2016 – ]
9. *Cost Burden –temporal reviews of people demonstrate changing forms of coverage over time.  At some periods in life, an individual may have just one health care coverage, such as COM provided by the employer, followed by MIL and then SELF and then HOM, then COM, and then GOV, MET, UNI, and finally MCRMCD.  Independent non-duplicated scores or indices are attached to each type of coverage, which can be logarithmically related to cost/risk (using base 10 or less) when compares with a cost amount developed as another Price Sheet (virtual or true). [2016 – ]
10. *Visits [inf.] – A visit is when the patient shows up for some reason.  A visit may have a direct disease or health state linked to that visit, such as assess for possible pregnancy, where physician decides to also engage in annual visit events, such as check vitals and give seasonal shots, and then reassess if any immunizations due, or renewals of unrelated drugs required, or referral to other specialist required, or annual exams rescheduled.  Each of these procedures is linked to that one event, and will usually related to conditions and diagnoses (ICDs) linked to that visit.  Thus a visit for one condition may have several ICDs attached to it, and numerous procedure identifiers.  Several recoding and reclassification processes are currently being tested.  *An integrative (multicolumn) NLP method is being tested as part of this process.  [2016]
11. Visit Types [9] – Visits may also be differentiated by type of visit, such as routine visit, emergent/urgent care visit, outpatient walk-in visit, inpatient hospitalization visit, referral visit, office (admin) visit, pharmacy visit, etc. [2015]
12. *Initial Activities/notes [0.5M] – activities are events that happen at each visit, such as check in, personal med hx sheet, initial interview for why patient is visiting, patient’s two mental health opening questions, main medical concern, history, etc. etc.  These activities are often entered as discrete activity events that occur with a patient care visit.  For inpatients, there may be standard floor nurse pulse taking events for example, followed by a special services provider visit, who also registers the vital signed separately.  Activities are events that occur at discrete moments of time in patient health, and may be used to evaluate care process and sequences, relative to time passage. Several recoding and reclassification processes are currently being tested.  *NLP methods will probably become a core part of this process, and are being tested. [2016 – ]
13. *Provider activities/notes and actions [100k] — in terms of content and nature, these are similar to the initial intake activities just described; however, differentiating the care related decisions made and actions are taken are two of the primary purposes of this documentation activity.  Another way to visualize these actions is to view the initial intake activities as documentation provided before seeing the NP or PA.  These “notes and actions” are produced by the provider and are activities that usually occur in the examination room.   Naturally, clinician’s decisions are made based upon a different set of findings and events than events related to intake processes.  There are however overlaps, such as physician providing the patient with an educational packet due to a question raised. *To evaluate these data, classes are still in the early phase of development. Ultimately NLP analyses will need to be developed as well.   [2016 – ]
14. *Observations — a physician documents various observations, findings and conclusions as part of the healthcare process.  Observations are document for such things as vital signs, responses to orally administered survey questions (mental health evaluation), findings on a new form the patient is asked to fill out (genetic screening questions, domestic violence, chronic disease questionnaire).  These data may be evaluated for reasons related to completion, form quality and follow up to care.  *NLP methods will also become a core part of this process.  [2015 – ]
15. *Procedures  [95k] – definition varies across systems, but these are the processes a patient goes through for specific reasons, like diagnoses, labs, xrays, assessment, scanning, recording, etc.  The renewal of a prescription may be covered as a procedure, although Rx data is typically reported as its own unique dataset and series of events.  These may be differentiated by visit types.  *Most of this has been successfully reclassified and recoded for multiple applications. [2015 – ]
16. *Outcomes/Results [inf.] – procedure related outcomes.  Whereas procedures bears the name of the process, this data set is where the results are kept.  For example, a 20 measure blood test has Blood test under Procedures, using one or more identifiers with each identifier describing slightly different types; this entry of the blood test (where, when, etc.) has its outcomes entered differently in the Outcomes/Results dataset, so a 20 metric procedure has 20 rows of data.  As another example, the Xray can have multiple opinions documented (MD, assistant, technician, NP, residents, Manager), with one opinion per row, and for well planned systems, the final accepted diagnosis identified and so marked. These have multiple atomic, descriptive and observational/outcome datasets (1 row per patient per event).  *Due to the nature of the notes provided, NLP is required. [2015 – ] 
