CHAPTER - I INTRODUCTION. 1.2 Importance of Studies of Medical Geography

Transcription

1 1 CHAPTER - I INTRODUCTION 1.1 Medical Geography in General 1.2 Importance of Studies of Medical Geography 1.3 Review of Work done 1.4 Concept of Urban Medical Geography 1.5 Choice of Region and Topic 1.6 A * Objectives of Study B - Hypothesis C - Methodology 1.7 Data Sources 1.8 Proposed Outline of Work References

2 2 CHAPTER - I 0,1, ft,,tlbjl SLJUJUL i*1 Wica^ Qfgfljrapny J.n $ The World Health Organisation has defined health as *a State of complete physical, mental and social well being and not merely the absence of disease or Infirmity'* (WHO, 1965). 'The State of completeness of health may differ from individual to individual on the basis of person's physiological characteristics and the pressure exerted by the environment in which he lives' (Misra, 1970} Disease is a departure from the state of health* It makes the changes in living tissues which are essential for living beings in particular conditions of environment and hence disease is nothing but a temporary maladjustment between man and his environment (Pandurkar, 1931)* There are a number of geographical factors that influence and sometimes even determine the health and reproductive capacity of living beings including man* The type and the amount of food available for human consumption is dependent to a great extent on the physical, economic and geographical conditions* Poo? food supply means poor health, resulting in malnutrition* The culture of people which is

3 3 at least partly a response of man to natural environment and which is by far the most important determinant of health and comes within the purview of Human Geography* The systematic study of the spatial distribution of diseases, health and ill health and the causes thereof fall within the field of what we call the Medical Geography. Health and Diseases are very important aspects of human life. Good health or ill health are related in several ways to different environmental situations. Geography, amongst other disciplines also deals with various aspects of man and his relationship with the environment. In recent years, a branch of this subject known as Medical Geography has come up which deals with the health aspects of human beings. 1.2 Igggjta ic(a.,gjr.s&^ i Medical geography considers disease as a 'maladjustment of human body to the environment to which numerous factors contribute' Disease, therefore, becomes an anthropological phenomenon with geographical distribution (Park and Park, 1979}«The object of medical geography is to study systematically the geographical distribution of diseases and relating them with the environmental phenomenon. Medical geography is a scientific discipline joining medicine and geography. As a technical term, medical geography is often equated at least in part with - geographical pathology, medical ecology,

4 4 geomedicine, disease ecology and by some with ecology* All these terms suggest growing awareness in the studies of medical geography (Park and Park, 1979)* Medical geography is concerned with the distribution and comparison of various indices of diseases arising in living population and comparing them with other elements of physical, biological and cultural environment* Dr* G*M*Howev a foremost British medical geographer, in a paper read before the IGU Commission on *Medical Geography1 defines it as *an interdisciplinary field of study concerned with areal variations of disease incidence as expressed through mortality or morbidity indices and with the demonstration of possible cause-effect relationship with elements of physical, biological and socio-cultural environments in space. Medical geography may offer pointers to possible answers but not the proof. That must remain the function of the medical men (Misra, 1970). Medical geography may be defined as the comparative study of the incidence of diseases and the distribution of physiological traits in people belonging to different communities throughout the world and the correlation of those traits with different aspects of the environment. In the West, Medical geography has been used rather as an aetiological research tool with emphasis on reducing mankind's load of

5 5 suffering from ill health. Perhaps the specialisation lies in the type of data which individual geographer ean most often use* Even Sir D. Stamp referred to Medical geography as a tool of research* The role of medieal geographer is to make available the skills of geography to medicine but in no way to disturb the functions of medical men. Traditionally medical geography has concerned itself with the problems of diseases which remained paramount in developing countries. Medical geography deals with the medical phenomenon in relation to place and seeks to identify the particular assemblages of those phenomenon which distinguish one place from another. It deals with assemblage, arrangements and circulations of medical and related phenomenon systems of localisation (MeGlashan, 1966). Thus Medieal geography is concerned with a study of those local variations of environmental conditions which are causatively related to the human health or ill health. Medical geography is a study of the relationship between the pathological factors which cause diseases and the geographical factors which give rise to the pathological factors (May, 1950). It studies the pathological factors (Pathogens) in relation to their respective geographical environments (Geogens). The pathological factors are causative agents, vectors, intermediate hosts or reserviours while geographical factors are physical, human or social and

