Discussion

Geography of Health and Migration( week-3)

Week-3 Agenda( Oct 1-7th Oct)

 Exam-1

 Assignment-2

 Discussion Questions

 Read Ch-4 and will start reviewing about Migration( Ch-5) but wrap upcomplete Ch-5 next week.

 Review PPT lectures

 Email me if any questions.

Medical Geography and GIS

 Health and Geography?

 Links and Books on Health and Geography

 Human Ecology of Diseases

 Major Diseases: AIDS/HIV

 Global Health care

 Applications of GIS in Health

 Role of GIS in Health industry

Books and Geo Spatial links in Medical Geography  http://www.wiley.com/WileyCDA/WileyTitle/productCd-1405170034.html

 http://www.cdc.gov/

 http://healthmapper.software.informer.com/

 http://www.esri.com/events/health

 http://www.llu.edu/public-health/programs/mph-envh-track4-gis.page

 http://www.esri.com/industries/health

Medical Geography  The application of geographic ideas, information, and theories to

the study of disease, health, and health care.

 Also called Health Geography

 http://www.merriam- webster.com/dictionary/medical%20geography

4-5

How can health and geography be related??

Health and Geography  Approaches:

• Human-Environment relationships  Poor environments can negatively affect health

 Pollution and other human-made problems

• Culture  Religious or other cultural attitudes/practices can affect how diseases or other

ailments are dealt with

• Movement  Diffusion of diseases

4-7

4-8

SARS 2002-2003

Human Ecology of Disease

• Human Ecology: • the interconnections

between human populations and the physical world

• Triangle of Human Ecology: • Population

• Behavior

• Habitat

4-9

Insults and Stimuli on Health  Chemical Insults:

• Drugs, exposure to chemicals or gases

 Physical Insults: • Trauma from accidents, radiation, shock

 Psychosocial Insults: • Crowding, anxiety, love, sense of belonging

 Infectious Stimuli: • Viruses, bacteria, protozoa

4-10

Understanding the concepts  Endemic:

• A disease that’s always present in a population

 Epidemic • A disease that occurs in larger #s than normal

 Pandemic • A worldwide epidemic

4-11

AIDS!!!

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors.

Disease and its scale

 Epidemic: Occurs when there is a sudden and severe local or regional outbreak( Cholera outbreak in refugee camps etc)

 Pandemic: Occurs when a disease spreads world wide( AIDS is a global Pandemic)

Rise of HIV/AIDS??  Issues: AIDS

 Countries impacted

 Role of World Bank and other More developed countries…  http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t

;nsl=t;se=t$wst;tts=C$ts;sp=5.59290322580644;ti=2011$zpv;v=0$inc_x;mmid=XCOORDS;iid=pyj6tScZq mEfbZyl0qjbiRQ;by=ind$inc_y;mmid=YCOORDS;iid=pyj6tScZqmEe1GaiYJX2qGA;by=ind$inc_s;uniVa lue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x; scale=log;dataMin=0.0095;dataMax=27$map_y;scale=lin;dataMin=10;dataMax=5600000$map_s;s ma=50;smi=2$cd;bd=0$inds=

 http://www.unaids.org/en/

 http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/

 www.gapminder.org

SOURCE: WHO/UNAIDS

WAYS PEOPLE BECOME INFECTED WITH HIV –AIDS..

 by having sexual intercourse with an infected partner

 by injecting drugs using a needle or syringe which has already been used by someone who is infected.

 by blood transfusions (it is a lower risk than in the past, but still a risk)

What can be done about AIDS in SSA?

Awareness and acceptance of the problem

Political will Lowering of cost of drugs Success in lower rates in

Uganda and Kenya

A. WinklerPrins

http://www.time.com/time/interactive/0,31813,2021888,00.html

A continent in Peril….

AIDS IN AFRICA  http://www.avert.org/africa-hiv-aids-statistics.htm

Diffusion of AIDS…..

