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Taking care with GIS: Status and prospects
Saswati Paik
GIS Development
While the developed countries are taking initiatives to establish a well-organised GIS based health care system developing countries are still facing increasingly diverse and complex health problems
Recently, the United Nation's Human Development Report, 2000 was released which has praised India's human rights endeavours. In the same report, it has also been stated that the health profile of the country is disturbing. Totally, 4,100,000 people below the age of 50 have HIV/AIDS. In 1997, the country had 275 cases of malaria per 1,000 people as compared to 163 in Thailand. Nearly 16 per cent of Indians are not expected to live to be 40, 44 per cent of adults are illiterate and 25 per cent are without access to proper healthcare. Going through the above statistics as putout by the UNDP, how much satisfaction can we get regarding our country's health?
Have a look at the most neglected parts of India, the rural areas that consist of more than 600 million people in total, but are provided the least infrastructural facilities. Most of the so-called 'rural health centres' are located far away from metalled roads, without electricity, without telecommunication and also without sufficient trained manpower. The medical students at the graduation level have to take the oath as a tradition since the Greek period: "Whatsoever house I enter, there with I so far the benefit of the sick, refraining form all doing and corruption…" Do they keep this oath in future? Not always. The dearth of rural health centres is well-known to the young medical practitioners who forget their oath once they get an offer to serve the rural health centres far away from the sophisticated urban hub. As a result, the rural health centres usually suffer from lack of doctors and any kind of basic medical facilities.
At this stage of medical achievements, when the researchers are creating the map of chromosomes, the doctors are detecting the diseases with the help of computers and the doctors in the US are using 'biochip', many people, especially from rural India die because of unavailability of proper medical facilities. Besides the lack of willingness from the practitioners' side, the paucity of health related data is a major handicap in conducting health studies in underdeveloped countries like ours, having overburden of population and financial constraints. It is the lack of information that creates a vicious circle between the planning and development processes in the field of health management. The researchers in the field of medical geography may not also avoid their responsibility in that respect.
If health is wealth
Geographers have a long history of applying geographical and cartographical analysis techniques to health problems. More than a century ago, epidemiologists and other medical scientists began to explore the potential of maps for understanding the spatial dynamics of disease. Medical geography, or spatial analysis, was taken up in the early 19th century by physicians attempting to understand the relationship between environmental conditions and the occurrence of disease. Dr. John Snow made the hypothesis that cholera might be spread by infected water supplies more than a century ago, using maps to demonstrate in a striking fashion the spatial correlation between cholera deaths and contaminated water supplies in the area of Soho in 1854. But, in India, the studies in the geography of health appear to be confined to studies in the spatial patterning of communicable diseases, especially of diseases like cholera or deficiency diseases particularly those associated with prevailing nutritional/malnutritional levels, whereas the researches in non-communicable diseases are lacking because published data on such diseases are difficult to come by. Therefore, it is very unfortunate that the changing patterns of health associated with hazards of development, demographic transition and changing lifestyles have failed to draw the attention of Indian geographers.
Looking for a new horizon
Still now, most texts of health surveillance recommend the use of pins to locate cases of notifiable diseases on a map following the way shown by John Snow long back. A variety of maps of origin-destination data are used to assess referral patterns of cancer patients in the northwestern part of the state of Washington, USA. Several simple area-based cancer maps have been produced in the European countries, on the basis of municipality data. Ecological approach has used incidence data in the municipalities of Finland in evaluation of the effects of the Chernobyl fallout on the risk of childhood leukaemia and also in evaluation of the association between mutagenicity in drinking water and gastrointestinal and urinary tract cancers. A similar methodology has also been applied in the Cancer Atlas of Northern Europe project which covers Finland, Sweden, Norway, Iceland, Denmark, Germany, Poland, Luthuania, Latvia, Estonia, Belarus and western parts of Russia.
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