6 6 biological factors. To a medical geographer, geographical environment in respect of pathogens is of vital importance. Hence the main aim of medical geography is to find out the geographical factors which are responsible for the areal distribution of diseases and of health conditions. Ify gh gi..stel.,stef Msii, S«suBtthx * Medical geography is a comparative study of the incidence of disease and the distribution of physiological traits in people belonging to different communities throughout the world and the correlation of these diseases with features of the environment. Much of the subject matter of medical geography is as old as Hippocrates and his article entitled on Airs, waters and placss* is well known. Even the term medical geography has been coined in Britlan only eighty years ago and was used by Dr. Alfred Haviland in his book Geographical Distribution of Disease in Great Britain1 Medical geography, a new discipline is now growing at a rapid pact. The study on this particular discipline was first initiated by non-geographers. The countries Initially showing interest in the subject are the U.S.A. (May), Britain (Learmonth), Geddes, Howe, Waddy, Germany (Jusatz) and particularly in the U.S.S.R. this work has begun by Dr. Arthur Geddes, a member of the Commission on Medical Ecology of the international Geographical union.

7 In India, the work still remains practically in its embryonic stage. Learmonth (1958) has done some fundamental work on the character and spatial pattern of a number of diseases in this country. Very recently Misra (1970) ha, 9 correlated the general health of the Indians with the geo- economic environmental set up of India. Probably the first scientific attempt to Identify the regional factors associated with the prevalence of diseases in India was made by Me Chelland (1859). Later Me Hamara studied the geographical factors influencing the occurrence of various diseases. The diseases of India (Chevars, 1886) by Chevars and Moore "Moore*s Tropical Climate and Indian Diseases, 1890* are also the efforts in this direction. The foundation of the studies of medical geography in India was laid down in the year Hesterlow-was the first researcher who has worked on the "Possible relationship of environmental factors and diseases in Southern India*. Later Arthur Geddes made a very important contribution when he studied the relationship between the general condition of health and population growth in India. The recent Indian researchers in the field of Medical geography are Dr. Bi reshwar Bannerjee and Hazra (1974) who have worked on Geo-ecology of Cholera in West Bengal. Beside these, some research articles have been published by Indian geographers in various Indian journals. Dr. A. Ramesh (with Dr. Hyma, 1977) on the Geographical Distribution and Trends in Malaria incidence of Tamil Hadu, Indrapal (1968) on Geographical Distribution of

8 8 the Tranchoma in Rajasthan, Choubey Kailash (1971) on Diseases of the Sagar City are the noteworthy. In India, almost all the work done by various scholars in this country has been inspired by Andrew Learmonth s pioneering studies. The Twenty First International Geographical Congress which was held at New Delhi in 1968 provided an encouraging opportunity to Indian medical geographers. Recently a number of writers in medical geography in respect of spatial distribution of different diseases and health care centres at national level, state level and micro level have been added by presenting the research papers. In Maharashtra br. Fandurkar (1981) has worked on the spatial distribution of some diseases in Maharashtra at district level. This work Is the generalised attempt at district level. The urban health problems and related urban environmental set up has not been studied in Maharashtra. The present work Is an attempt in that direction. 1.4 Concept of Urban Medical Geography s Medical geography is concerned with the distribution and comparison of various indices of diseases in human populations and relating it with other elements of physical, biological and cultural environment. The culture of the people which is at least partly a response of man to natural environment. Medical geography is an important inter-disciplinary

9 9 branch of knowledge. It brings medical scientists, environmentalists, geographers, agricultural scientists, social scientists and health planners closer. The disease by itself does not draw the attention of a geographer. But the role of environment on a particular disease i.e. the causative factor Is of spatial interest to him. In other words, a medical geographer should study not only the spatial distribution of a disease and the conditions in which it thrives but he also takes into consideration the interaction of environment and human life and society, including the role of man in it. The process of urbanisation and industrialisation have greatly led to the process of agglomeration of people and activities. Without taking adequate care of human values and health, today the urban living has become intolerable. The components of urban environment such as crowding, quality of drinking water, the conditions of sewage lines and their performance in different seasons, routes and intensities of automobile traffic, the location of industries, the height of chimneys, the disposal of wastes, the urban facilities, their efficiencies, capacity and cost etc, have impoverished the urban dwellings. The quality of urban environment influences the physical and mental fitness of the urban dwellers. The infectious diseases are *geographic" in nature as their spatial spread depends entirely on human interactions-in space. Much of the social diseases of the urban areas have been attributed to high density of population or over crowding. The communicable

