Modelos de mortalidad a partir de datos de salud y discapacidad autopercibidos: Un informe sobre Irlanda a distintas escalas 2011-2016

Relationships between mortality and morbidity are long established within geo-spatial modelling and GIS-based analyses. While there has always been a strong associational relationship between the two measures, this has been less tested at an aggregate areal scale than one might expect. From a geographical perspective th is has been in part because access to data at meaningful spatial scales, especially for mortality, can be difficult. This paper presents newly collected data from Ireland on mortality and maps cross-sectional associations with self-reported healthand limiting long-term illness and disability conditions (LLTC) for the first time at an intermediate level geography. Data is also available for two different time-periods from administrative records and from five-yearly censuses. Mortality data was collected at a newly-created intermediate level geography (IA, n=410, averagepopulation=10,900) while the self-reported health/LLTC data was collected at a long-standing administrative scale (ED, n=3409, average population=1,350). Given there was a nested relationship between the two scales, redistricting techniques were used in GIS to enable direct comparisons. Mortality data was available for all deaths (SMR) and premature death (ASR), as well as for four different causes of death. Self-reported health was mapped in three ways; as a combined rate for poor health status; as a weighted health score and as a combined rate for LLTC. The associations were derived from correlation/regression modelling at the smaller IA scale. The results identified that the associations were statistically significant and of mixed magnitude, but had relatively low r-squared values. The associations were strongest for premature (under 75) mortality, while additional correlations for cause of death were lower again. From this, weconcluded that the self-reported health/LLTC statistics, while of some potential explanatory value, were not especially useful as predictive variable. Suggestions for improvement would be to weight the self-reported health data by age andadditionally to take into account deprivation as a second explanatory factor operating within cross-sectional work. Finally, modelling at different spatial scales might act as a useful guide for comparative analysis in Andalucía and other regions of Spain, where spatial scales may be similar in terms of size and scale.Desde hace mucho tiempo, se vienen realizando análisis geoespaciales utilizando herramientas SIG para establecer la relación entre mortalidad y morbilidad. A pesar que siempre ha existido una estrecha relación entre estas dos dimensiones, esta ha sido escasamente evaluada a escala agregada. Desde una perspectiva geográfica, esto no ha sido posible en parte debido a que el acceso a datos, tales como mortalidad, ha sido difícil para determinadas escalas espaciales. Este artículo presenta por primera vez, a un nivel geográfico intermedio, información y mapas recientes sobre mortalidad en Irlanda, asociándola de forma transversal con la salud auto-percibida, la limitación a causa de una larga enfermedad y el nivel de la discapacidad (LLTC). Los datos utilizados provienen de dos fuentes, registros administrativos y censos quinquenales y pertenecen a dos periodos diferentes temporales. Los datos de mortalidad se recopilaron en base a un nivel geográfico intermedio (IA, n = 410, población media = 10,900), mientras que los datos de salud auto-percibida/LLTC se recopilaron en base a una antigua escala administrativa (DE, n = 3409, población media = 1,350). Ante la falta de homogeneidad entre las dos escalas, se utilizaron técnicas de reordenación mediante SIG para realizar comparaciones directas. Los datos de mortalidad estaban disponibles para todas las muertes (SMR) y las muertes prematuras (ASR), para cuatro causas diferentes de mortalidad. La salud auto-percibida fue cartografiada de tres formas distintas: como una tasa combinada para el mal estado de la salud;como una puntuación ponderada de la salud y como una tasa combinada paraLLTC. Las relaciones fueron derivadas desde un modelo de correlación/ regresión a una escala más pequeña IA. Los resultados han puesto de manifiesto que las relaciones eran estadísticamente significativas y de magnitud mixta, pero tenían valores r-cuadrados relativamente bajos. La relaciónfue más significativa para las muertes prematuras (menor de 75), mientras que las correlaciones relacionadas con la causa de muerte fueron bajas. A partir de esto, se llegó a la conclusión de que las estadísticas respecto a la salud auto percibida /LLTC,aunque poseen algún valor explicativo, no se pueden utilizar como variables predictores. Para mejorar los resultados enla realización de estudios transversales, se sugiere que la información sobre la salud auto-percibida se divida por grupos de edad y, además, se tengan en cuenta la deprivación como un segundo factor explicativo. Finalmente, el modelado a diferentes escalas espaciales podría servir como una guía útil para realizar análisis comparativos en Andalucía y otras regiones de España, donde las escalas espaciales pueden ser similares en términos de tamaño y escala