17. *Visit Activity Groups [81] – Various activities can be clustered into particular forms of knowledge acquisition or physical and mental needs that apply to a each and every activity.  Some knowledge acquisition may be most relevant to long term quality of life issues, or behaviors, or  allied health histories.  An example of an activity group is nutrition, in which all the basics of nutrition are made reviewable using this additional identifier.  This dataset also applies to special services provided by individuals whose service focus on this topic, such as nutritional counseling.  There may be separate specialty groups linked to this identifier, such as unique clinical service groups of data, referred to by this column, that when visits provided even more highly detailed non-structured data about a patient’s medical state and history. *This grouper provides additional services for queries because it simplifies the filtering and mining processes. [2016 – ]
18. *Ratios — Three ratios are defined for this group as essential metrics: Visits:Patients Ratio (VPR), Procedures:Patients ratio (PPR), Procedures:Visits Ratio (PVR).  [2016]
19. *Risk Indices or Scores.  Population health frequencies, incidence, prevalence. Demographic counts for each. Elixhauser, Charlson, and Federal Chronic Disease Indices.  [2015-2016]
20. *ICD Groups.  ICDs groups should be managed as ICD9 and ICD10.  If the latter is the only method use, some grouping is required for reliable evaluation processes to be developed.  For ICD9 the n=about 14,500; for ICD10 the n=about 65,000.  Historically, using ICD9, I was able to develop the following sets of groupings. These can be correlated to the ICD10. [2015 – 2016]
    • n=135
    • n=303
    • n=475
    • n=750 about
    • n=1000 (integer ICD)
    • n=1275 (ICD, E and V codes)
21. *Special ICD groups.  Specific ICD code groups were defined for the projects.  These groups include ICDs or ICD ranges/content, and groups labels for the following common special studies topics.  These groups can be roughly defined using the population pyramid modeling processes developed.  In another presentation, the tendencies for diseases to demonstrate distinct pyramid forms in relation to age and gender may be used to better test and cluster these disease patterns.  Diabetes for example shows a progressive increase in counts in the population curve for both genders; schizophrenia demonstrates an asymmetry for Male versus Female with earlier adult age of onset; atrial fibulation demonstrates onset beginning at about 45 years of age and increases in number and frequency as the population ages, whereas diabetes cases reduce due to directly and indirectly-linked causes for mortality.   For each of these Special groups, the ICDs, V codes and some E codes may be included in the algorithm developed. [2016 – ]
    • Infectious Diseases (lower ICD)
    • STDs and HIV
    • HIV, related complications and comorbidities
    • Fractures
    • Cancers, by metastases patterns and organ system
    • Old Age ICDs
    • Prenatal-Postpartum ICDs
    • Foreign Born in-migrating diseases (incl. vectored, zoonotic)
    • Country or Region specific in-migrating behavioral, physical and socicultural ICDs (culturally-bound vs. culturally-linked)
    • Genomic diseases, all, or by system
    • Neurological Genomic or Developmental
    • The Mental Health Early Onset case ICDs
    • Early Onset High Fatality Diseases and ICDs
    • Broad Range Genetic, Genomic and Congenital/ Development Diseases
    • Chronic or Long term QOL Diseases
    • Old Age Onset diseases
22. *Spatial Modeling Lat-Long Datasets, point data.  i) Patients: developed for Zip Code (3- and 5-digit), Census Block or Block group (tracts are not used), and based upon need, per patient address (top security).  Used to develop spatial modeling analyses and presentations.  ii) Facilities;  iii) regions, towns, boroughs, etc.; iv) allied health or other healthcare/managed care associates locations;  v) complementary alternative health care provider data (if possible)
23. *Spatial Modeling Areal Analysis datasets, areal definitions and data points.  Regional boundaries and areal centroids (borough, county, township, town, village).  Functional, healthcare service related areas (Theissen polygons); equal area polygons.
24. *Spatial Modeling, Transformative Areal Models and Grids (political and economic grid mapping).  Traditional square grids and hexagonal grids(?).  Several modeling protocols for each.
25. *Spatial Modeling Auxiliary data.  Additional data gathered and developed for transforming spatial model into useful modeling or predictive tool, spatial analysis tool, interventions driven programming tool.