10 10 diseases spread quickly in the neighbouring areas of high density of population in the huddled houses. The rural way of life is much controlled by the factors of the natural environment. While the urban life is a product of the artificial environment* Therefore, there is a much difference in the distribution of diseases in the rural areas and in the urban areas. The vertical and horizontal development of the slums in the cities have created many sanitation -problems. Rapid growth of the industries in the cities and their fringe areas have invited large pollution, thereby causing many respiratory disorders. The urban way of life is artificially controlled by the machines. Hence urban health problems are quite different from its couhter part. Considering this, "The Concept of Urban Medical Geography" is to be studied separately by considering the disease distribution and the artificial environmental factors originated in the cities. 1.5 Choice of Region and Topic t Recently much of the work has been done by medical geographers in this field. The researchers have presented the articles and research designs on the spatial distribution of different diseases and health care systems at national level, state level and micro level as well. Dr, Shinde (1982) has worked on medical facilities in Maharashtra and

11 Dr. Pandurkar (1981) has worked on the spatial distribution of some diseases in Maharashtra at district level. The author in this work has selected the cities of Solapur district. As Medical geography is concerned with areal distribution of diseases and their relationship to environmental factors such as physical, socle-cultural and biological, this type of study will serve to explain the spatio-temporal distribution of diseases in the cities of Solapur district. Solapur, the author's home district is divided into eleven talukas for administrative purpose which in themselves formed by 1110 inhabited villages and ten towns. The area which now forms the Solapur district was formerly a part of Ahmednagar, Pune and Satara districts. Karmala tehsil was the part of Ahmednagar district, Mohol was in Pune and Pandharpur, Malshiras and Sangola were in Satara district. Barshi and Solapur were frequently changed between Ahmednagar and Pune districts. The sub collectorate of Solapur was formed under Ahmednagar district in X830. The Solapur district was formed in 1838 and was consisted of the eight sub-divisions namely Solapur, Barshi, Mohol, Madha, Karmala, Indi, Hippargi and Muddebihal. At present after many changes, it is consisted of eleven tehsils namely : (1) North Solapur, (2) South Solapur, (3) Barshi, (4) Pandharpur, (5) Sangola, (6) Mangalwedha, (7) Mohol, (8) Akkalkot, (9) Malshiras, (10) Karmala and (11) Madha,

12 12 Tabl«aluka and Citywisa). (Figures In thousand) Nana of Taiuka II, Solapur , S. Solapur , Barsi , Pandhaxpur , Mohol , Mangalwadha , Malshiras , Kaxaala , Sangola * Madha Akkalkot District Total Hama of Citias 1, Solapur , Bars! , Pandhaxpur Kurduwadi , Akkalkot , Maindargi , Dudhani Mangalwadha * Karmala , Sangola Urban Total (Sowtra).

13 13 The researcher has taken into consideration the district at two levels i.e. at tehsil level and at city level* The author has concentrated her attention specifically on urban area of the Solapur district* As per 1981 census* the district has 10 classified cities namely t (1) Solapur, (2) Barsi, (3) Pandharpur, (4) Akkalkot, (5) Sangola, (6) Mangalwedha, (7) Kurduwadi, (8) Karmala, (9) Maindargi and (10) Dudhani. The Solapur district is one of the five districts of Pune division, situated on the south east fringe of the Maharashtra State. The Solapur district lies entirely In the Bhima, Slna and Man basins. The latitudinal extent of the Solapur district is 17-10* North to i8-32* North and the longitudinal extent of it is of 74-42* East to East. Xt covers an area of 15,021 Sq. Kras and has a population of million as per 1981 census (Table 1.1). Xt ranks 6th in area and 7th in population, amongst the 30 districts in the State. With the reorganisation of states in 1956, the district was Included in the Bombay State and since i960, it forms a part of Maharashtra, At the time of 1961 census, the district comprised of 11 talukas which in themselves Included 946 Inhabited villages and 10 towns. During the decade there were no changes in the number of tehsils and towns. Even there was no jurisdictional change till the reference

