Report: Joint Symposium in Medical GeographyAuthor(s): Marian CraigSource: Area, Vol. 17, No. 4 (Dec., 1985), pp. 315-316Published by: The Royal Geographical Society (with the Institute of British Geographers)Stable URL: http://www.jstor.org/stable/20002228 .

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Uses of microcomputing in geography 315

References Dawson J A and Unwin D J (1984) ' The integration of microcomputers into British geography ' Area 16,

323-9 Meredith B R (1984) 'Staff response to computerisation in the South Wales Constabulary' MSc (Econ.)

thesis, Department of Social Policy, University College of Swansea Unwin D J and Dawson J A (1981) ' Microcomputers in geography in higher education ' Area 13, 321-4

Joint Symposium in Medical Geography

Report of the Institute of British Geographers/Association of American Geographers Medical Geography Symposium held at the Department of Geography, Nottingham University, 15-19July 1985

Forty-nine papers were presented at the IBG/AAG Medical Geography Symposium organised by John Giggs (Nottingham). Such was the response by geographers (and one specialist in veterinary science) from Belgium, Britain, Canada, Eire, USA, Sierra Leone and Zambia that it was necessary to run two concurrent sessions, on 'health service systems: policy and analysis ' and ' disease ecology '. In some ways this split was regrettable, but forty-five minutes for each presentation left ample time for discussion, and the option seemed to suit most people. It would be impossible to mention every paper here, so all I can hope to do in this short report is to identify the more common topics and briefly describe some of the papers in those areas.

With increasing restraint on resources available for health care in the West issues of equity and efficiency in resource allocation come to the fore. This was reflected in the presentation of a whole host of papers on need and demand for and access to health services in the sessions on health service systems. Three papers took Tudor Hart's inverse care law as their starting point, two looking at how the law works empirically. Smith (SUNY, Albany) compared the relative ability of the state and 'grass roots' delivery systems to secure equity in provision of services for alcohol treatment; while Powell (QMC) used data from London to look at territorial justice, that is the extent to which the provision of services meets the health needs of populations in defined areas. The third, from Eyles and Woods (QMC), examined the operation of the 'inverse interest law', where medical problems are prioritised by the medical profession such that it is mainly the individual with a health problem who cares what care is actually provided.

Donovan and Eyles (QMC) presented preliminary results of a survey of regional variation in individuals' felt need for and utilisation of services as expressed in their conceptualisation of health problems.

The topicality of the issue of the de-institutionalisation of care on this side of the Atlantic was reflected in the presentation of two papers on this theme, one from George (QMC) focus ing on care for the elderly and one from Radford (York, Ontario) and Phillips (Exeter) which compared the ease with which a long-stay hospital may be closed with the complex problems of establishing effective care in its place. One wonders whether any amount of diligent research in this area will convince policy-makers of the fallacy of relying on de-institutionalisation to make economies in caring for the long-term ill, when such a policy rests on a false idea of the cost of generating better health outcomes outside long-stay institutions.

It was in the nature of an Anglo-American symposium that the differences between health care organised in a free market system and in one of state provision should be constantly highlighted. Thus Mayer (Washington) discussed the health care crisis in the United States from an international perspective, concluding that problems of cost and access are not best tackled in a system of corporatised medicine and limited government involvement in health care and planning. McLafferty (Columbia) analysed spatial dimensions of the restructuring of

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316 Joint symposium in medical geography

hospitals in New York City, likening the reorganisation of privatised nonprofit hospitals to the corporate strategies of private sector firms.

Third World health care and disease featured more heavily in the disease ecology sessions, in which seven papers on tropical disease were presented, focusing mainly on control. Two papers on diarrhoeal diseases included one from Taylor (McMaster) who reported results from a project in Grenada which aims to identify risk factors for childhood diarrhoea with a view to designing effective intervention strategies; while Craig (Community Medicine, St Thomas'

Hospital, London) discussed patterns of cholera diffusion in Bangladesh in the light of recent ideas about primary (environment-host) and secondary (host-environment-host) transmission of Vibrio cholerae. Two papers on infant mortality were presented. Kandeh (London School of Hygiene) argued for intervention in the major causes of infant and early childhood deaths in Sierra Leone in the form of oral rehydration therapy and the training of Traditional Birth Attendants. Bhardwaj and Paul (Kent State) reached similar conclusions in a paper on medical pluralism and infant mortality in Bangladesh suggesting that traditional practitioners must be trained in methods for preventing neonatal tetanus and treating symptoms of diarrhoeal disease.

A whole day was devoted to mortality studies. Kearns (Liverpool) presented data on sex specific urban death rates to argue that the relationship between urbanisation and mortality influenced population levels to a greater extent than the seminal work of Wrigley and Schofield on the impact of fertility rates on population levels suggests. While the over-riding theme of

most of the other mortality studies was regional variations in mortality, including mortality from cancer and cardiovascular disease, Greenberg (Rutgers) discussed disease competition as a factor in ecological studies of mortality, identifying three possible causes of competition: namely 'error', 'dominant etiology leading to dominant disease outcomes' and 'dominant culture with a variety of disease outcomes'.

Finally a word about the return match across the Atlantic in July 1986. The second AAG/IBG Symposium in Medical Geography is to be held at the State University of New Jersey, Rutgers, from 14-18 July. Offers of papers should be sent direct to Dr Michael Greenberg, School of Urban and Regional Policy, Rutgers University, Lucy Stone Hall, Kilmer Campus, New Brunswick, NJ 08903, USA and to Dr John Giggs, Department of Geography, University of Nottingham, University Park, Nottingham NG7 2RD. The con ference organisers would also like to know people's preferences for field trips so if you are more interested in the Adirondacks than Atlantic City, do write to let them know. The day trip to

Lincoln this time with expert commentary from the indefatigable John Giggs was certainly enjoyed by all, as indeed was the whole conference. Thanks are due to him for organising such a smooth-running and stimulating meeting.

Marian Craig Department of Community Medicine

United Medical Schools of Guy's and St Thomas' Hospitals

Newcastle Seminar Papers

Three further papers have been published in this series; they are available at ?1.25 each from the Secretary, Seminar Papers, Department of Geography, The University, Newcastle upon

Tyne NEI 7RU. Cheques should be made payable to the University of Newcastle upon Tyne.

39 Context and structure: towards agrarian capitalism in north-west England, by Nicky Gregson

40 The geography of party support: comparative studies in electoral stability, by R J Johnston, A B O'Neill and P J Taylor

41 Heavy metal transport and storage in an upland catchment: a case study from the River West Allen, Northumberland, by R J Aspinall and M G Macklin

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