 

I developed algorithms for a number of these datasets in this new system a year or more ago, about a third of them perhaps.

Another third have been perfected a little bit more this past year, each tested several dozen times and integrated with all of my normal data pulls for internal review of validity of reliability.  Some of these I even added new columns to, after producing a more helpful reclass tool.  The reason for these reclassification systems was to take full advantage of their research potentials and applicability to grant writing, prototype development, the investigation of newly discovered relationship.

The final third of database development projects are ongoing, and have been active and producing over the past year or two, but are obviously in need of more development so they may be integrated with the other tools I developed.

The details of the projects developed for the upcoming months are briefly defined on another of my blog sites.  These versions of two or three of the previously defined projects are a little more defined, and solid in their methodology and constructs, that similar ones posted one year ago.

There are also a few new topics added due to my review of the 1800 grants available this, posted about two weeks ago.  I determined what the hot topics are for this upcoming year, and from that chose the grants that were not due in the near future and which emphasized research approaches and topics related to the demographics I am dealing with.

Over the past year, my work has focused on producing as many new algorithms as possible, reclassification and analytic routines, and testing the algorithms, math and their outcomes.  Now that these formulas heave been pretty much validated (with the exception of the cost-burden analysis method, which is still in it final stages of multiple use QA review), they will be tested in several grant-funded project (assuming grants are awarded), as well as several other very fitting applications of their use.  These other items are also detailed on the other page.

What I consider the first book on medical geography, in terms of: i) a complete study of cultures, their differences, and distribution around the world, ii) medical and health related needs and natural offerings for disease prevention and cure, and iii) all of these in terms of time and place in the world.  This actual book may be reviewed at Archive.org, or my page on it and the history of its author.

When I go through my site, and review its responses by the public (the world!) over the past few years, I cannot help but be amazed at the number of visitors interested in these subjects, as a learning experience.  One of the things I have tried to remain humble too for the past two decades is how lucky I have been to tap into an unresearched or under-researched part of the history of medicine, that part pertaining to the culture and philosophy of disease, and how these vary around the world.

One of the more important lessons I had in all of this came from the religious scholars who speak of science as another philosophy, or way of explaining things.  The philosophy of science is dualistic, in that it takes what is seen and define the other form or opposition to that thing and abides by the premise that these opposites exist.  Since energy produces light for example, there is also this entity called darkness, when in fact, the reality of this scenario is that the absence of light is darkness, and darkness therefore is not a physical thing that must exist.

Now, it is important to note that this theory is found elsewhere in the writings–it is not my own.  But it relates to the religious name for scientific beliefs called “scientism.”   Scientism is the philosophical paradigm upon which all beliefs are based, in order that the best explanation of all that is found and seen can be provided.  Since scientific observations guide scientists further, or in a new direction, that move then either reconfirms or cancels the ideology upon which beliefs are based.

On some of the earliest pages I wrote on this site about 8 years ago (for example, see my phenomenology approach), I summarized my teachings and discoveries of how and why medical beliefs change.  Why is it that physicians were so convinced that they were right that they had to practically kill patients through the blood letting process?  Why were such injurious processes as blistering, baunscheidtismus, the prescribing of purgatives, caustics, and emetics so important.