14 7ft E a st of Greenwich

15 15 data of first March 1981* However there has been certain changes as to the number of villages within the tehsils during the decade of * With the upgrading of hamlets/ wadis in the district, the number of villages have gone up to 1,110 (including 6 uninhabited) whereas the number of towns in the district, remains the same as ten. The Solapur district is surrounded by Ahmednagar and Osmanabad districts in the North, Osmanabad district and Andhra Pradesh in the East, Sangli district and Karnataka State in the South and Satara and Pune districts in the West, The Solapur district comprises of an area of 15,021 Sq.Kms. which is 4,88 % of the total area of the state. Out of this, urban areas account for 414 Sq«kms and rural areas for 14,607 Sq. Kms, In terms of area, Barshi is the biggest tehsll with an area of 1,626 Sq, Kms and the smallest tehsil is North Solapur with an area of 736 Sq, Kms (Fig, 1,1). According to 1981 census, the population of the district is 2*612 million* Out of which million live in the rural areas and the remaining million live in the urban areas. Percentage of the urban population to the total population works out to 30.35, The sex ratio (number of females for 1000 males) was 933 in 1971 as against 936 in The density of population per sq. km for the district was 150 in 1971 as compared to 124 in The physiographic features of the district are dealt with in Chapter II.

16 16 1.6(A) Obiactives of Study * The author in the existing study has decided the following objective*. L-s v Vr y'nw-'' To nap, describe and analyse the spatial distribution of the selected diseases in relation to physical and socio-cultural environment existed in the different tehsils_j>f the Sol spur district. t-vy 2. To study the pattern of spatial distribution of f S' j, selected diseases in the urban areas of the Solapur district. 3. To analyse the spatial distribution of Malaria in - jjh i , ( the Solapur district and to study the spatio* p r '' ' ((^ temporal pattern of cane err of the Solapur city. l 4. To study the existing pattern of distribution of * * j /k^ v-c (A ' * 8 medical facilities in the districts and to suggest p r '... i ^ 10 Probabl* ntw localization of facilities in the vt. yai.tiiet. ik vu-m V.... tl v 9eneral, the aim of this study is to establish the relation of various environmental factors responsible for distribution of different diseases spatially and temporarily. 4' Lj-, / f / ' : ( t f

17 17 i' i*6(b) Hypothesis t Much of the ill health in individual and society is due to defective environment* The geographer*s contribution to medical knowledge can properly be expected to lie chiefly in the field of environmental studies and the relation of disease distribution to other geographic variations* The physical factors are more or less the same even in a small region but sociocultural (Human) factors do vary* Hence the combined effect or the effect of the individual socio-cultural factors might be responsible for the disease distribution in any area. The communicable diseases occur more in urban areas* The physical, sociocultural and biological factors might be prevalent in the spread of diseases* The distribution of health centres are uneven in any region* They only serve In \ the urban areas and the rural areas have very less share. Methodology : For this work the data are collected for a period of 20 years i*e* from 1964 onwards* The author proposes to analyse the data at various levels. The available data will be correlated with different environmental parametes such as physical and sociocultural. The data so collected are at district level, city level as well as at tehsil level* The author has selected eleven diseases for which the mortality statistics are available of urban areas of the Solapur district*

18 18 The disease ranking technique is used for understanding the distributional pattern in the district* The author has calculated the causes of specific death rates and attack rates wherever possible and these data are analysed with the help of different cartographic techniques. The data so calculated and processed will be depicted with the help of line graphs and choropleth maps. Attention is also paid to collect the data for malaria incidence in the Solapur district and for cancer mortality in the Solapur city. The author has calculated the prevalence rate of malaria tehsilwise as per 1961, 1971 and 1981 years, in the Solapur district and is depicted with the help of choropleth maps. Importance of the spread of the particular disease is shown in the maps with gradually increasing intensity of shading technique. The choice of the class interval is as per range of death rates. The details regarding the various other methods and techniques have been discussed appropriately in the text. Citywise death rates have been correlated with climatic parameters and the disease ranking technique is used to find out the dominant diseases prevailing in each city. While discussing the medical facilities distribution, the data are collected districtwise and citywise in which different ratios have been calculated and they are compared with different norms wherever possible.

19 19 1*7 Data Sources * The present study is based on three distinct principles i.e. (i) collection of basic data, (ii) their subsequent processing and (iii) their analysis. It is meant for bringing out any possible correlation between the existing geosystem and the incidence of the diseases. The data of this study are based on the records of the vital statistics of the Maharashtra State. The tehsilwise and cityvise number of deaths by age, sex and causes of deaths are collected for e period of 20 years from 1964 to The diseases selected for the study are eleven In number. They are : (1) Cholera, (2) Dysentery, (3) Diarrhoea, (4) Tuberculosis, (5) Leprosy, (6) Tetanus, (7) Smallpox, (8) Measles, (9) Malaria, (10) Cancer and (11) Pneumonia. Another major source of data is the records of the different municipal corporations and municipalities located in the ten cities of this district. The detailed mortality & vf and wherever possible morbidity statistics is collected from the primary source through these municipal councils. The detailed data of malaria disease have been collected from the District Malaria Office located at Pandharpur, Siddheshwar Cancer Hospital located in the Solapur city was of much help to the researcher from where the morbidity and mortality statistics of Cancer prevalence was collected. The number of deaths by Cancer site, age and ssxwise were collected from the original records of this hospital.