 Heterosexual transmission of HIV dominates  Urban areas  Commercial sex  Sexually transmitted diseases, condom use neglect  Cultural context : men don’t use condoms  Women reluctant to insist on condoms  Rural areas: More silent  Lack of adequate medical facilities, poverty,

insecurity, gender inequality, migration, war and civil conflict

Diffusion of AIDS  Commercial Sex is widespread(Cote d Ivorie)

 Female sex workers are HIV positive

 Economic needs compels women to provide sexual favors

 Blood transfusion, Long distance truck drivers-sex-local women

 Highway of Death: Malawi-Durban in S Africa(92% of truck drivers were HIV positive)

How AIDS impact the regions???  Decline in Life expectancy

 (Swaziland: 39 yrs for females and 36 yrs for males)

 Lack of working population/workforce

 Orphans/lack of parents

Coping with AIDS  Developed world: Antiretroviral drugs are delaying the development

of full blown AIDS

 Extending the lives of people living with AIDS

 Preventing vertical transmission from mother to new born

 AFRICAN Countries: THESE MEDICINES ARE ONLY A DREAM… expensive beyond HOPE!!

 Generic Versions of Drug are Underway

 Uganda and Zambia: Reversing the AID

 Effective prevention measures

 Access to condoms

 Treatment of opportunistic infections

 Sexually transmitted diseases

 Sex education at school

 Voluntary counselling

 Support for pregnant women

 Efforts to prevent mother –child infection

How Geographic Information Systems can be used and is used in Health Applications

GIS and Health Applications

 John Snow and Cholera case

 How Can GIS be used in Public Health?

 Health Industries and Administration

 GIS and Health applications-egs

 Websites using GIS for Health

GIS and Health???

 How can GIS be used for Health/What are the applications where GIS can be used in Health?

 What are the methods/techniques which can be used to understand health?

 What were the various applications where GIS has been used in the readings ?

 http://www.esri.com/apps/esriclips/clip.cfm?ClipID=165

"Can Geographic Information Keep You Healthy?" Davenhall suggested that a patient's geographic (or place) history is as relevant to personal health as genetics and lifestyle. One reason for including geography is that where you live can expose you to environmental toxins.

Famous Health Map! http://www.ph.ucla.edu/epi/snow.html

Snow, J. (1949) Snow on Cholera. Oxford University Press: London.

http://www.ncgia.ucsb.edu/pubs/snow/sno w.html

In and around Louisville, Kentucky, industries produce multiple contaminants (Arc News ,Spring 2010)

Heart attack risks for U.S. Medicare enrollees shown here in the contiguous United States, mapped by county. (Data source: Dartmouth Atlas of Health Care.)

Poverty and BMI (Body mass index)

BMI ! 18.5 - 24.9

25.0 - 29.9 30.0+

Percentage in Poverty 0 - 12.5%

12.51% - 19.99%

20.0% - 39.99%

40.0% - 70.10%

!(

!(

!(

!(!( !(!( !(

!(

!(

!(!( !(!( !(

!( !(

!(

!(!(

!(

!(

!(

!(

!(

!(

!(

!( !(!(

!(

!( !( !(

!(!(!( !( !(

!( !(

!(!( !(!( !(

!( !(

!(

!( !(!(

!( !( !(

!( !(

!(!( !(

!( !(

!( !(

!(

!( !(

!(!(

!(

!( !(

!( !(

!( !(

!( !(

!(

!(

!(

!(

!(

!(

!( !(

!(

Data Sources: BRFSS data, 2000;City of Pgh City Planning Dept., U.S. Census 2000

Pittsburgh, PA: Neighborhood proportion under poverty and average BMI per neighborhood

How can GIS be used in Public Health?

Determining geographic distribution of diseases

Analyzing spatial and temporal trends Mapping populations at risk Stratifying risk factors Assessing resource allocation Planning and targeting interventions Monitoring diseases and interventions

over time Ref: http://www.who.int/health_mapping/gisandphm/en/index.html

Health Industries  Public Health

 Epidemiology

 Health and Hospital Administration

 Health Policy

 Environmental Justice

 Medical Research

 Insurance Industry

 Homeland Security

 Emergency Response

 Disaster Management

Public Health  Organizations use GIS to map data, facilitating assessments on a

variety of issues including:  Diseases and epidemics

 Air and water quality, sanitary conditions of food handlers

 Vital events such as births, deaths and immunizations

 Readiness to respond to natural and man-made disasters

Health Care Administration

Health care is in part controlled by geographic location  Benefits:

 Identifies new markets

 Analyzes current or projected patient population locations and needs

 Conducts market studies and documents health care needs for a community

 Maps information about health care providers: hospital and clinic locations, physicians, and ancillaries

Health Care Administration •American College of Health Care Executives

World Aids Rates

U.S. Cancer Mortality Rates

Healthcare Distribution

MIGRATION

MIGRATION

https://www.nytimes.com/2017/04/21/ opinion/sunday/go-east-young- american.html?_r=0

What is Migration?