All of these “mistakes” disappeared once more proof as to a better way to treat such patients came to be.  In my transformation of common belief , I argue that medicine survived mostly because practice and error were consistent, and that corrections always had to be made, the treatments had to be improved or made to be better.  With success, we saw patients survive a health crisis, or become better, and/or live longer.  With success, we dropped the older practices and substitute the new, until a still better belief and method complying with that belief can be discovered (see my anthopological cultural rendering of this recurring human behavior pattern).

Knowledge is the way to learn medicine, and my work on this site is to find knowledge not promoted much in the years before me.  Unexpectedly, I found a lot of new concepts not yet taught in medicine, and was able to break the barriers that exist between the reading of historical beliefs and philosophies and relating them to the common themes that different cultures based their health practices upon.  Many of the items posted on this page have never been posted or written before by previous medical historians, much less historic medical geographers.

Dr. Carl Friedrich Canstatt, whose book Handbuch der medicinischen Klinik, published in 1847 [in German], is the first book to provide a taxonomy of diseases that is based mostly upon environmental theories, including exposure to climate, chemicals, other parts of the human ecological settings.  (I cover this book on this page.)

With that all said and done, I can report the following: several themes, topics and subjects continue to demonstrate popularity in the medical philosophy and history, and medical geography and spatial epidemiology fields.

The first is very popular to academia and the popular culture movements pertaining to alternative medicine, mind-body philosophy, and other cultural renderings or histories of health care and healing.  The second is very popular due to the advancing fields and professions of medical geography, spatial epidemiology and research, and the rapidly growing GIS-guided research and professions, in the environment and health.

This first table is of the top 50 countries visiting this site and reviewing my information over the past 4 years.  Some color coding is provided so the reader can follow the country across all four years.  As expected, the United States is the top country to follow my posting on the value of spatial epidemiology, GIS and medical history.  The United Kingdom, being the inventor perhaps, if not the most important influencer of spatial epidemiology and medical geography, is now second in terms of following this site, but is closely followed by its largest “sibling” Canada.

Canada is perhaps one of the leading countries in the world for use of unique spatial methods to evaluate the environment and the human impacted built-in urban environment.  The U.K. is the creator of many of the ideologies we base our practices of medical geography upon.

The U.S. by the way is close to the U.K. in terms of its contributions to the fields of spatial epidemiology and medical geography.  Were it not for the stubbornness of the early 20th century post-eugenics era scientists, and their pro-socialist sociologists and Marxists in the U.S transforming geography into two practices–environmental science and the controversial sociological alternative culture–the U.S. may well have excelled over the U.K. these past 75 years in terms of Geography field contributions.   Our diminishment of “geography” from the pre-college programs and many of the colleges and university further diminished the roles of the U.S. in advancing the field of Geography; countering this were the U.S. contributions to Environmental Science.

Top 75 countries visiting my blog, per year from 2013-2016 (max number as of 2016 was 198)

Take a few minutes to let the variety of countries visiting this site set in.  Medicine is a very hot topic worldwide.  Many of the topics I cover are multicultural and crosscultural.  Medicine itself is one of the most important topics for individual and group survival around the world.  The skill of medical geography and mapping disease and health is equally important, at the worldwide level.

The unfortunate nature of the U.S. healthcare system is that it is making us fall far behind developing countries in how we utilize GIS and spatial health to the best of our potentials and ability.  The fragmented nature of the U.S. healthcare system makes it difficult and almost impossible to produce a nationwide healthcare program, like other countries are now doing.  That may be one of the benefits of socialized medicine in the decades to come, assuming our current HIT level remains stable and productive, and that is not hindered by political changes now happening around the world.  An overtake of major forces, governments, ideologies, can have some drastic impacts upon the advances now being made in medicine, the internet, world information exchange, the iCloud, the use of medical and healthcare data to the best of our ability, in terms of fighting the health changes that may ensue in upcoming years.

E. N. Pavlovsky, perhaps the most important medical geographer and disease ecologist in Russian medical history, specializing (inventor of) in modern parasitology and the biology and ecology of vectored and zoonotic diseases (my introduction page on this).

