Medical/Health Geography Research

Research Interests

My research interests are mainly in the epidemiological side of the subject rather than the geography of health care. I have always believed that it is better to try to prevent illness, through a better understanding of its causes, rather than to try to cure people once they become ill. However, as I get older, and I realise that it is probably already too late to prevent whatever is in store for me personally, I am developing a greater appreciation of the benefits of good health care. So, as my personal circumstances change, perhaps I may be prompted to explore the other side of the subject more extensively. The geography of health care also lends itself more readily to GIS (another of my teaching / research interests) than does the Geography of Health, thereby providing a second reason for expanding my interests in that area. However, for present, my teaching and research interests are strongly biased in favour of geographical epidemiology.

Most of my research to date has been focused on social and spatial inequalities in health. Whilst some studies have used morbidity data, most of my work has involved analysing mortality data. I have research interests in a number of areas, which I tend to revisit from time to time. Recurrent themes include:

• Temporal trends in the spatial patterns of disease mortality. Death rates in Ireland until recently tended to be higher in areas which are generally believed to be more affluent and to enjoy a higher quality of life. This is the opposite to the pattern found in Britain and many other developed countries. However, there is evidence to suggest these patterns may be breaking down.
• Temporal trends in the cause of death. Ireland has traditionally been characterised by very high rates of mortality from diseases of the circulatory system (i.e. heart disease, stroke). The death rates from these causes, as in many other developed countries has declined over the past couple of decades. However, there has been an increase in the number of deaths from malignant neoplasms (i.e. cancer). What is not so clear is the extent to which the increased number of deaths from certain types of cancer may be the result of changes in lifestyle or environmental factors, or simply a reflection of a decline in the number of deaths from other causes.
• Schizophrenia in Cavan and Monaghan. Studies of spatial inequalities in schizophrenia prevalence have traditionally tended to favour a 'drift' interpretation - i.e. that people susceptible to schizophrenia tend to drift into particular areas (e.g. urban inner cities) which then record a high prevalence, rather than being caused by environmental factors associated with these areas. Data on schizophrenia morbidity in Cavan and Monaghan (painstakingly collected by the Stanley Foundation Research Unit in St. Davnet's Hospital, Monaghan) suggests that there may be localised clusters of higher prevalence which would be difficult to explain by 'drift' factors. This in turn would suggest that the alternative 'breeder' hypothesis may need to be taken more seriously. However, it is very difficult to establish whether the localised areas of high prevalence in Counties Monaghan and Cavan are statistically significant, let alone to identify which environmental factors might be involved. Research is ongoing.
• Cancer in Louth. This involves an evaluation of possible health effects of the Sellafield nuclear plant in Cumbria, England on people living in County Louth. The evidence would appear to indicate that Louth may have a higher rate of cancer mortality than most other counties, but there is no hard evidence to suggest that this can be attributed to nuclear contamination from Sellafield. Other, more localised factors, provide a more likely explanation. (N.B. The potential dangers associated with the risk of a major incident in the future, arising from an industrial accident or an act of terrorism, are a different issue).
• National cancer patterns. More detailed cancer morbidity data has recently become available in Ireland following the establishment of the National Cancer Registry. Time has not permitted me to engage in a detailed examination of this data yet (although it has of course been analysed by others), but it is near the top of my research agenda.
• Perinatal influences on life expectancy. This involves an examination of evidence to test the theory that health in adult life may be influenced by living conditions around the time of birth. Studies in other countries report an association between factors such as birthweight and foetal development and the risks of cardiovascular and other diseases in later life. The evidence for Ireland is not totally convincing, but it does reveal a fascinating pattern of infant mortality in the early decades of the twentieth century which is almost the opposite of what many people might have expected.
• Methodological issues. One of the major problems facing medical geographers and health researchers is that it is often very difficult to ascertain whether there are statistically significant variations in the incidence or prevalence of a disease because there are too few cases to establish if there is a pattern. (N.B. Too few cases is not a problem in other senses - obviously the fewer cases of a disease the better!). One of my recurring interests has been in ways to tackle the 'small numbers' problem and to develop an intuitive understanding of the implications of small numbers for research. Bayesian statistics would appear to offer the best, but an incomplete, solution at this point in time.

Research Students

I am currently supervising several students working on their doctoral theses. Topics covered include: factors contributing to popular perceptions of environmental health risks; factors possibly contributing to increased risks of schizophrenia; and the spatial organisation of the Irish mental health services. Another student recently successfully completed his doctorate on the relationship between health and relative deprivation.

The Cross-Border Health Research Network

Medical/Health Geography in Ireland was traditionally hampered by an absence of data suitable for research purposes. However, the situation has improved dramatically in recent years following the creation of Departments of Public Health within the Regional Health Boards. There are now considerable opportunities for productive co-operative research between the Health Boards, other state agencies and academics. There is also considerable scope for co-operation between health workers and researchers in Northern Ireland and the Republic. One of the major limiting factors, however, is that many of those who could benefit from such work are unaware of the skills and resources which others could contribute to co-operative research. It was for this reason that I became involved in attempts to establish the Cross Border Health Research Network with financial support from the Royal Irish Academy.

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