20 r 6. 0 The yearwise socio-economic abstracts of the Solapur district were the another prime source of data, from where the related data about environmental parameters were collected* The data about occupation structure, climatic data like temperature, monthly and annual rainfall, literacy, density of population have been extracted from the socio-economic abstracts* The census reports of the Solapur district for the year 1961, 1971 and 1981 were of immense use to the researcher* Besides, the Solapur Gazetteers and Town and Village Directory of the Solapur district were used for collecting related information and data of the Solapur district and major cities of this district* * 8 ftf Jitoli * The entire study is divided into tight chapters* The first chapter of introduction deals with the importance of study of Urban Medical Geography, Review of work done in medical geography, concept of urban medical geography, choice of region and topic, objectives, hypothesis and methodology of study. Various physical and socio-cultural factors do Influence on the spread of diseases in the district* Chapter second includes the effect of environment on the distribution of (Uaeases, The effect of physical environment on health and its associated factors such as physiography, drainage and climate are discussed in detail* This chapter also deals with

21 the effect of socio-cultural environment on health. Here the different aspects such as growth of population, vital statistics rates, density of population, literacy and education level, age and sex, occupation structure, water supply, food diet and nutrition, social customs and habits are dealt with. Chapter third deals with "The Pattern of Infant Mortality*, in which climatic effects on the occurrence of infant mortality are discussed. Infant mortality by age and sex and causes of infant mortality at tehsil and city level are discussed. Chapter fourth deals with "Temporal variations in the pattern of diseases*. The mortality data have been collected for the Solapur district from 1964 to In this chapter, eleven diseases have been selected namely i (1) Cholera, (2) Dysentery (3) Diarrhoea, (4) Tuberculosis, (5) Leprosy, (6) Tetanus, (7) Smallpox, (8) Measles, (9) Malaria, (IQ) Cancer and (il) Pneumonia. They re studied in detail and the trends of disease mortality is discussed. Chapter fifth studies the -i 1 Spatial distribution of diseases* in three major cities of the Solapur district vis. Solapur, Barshi and Pandharpur. The morphology and medical landscape of these cities are discussed along with spatial distribution of diseases. The spatial distribution of diseases of remaining seven small cities of the Solapur district is discussed in Chapter sixth. Those cities are s Akkalkot, Mangalwedha, Sanaola, Kurduwadi, Karmala Maindargi and Dudhani. Chapter seventh deals with health care facilities in the Solapur district. It includes the present

22 22 status of the medical facilities located in different tshsils and citiss. The Doctor population ratio, bed population ratio, hopital population ratio and work-load factors etc. are calculated and the major health problems of the district are discussed in detail. Chapter eighth contains the summary of the work done so far with general conclusions and recommendations. The references are given at the end of each chapter. It is very difficult to Include all the data collected and processed In the thesis. Hence only available and necessary data are represented in respective chapters. The tables have been used at proper places to make discussion easier and relevant. While carrying out the research on this title, the author had to collect data from many sources. The data collected from government records are used without testing its accuracy for obvious reasons. The spatio-temporal variations in the disease distributional pattern have been attempted from the available data alone. *****

23 23 ft. E If. E.IUUI c. B.J 1) How* Q.M. (1977) : A World Geography of Human Diseases. Academic Press-London, Page 20. 2) (toy J.M. (1950) jmedical Geography its methods and objectives^ Geographical review, 40(10), pp ) Me 61aShan N.D. (1966) / The Medical Geographer* s Work"' International Pathology* July 1966, Page 61-63* 4) Misra R.P. (1970) * Medical Geography of India. National Book Trust, New Delhi, Page 3,12.».. f 5) Pandurkar R.G. (1981) t Spatio temporal distribution of n some diseases in Maharashtra^ Unpublished Ph.D. Thesis, Shivaji University, Kolhapur, Page 32. 6) Park and Park (1979) i Preventive apd social medicine - i Mrs. Bevarasidas Bhanot, Jabalpur, Page 41. 7) Stamp L.D. (1965) s The Geography of life and death, Collins, London, Page 15* *****