This detailed review of the history of medical geography that I do is focused on the U.S. often, but is not exclusive of other countries, some more important than the U.S. is some parts of the history of this profession.  The Russian medical geographers of the nineteenth century are not covered in any anglican writings in this field, which is a shame, for their theories in economics and ecology are in some ways better than those of western society.

In the following photography, the leader of Middle Eastern medicine up until the 1990s, Hakim Mohammed Said, made it a point that the ancient practices remain alive, practiced, researched, and documented.  Globalization of health care can effectively makes many of these alternative practices extinct.  The practice Said was most attached to was Unaniism, and its resemblances in theory to Hahnemann’s teachings of homeopathy.  The political events taking place in the Middle East make some of the Iranian and Iraqian forms of practices extinct from common knowledge.  Right now, parts of this medical philosophy and belief system are travelling the globe, and will soon be the next form of alternative/complementary medicine most of allopathy will be having to deal with, along with the health conditions attached to this philosophy of health (more on this at the end).

Hakim Mohammed Said (https://en.wikipedia.org/wiki/Hakim_Said)

Back to the history of medicine in the Americas, when the U.S. established itself following the Revolutionary War, U.S. scholars set the stage to become important contributors to the field of Geography during the first 125-150 years of the existence of this new profession in US culture and academia.  Many of the teachings back then were quire different from those of the Western European leaders.

Most of the teachings that appear in the medical literature at the time are all accurate environmental renderings of disease patterns, and are directly applicable to the sudden re-emergence of interest in new diseases migrating into the U.S. from afar, and to the return of the old diseases that once were considered eliminated.  To best understand the older disease patterns, we need to look at how they existed and were dealt with during their peak ages of existence.  Contemporary medicine has not yet taken on that task of relearning its historical background and knowledge.

A very early project of mine, on the diffusion of allopathic and non-allopathic health professions in the U.S. from 1750 to 1860, based upon the establishment of medical schools and their geographic and political “spheres of influence.”  (See my pages on this, Part 1 and Part 2,)

For examples of applications, review the maps I posted, many of which are the most important to medical geography history.  Some of them are basic maps that we immediately understand.  Others are maps that we wish we had continued to work on, so as to perfect this skills by today’s day and age, for now we are more than a century behind in this knowledge based, and back to beginner’s level for the most part in trying to implement the same exploratory processes.

The U.S. experienced the first large area, large distance diseases to travel expansive waterways between continents, and to demonstrate quite clearly that there were latitude and longitude differences regarding disease behaviors and distribution.

Yellow Fever Insert of Alexander Keith Johnston, 1856 (See https://brianaltonenmph.com/gis/historical-disease-maps/alexander-keith-johnstons-famous-map-a-detailed-review-1856/)

The yellow fever outbreaks of the post-Revolutionary War years into the early 19th century were at first puzzling (“The Extraordinary Disease at Martha’s Vineyard”), but later better understand and gave rise to the development of the quarantine policies for incoming ships.

The cholera had stricken Western Europe a number of times, and European geographers were able to develop some very important hypothesis regarding spatial disease spread behaviors and patterns.  British epidemiologists developed the models claiming disease spread patterns were in part due to populations,  but perhaps more so due to living style, the distribution of poverty, and the practice of poor sanitation.  United States geographers developed the models relating disease to urban density and what may now be called hierarchical diffusion patterns for disease transmission, an ideology re-invented in the 1960s by a U.S Economics Geographer.

Top sites people visited

Notice, the 1890 Census Medical Geography has surpassed the page with my personal information, an important change in the pattern of use of this site.

More important perhaps is the fact that geography and my review of geography as a historical medical geographer are now contributing greatly to fields other than healthcare, epidemiology and medicine.