Performing health in place: The holy well as a therapeutic assemblage

This paper examines the holy well as a representative therapeutic landscape with a particular focus on linking a traditional setting with contemporary theory associated with the ‘performative turn’. This is developed within the paper to suggest a new theoretical model of the ‘therapeutic assemblage’ containing material, metaphoric and inhabited dimensions. Drawing empirical evidence from Irish holy wells, complex holistic performances of health are identified within such settings. Deeper associations with more-than-representational theory suggest new directions in the study of therapeutic landscapes to uncover the importance of cultural practice and lay narratives of healing in the creation of healthy place

Small health pilgrimages: Place and practice at the holy well

While established pilgrimage sites have extensive literatures, holy wells are less well documented, yet remain significant sites of pilgrimage with healing associations within more localised settings (Rattue 1995). Health geographers describe such settings as therapeutic landscapes where established reputations for healing are central to the production of place (Gesler 2003). Drawing from a sample of holy wells in Ireland, the operation of holy wells as markers of mind/body/spirit health is explored through a deep mapping of place. Taking account of material, symbolic and inhabited dimensions of wells, they are explored under three parallel themes. Retreat is identified as a core aspect of the well visits informed by phenomenological engagements and material spaces of the well where stillness forms the basis of a spiritual health practice (Conradson 2007). The histories of the wells also contain surprisingly liminal and carnivalesque recreational elements wherein the sacred mingled regularly with the profane. Finally, well pilgrimages connect to a range of scale issues around their position as between special-and-everyday spaces within which heterogeneous healing practices emerge. In the sustenance and revival of holy well visits, the notion of the small pilgrimage as a performance of health emerges to broaden our understanding of the wider pilgrimage process

Father Moore’s Well: An Appreciation

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Spatial Data Infrastructures

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Cross Border Health Data: Geographical Considerations?

While spatial studies are only one part of a wider critical study of cross-border service planning, medical / health geographies have much to offer in terms of spatial data analysis. Based on the existing literature and developing a proposed index of well-being, a new micro-geography of potential patient demand is identified for the island of Ireland. In addition, new proposals on improved data sharing and a stronger focus on the collection of utilisation data are identified as valuable future empirical directions for applied research

Health, Place and Hanly: modelling accessibility to hospitals in Ireland

The Irish Government is currently engaged in considerations about a proposed reorganisation of acute hospital services. The proposals in the 'Hanly' Report recommend the creation of new classifications of Major, General and Local Hospitals. This paper looked at how these proposals might affect geographical accessibility to Irish acute hospitals and modelled it within a GIS framework. Spatial data in the form of hospital location and size, road network and demographic distribution of over 65 's were drawn together within the GIS. A weighted accessibility formula was applied to produce a measure of accessibility called a Spatial Accessibility Measure based on travel time, hospital size and population-weighting. This measures was then applied to produce three scenarios modelled on; a) the existing configuration of services, b) a partial roll-out and c) a full roll-out of the proposed changes in the 'Hanly' Report. The scenarios identified those parts of the country, which were potentially likely to have increased/decreased accessibility to acute hospital services based on the different scenarios. Residents in the central and western parts of the country were shown to be most vulnerable, while the impacts of a full roll-out of Hanly suggests additional potential impacts on some suburban hospitals in the Greater Dublin area. The work provides a valuable and previously underdeveloped set of policy-informed spatial outcomes which can be adjusted if or when more beds are introduced into the Irish health care system in the next five to ten years