Is the permanent relocation of both place of residence and activity.

Go East! Young Americans!

Needed but not wanted Economic migrants are seen as a threat to jobs and the welfare state. The reality is more complex!

Immigration is a boon for Britain. The 9m-odd foreign-born people living there bring with them skills and attitudes that make the country more productive. Younger and better educated than natives, immigrants pay more in tax than they use in the way of public services. For some institutions they are indispensable: perhaps 30% of doctors in Britain are non British

http://www.pewresearch.org/fact- tank/2016/08/03/nearly-1-in-100-worldwide-are-now- displaced-from-their-homes

http://www.unhcr.org/en-us/figures-at-a- glance.html

Agenda

 Migration-Spatial Interaction

 Push and Pull

 Types of Migration

 Immigration

 Sun and Snow Belt

 Laws of Migration_Ravensteins

 Gravity Model

What is Migration?

Is the permanent relocation of both place of residence and activity.

What is Spatial Interaction??

 Used by geographers to study the interdependence between geographic areas.

 It can be movement of people, between places, flow of goods, diffusion of ideas, and spread of diseases.

 It is a function of the size of the interdependent population and the distance between them.

Why Migrate?

 Push Factors  loss of job, lack of professional opportunity, overcrowding and slum clearance

 Pull Factors  safety and food, job opportunity, better climate, lower taxes, more room

Why Move??

Life cycle change induces MOVE!!

Forced Migration

http://www.economist.com/news/special- report/21699307-migrant-crisis-europe-last-year-was- only-one-part-worldwide-problem-rich

http://www.unhcr.org/en- us/figures-at-a-glance.html

Migration Mapping (Flow mapper)

Incentives to migrate

 Social factor

 Cultural factor

 Geographical

 Political

Types of Migration  Recurrent

 Repeats on a regular basis, commuting

 Crossing of an international border

 Seasonal movement

 Non recurrent  Residential mobility (local moves)

 Migration (between metropolitan areas or between states, nations)

Ethnic Distribution in Los Angeles

Migration within South Asia

Rural-Urban Migration Dominates in Developing World

Why people migrate to foreign countries??

Current Migration Routes76

Some Risk Takers (Source: The Economist)

77

Trend of Immigrants:1881-1960

Trend of Immigrants to USA:1961-1999

SUN BELT? Johnston (2000) defines Sun Belt and Snow Belt as the two regions which refers to the growing and declining regions in the US economy. Greene et al. (2006) defines Sun Belt cities as the fastest growing cities and are located below the 37th parallel. The country’s Snow Belt region refers to the the older industrial districts especially in the North East; and Western and the Southern part are often called as the Sun Belt.

Sun Belt

The Great Plains Drain

What growth in Sun Belt?

 Southward and westward movement of people  Fast growing cities  Hot and humid  Defense and other federal spending  Boom in high-tech industries  Growing affluence  Moderate price air conditioner after WWII.  Higher availability of jobs and competitive wages  Sun rise industries (Home of Silicon valley, Hollywood,

aerospace)

Mean Center Moving towards Sun Belt??

E.G. Ravenstein’s Laws of Migration

• Most migrants move only a short distance

• Longer distance migration favors big city destination

• Most migration proceeds step by step

• Most migration is rural to urban

• Each migration flow produces a counter flow

• Most migrants are adults

• Most international migrants are males

Important Concepts

 Distance Decay: The declining intensity of an activity with increasing distance from its point of origin.

 Outlier: Point on a scatter diagram that lies far off the trend line.

 Outliers on the graph correspond to cases that are poorly predicted by the model. Outliers are not to be confused with extreme values,

which may lie far from any other point but which are still close to the best-fitting line.

Gravity Model (Jones,1990 and Zipf,1949).

A model to predict spatial interaction, where size (population) is directly related to interaction and distance is inversely related to interaction.

Gravity Model Formulation

 M: number of migrants flowing between i and j

 P: refers to population and d is the distance

ijjiij dPPkM /=

Pi

Pj

dijLos Angeles

Sacramento

We will wrap up Migration now next week….Complete reading ch-5