Native American, Indigenous culture and philosophy, and Indigenous health are teachings that stand out on my site.  The immediate popularity of the fairly thorough work I did (from 1990-1994 about), on Chicle and the Chewing Gum industry is probably due to the large numbers of classes in the U.S. with Hispanic students and teachers wanting to find important topics that portray the contributions Hispanic cultures made to the history of the U.S.  The late 1800s map of Mexico’s disease patterns and the regionalism of disease patterns is an important example of how we developed our “deterministic” philosophies during the late 19th and early 20th century (the eugenics period).

A map of the diseases of Mexico, from a World Geography set ca. 1897.  The history, meaning and anthropological, cultural interpretations of these diseases and their distributions is extensively reviewed at  my page on this map’s history.

When I began teaching in 1988, in fact, my goal was to point out the firsts in American and U.S. culture.  This included the first uses of Native American philosophy for medicine, the first use of a U.S. plant for the more modern 19th and 20th centuries western European pharmacy, the first time we reviewed natural causes for diseases outside the human body, aside from temperament and inheritance.

I was also fortunate enough to uncover evidence for the first Jewish MD physician and doctor in the mid-Atlantic (New Amsterdam/New York) part of the North America–Dr. Isaac Marks.  Researching him as part of the Revolutionary War doctor’s manuscript (Dr. Cornelius Osborn) that I re-discovered in 1981, opened the door to understanding and demonstrating colonial interpretation of the American Indian philosophies, and their willing to engage in new versions of older theories like alchemy in the New World, as the predecessors to understanding human emotions, spirit, emotions, and psychology (Harvard’s 1650 Charles Starkey‘s practice of this and its parallels with the Dutch (and thus New Netherlands) preacher and professor of medicine/mindbody effects–Hermann Boerhaave).

The first medical geographers

Disease mapping is also a major topic of interest now to medical history and geography students.  The first disease maps came from the United States (although I wouldn’t be surprise if somewhere we do find some European mapper producing something like this in a manuscript collection).  The local New York City patron of medicine in the field, Dr. Samuel Mitchell, published this country’s first article(s) on “medical geography” and may  in fact be the first to popularize, if not both publish and popularize, this term.

The U.S. doctor next in line for the U.S.’s fame in this field is Valentine Seaman, of NYC, who produced the first epidemiology map. using it to explain the recurring seasonal yellow fever outbreaks in lower Manhattan.  No one was in the famed city of Philadelphia was like Seaman or Mitchell, including the famous Benjamin Rush.

Benjamin Rush, however, did introduce to us other important “discoveries” and additions to the field of medicine, thereby distinguishing it completely from the medicine practiced in Great Britain.  He produce the precursor to the idea that as land use patterns change with time, as will lifestyles and disease patterns.  Rush didn’t take it as far as health and diseases, but managed to at least defined the impacts of land use changes upon the occupations and lifestyles of people surviving in different regions, ranging from farming communities, to villages and small town and larger cities.

Benjamin Rush and his important article proposing a sequent occupance type model is available for review on this page.

With this, Rush provided the medical geography field the first example of a use of an ideology that would later be reborn again by midwestern U.S., helping scholars imagine and publish the sequent occupancy idea.

Although never related directly to just health and disease patterns, sequent occupancy was the preliminary idea that was born again later under the term epidemiological transition.

How the contamination of Cumberland city water happened by the seepage of waste from barkyard privies and city sewage overflow into the Potamac river, as revealed by Dr. William Wyett Wiley with the quickly handrawn map (right) subsequently published in a medical journal. [From one of my pages on this.]

For geographers, the sequence of change was popularized in 1890s (Derwent Whittlesey [professional obituary]), but then forgotten. The temporal-spatial disease diffusion process was explained and popularized with models published by geographer Gerald F. Pyle in the 1960s, and promoted further by his 1979 book “Applied Medical Geography”.

In 1832, Cholera entered northern North American via Canada and the St. Lawrence Seaway, impacting inland cities like Quebec and then almost immediately migrating southward to New York City by way of heavily travelled water routes.  This introduction of cholera by way of major heavily populated places was first published by NY Medical Geographer Lewis Beck (Report on Cholera in Canada and New York, 1832).  This hierarchical diffusion path was duplicated 150 years later when Ebola was introduced to North America for the first time about a decade ago, this time by airplane.   