Geographies of informal care in Ireland, 2002-2006

Given the increasing role that informal caregivers play in the Irish health, social and economic systems, this short empirical paper outlines and maps the spatial distribution of caregivers from the 2002 and 2006 Censuses to provide some preliminary insights into patterns of caregiving in Ireland. The primary tasks involved mapping the distribution of carers at small area-level in both 2002 and 2006 and noting specific changes in patterns from the 2006 data. Patterns of informal caring are discussed in relation to: (a) clusters and concentrations (as measured by location quotients), (b) specific distributions related to intensities of caring, (c) key changes noted between 2002 and 2006 and (d) some preliminary explorations of explanatory data. Associations were identified between high-intensity caring and age, social class, deprivation and working in the home. Finally, potential applied policy uses for data for informal caring are identified including needs assessment and as an evidence base for modelling spatial service equity

Assessing the applicability of GIS in a health and social care setting: planning services for informal carers in East Sussex, England

Informal carers save the state’s health and social care services billions of pounds each year. The stresses associated with caring have given rise to a number of short-term care services to provide respite to carers. The Carers (Recognition & Services) Act of 1995 identified formally for the first time, the important role that unpaid carers provide across the community in Britain. The planning of combined health and social care services such as short-term care is a less developed application of geographical information systems (GIS) and this paper examines awareness and application issues associated with the potential use of GIS to manage short-term care service planning for informal carers in East Sussex. The assessment of GIS awareness was carried out by using a semi-structured questionnaire approach and interviewing key local managers and planners across a number of agencies. GIS data was gathered from the agencies and developed within a GIS to build up a set of spatial databases of available services, location of users and additional geo-demographic and topographic information. The output from this system development was presented in turn at workshops with agencies associated with short-term care planning as well as users to help assess their perspectives on the potential use and value of GIS. A renewed emphasis on a planned approach to health care coupled with integrated/ joint working with social care creates a need for new approaches to planning. The feedback from planners and users, suggested that a number of key data elements attached to data-sharing may prove to be simultaneously progressive yet problematic, especially in the areas of ethics, confidentiality and informed consent. A critical response to the suitability of GIS as a tool to aid joint health and social care approaches is incorporated within a final summary

Modelling Changing Hospital Service Accessibility in Ireland 1999-2006

On the island of Ireland, there are two distinct and separate jurisdictions, namely the Republic of Ireland and Northern Ireland. Both were founded in 1922 with the former developing into an independent state while the latter still remains a part of the United Kingdom. The Irish Republic operates a primarily state-funded health care system, but an increasing input from private health insurance has arguably created a two-tier publicprivate system (Wren 2003). Northern Ireland’s health care system is primarily based on the UK’s National Health System (NHS) with some place-based variation (Jordan et. al. 2006). With the recent peace in Northern Ireland and the success of the ‘Celtic Tiger’ economy of the South, both governments are exploring joining up the economic and social structures across the whole island. Modelling access to health is one of the areas, which are currently being explored. Informally, there has been cross-border movement in the utilisation of health care for decades but there has been no strategic approach to modeling the implications of those flows. The need to plan in a cross-border setting is also explicitly stated in the new Republic of Ireland National Development Plan (NDP) for the period 2007-2013. With both governments being engaged in the restructuring of health care services, the Departments of Health in both countries were keen to explore the spatial dimension. As a result the potential of a GIS-based approach was identified as worthy of exploration. The National Centre for GeoComputation (NCG) at NUI Maynooth were approached and asked to develop an initial modelling of access to hospitals on an All-Ireland basis. A number of problems needed to be addressed related to the compatibility of spatial data, data merging in a cross-border environment and reliability issues. However each of these issues were likely to be an issue affecting the quality of the GIS analysis. The combined datasets were then used to examine the potential impact of policy-driven change both north and south of the border