Medical geography in public health and tropical medicine: case studies from Brazil

Abstract

Within the last few decades, the multitude of infrastructural and environmental changes associated with population growth, human migration, and economic development have catalyzed the emergence and re-emergence of many infectious diseases worldwide. The morbidity and mortality associated with these diseases have in turn led to an increased and renewed impetus to gain a better understanding of the etiology, epidemiology, prevention, and control of these diseases in order to achieve better health and well-being, especially for underprivileged populations. Two traditionally separate fields, medical geography and tropical medicine, have recently seen complex and radical paradigm shifts in response to this global situation: medical geography has been developing many new and sophisticated methods of data collection, data manipulation, and spatial analysis that make it more suited for the study of health-related problems; and tropical medicine has been revisiting the fundamental notion that disease is intimately linked to the physical and cultural geographic environments in which humans live. As a result, concepts of medical geography are being more readily employed within tropical disease research, and tropical medicine is embracing geographic methods as a central mainstay in the control, management, and prevention of tropical diseases. As the associations between these two fields continue to grow, a clearer understanding of how they compliment each other will be needed in order to better define their interrelated roles in augmenting human health. This dissertation examines the multifarious relationships that have developed between the fields of medical geography and tropical medicine in recent years by presenting the reader with a brief history of their common origins and a comprehensive review of the techniques and methodologies in medical geography that are frequently employed in tropical disease research. Following this background information, several case studies are investigated that provide examples of how geographic methods can be easily and effectively employed in the analysis of several tropical diseases, including tungiasis, intestinal helminthes, leprosy, and tuberculosis. These case studies demonstrate some of the advantages and disadvantages of current geographic methods employed in health research, and offer a framework for readers who are interested in applying basic geographic concepts to analyze questions of health.