For epidemiologists, epidemiological transition is linked mostly, or only to scholar Abdel Omran, conceived in the late 1950s and 1960s, as part of the Columbia University school of Public Health, but not popularized until 1971 (see my page on his study as it relates to Native American epidemiological transition).  Several attempts have been made to modify the Epidemiological Transition theory, to better fit the changes over time and new observations being made, but the sequent occupance model remains a more valuable and precise interpretation of changes in disease patterns over time and space.

The first map of disease by Valentine Seaman, Yellow Fever outbreak, NYC, ca. 1798/ mapped by its 1803 publication date; part of the first Medical Charts series ever produced, used for defining insurance payments, by Sydney H. Carter’s Insurance Company in NYC; three examples of the first disease maps published in the 1890 U.S. Census (area highlighted was reviewed for one of my studies posted on this site).

The ways in which medical geography can be directly related to epidemiological transition theory, through the sequent occupancy model, are defined in my thesis (posted by itself and the theory discussed briefly on several pages at this site).

The present state of utilizing GIS for surveillance by the U.S. managed care systems.

We remain at this level, although I am inclined to prepare for changes in 2017.  Once evidence is published for use of GIS in ways other than “descriptive”, the medical profession will be heading into the next generation of GIS use, as an analytic tool.

Famous medical geographers

There are several medical geography topics that are going to become increasingly important in 2017.  

#1

Islamic culture medicine has to be further investigated, with an emphasis on Unani and non-Unani medical practices.  We are provided more information about the practice of Unani medicine through the Muslim India internet sites, than through Iranian, Iraqian sites–the two philosophies do demonstrate some important subjective, cultural differences (which I must cover later).

#2

The impacts of Islamic practices (Unani and non-Unani, Sharia Law practiced) in the Middle East,  on people migrating to the U.S. is going to have a profound financial and cultural impact on the U.S. health care system.  Some legal impacts may be experienced and become problematic as well.  The three most important issues uncovered to date are: infibulation (female circumcision) history and practice and its practice on children under 18 years of age, and especially under 9 and under 5 years of age.  The younger the patient residing in the U.S., the more likely she will have received this practice while living in the U.S., by a U.S. MD or non-MD practitioner, including the use of methods practiced in some very “crude” ways (“broken bottle process”).

#3

The Obamacare PPACA plan may change or even go away, but the need to demonstrate cost improvements in healthcare will not.  If the current PPACA is changed, disenrollment and increases costs may drive up epidemiological problems once again; without the development of spatial GIS methods in the American healthcare systems, we will certainly experience more unpredictable disease outbreaks, in lower income areas and in the form of in-migrated disease patterns.

#4

The BD2K (Big Data to Knowledge) plan now being initiated in health care–making available, testing, sharing and employing these larger datasets to develop more comprehensive population health research programs–will cause radical changes in the system, regardless of the program that exists.  Insurance programs, if they continue practicing unengaged irresponsible, non-forward thinking healthcare practices, will ultimately lose their trustworthiness and integrity.  The application of GIS to healthcare is one of the most time-saving methods for analyzing BD2K data thoroughly and completely, reporting the outcomes frequently.

#5

The numerous “genomic plans” developed to improve genome centered healthcare practices must be performed along with an equal number of “epigenomic” programs, designed to focus on the environment, neighborhood, people and health.  This can only be performed using GIS or some form of Spatial analysis routines.

#6

Spatial analysis provides more accurate ways to analyze healthcare statistics.  The hexagonal grid model I developed is 27% more accurate than traditional grid models.  It produces smoother more realistic 3D modeling results, and is the visualization tool that must be utilized by the public medial geography sector to produce more accurate results, more rapidly than through the use of traditional modelling tools already in place.

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