Cristiano Pesaresi1*, Miriam Marta2, Cosimo Palagiano3 1* Geography Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; Tel. +39 06 49913587, Fax +39 06 49913874; e-mail: [email protected] (Corresponding author) 2 Geography Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; Tel. +39 06 49693233, e-mail: [email protected] 3 Geography Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, GEOGRAPHY Italy; Tel. +39 06 49913917; e-mail: [email protected] 24 THE CAUSES OF DEATH IN THE PROVINCE OF ROME BETWEEN 1981 AND 2007: A GEOGRAPHICAL ANALYSIS ABSTRACT. In this paper we provide an health and health inequalities”. Experts in overview of the main causes of death in epidemiology, sociology and geography the province of Rome in 1981 and 2007, consider this role of space significant, because showing the most relevant variations which they recognise “that there is a mutually have been recorded over time. Using ArcGIS reinforcing and reciprocal relationship 9.2 software, we have drawn up several between people and place”. These medical-geographical thematic maps and academics “argue that these approaches to specific land use maps which corroborate understanding how place relates to health the temporal and spatial analysis, and which are important in order to deliver effective, provide suggestions about the relation ‘contextually sensitive’ policy interventions” between causes of death and certain risk [Cummins et al., 2007, p. 1825]. factors. Particular attention is given to the diseases of the circulatory system and In a more recent paper Rainham et al. [2010, neoplasms which caused, respectively, 38.4% p. 668] introduce “the need to move beyond and 32.6% of deaths in 2007 and which conventional place-based perspectives in followed substantially different trends. Then, health research, and invoke the theoretical we focus on the city of Rome, where we contributions of time geography and spatial examine the evolution of land use between ecology as opportunities to integrate human 1980 and 2001 in order to investigate, by agency into contextual models of health”. They means of detailed screening, the changes also introduce the concept of healthscape “as recorded in a city where, in 2007, 67% of the an approach to operationalizing context inhabitants of Rome province lived. as expressed by the spatial and temporal activities of individuals”. KEY WORDS: causes of death, circulatory system, neoplasms, medical-geographical In a previous paper other researchers thematic maps, land use maps, risk factors, GIS. explored the links between (perceived) environmental risk and community (re)action in a urban industrial neighbourhood in INTRODUCTION Hamilton, Ontario, Canada. The analyses For some years experts in health research “were conducted with residents of an area “have been successful in re-establishing with a documented history of adverse air interest in the role of place in shaping quality, in order to determine the relative influence of social capital (networks, norms, organise a wide database which can be and social trust) and place attachment progressively updated and upgraded and (sense of belonging in a neighbourhood) can produce a number of superimposed in deciding to take civic action around this layers. For the purposes of our project and particular environmental issue” [Wakefield et thanks to the characteristics of GIS, the maps al., 2001, p. 163]. and the problems shown for the province of Rome [Pesaresi, Marta, in press] will be GEOGRAPHY The above papers present some interesting comparable with those of the oblast of approaches for our international project Moscow produced by colleagues of the 25 Medical and geographical analysis of urban Faculty of Geography, Lomonosov Moscow agglomerations in different natural and State University, Russia [Malkhazova et al., socioeconomic conditions, whose main goal 2007], for the same project. In this way, we is to establish the role both of space and provide input for communal reflections and time in the distribution of the diseases in two analysis. different areas of Europe, i.e. the province of Rome and the oblast of Moscow. In the geographic literature, however, this kind of comparative study has already been For this purpose, we evaluate: carried out. For example, in 1963, Ortolani (in collaboration with Mounfield) made a the relationship between people, health comparison between two industrial regions, and space; Lombardy in Italy and Lancashire, in the UK. Likewise, in 2004, Cristaldi and Darden the importance of time geography and analysed the demographic structures and spatial ecology; social networks among Filipino immigrants in Rome and Toronto. We intend to refer to the effective “contextually sensitive” policy these projects to show the differences and intervention; similarities of the relationship between the health situation in two different areas of the contextual models of health; Europe, the province of Rome and the oblast of Moscow. health in the industrialized areas; THE MAIN PHASES AND AIMS health in green areas close to and in cities OF THE RESEARCH and towns; “Empowerment” is a process of social activity the influence of immigration on health. which allows people, communities and local administrations to acquire information and As far as regards methods and tools used, competences in order to change and improve we have employed ArcGIS 9.2 software the features of their environment and of their in order to draw up and analyse various quality of life [Italian Ministry of Health, 2010, maps, which show the distribution of some p. 14]. One of the key components in the diseases in relation to selected particulars acquisition of this information is knowing of municipalities in the province of Rome. the main causes of death and the related Recently, in our book La salute nel mondo. risk factors on a large scale. With the aim Geografia medica e qualità della vita, we have of encouraging a similar process, and the already explored the possibility of introducing development of adequate socio-sanitary GIS in our researches on medical geography, facilities, besides a continual reflection on discussed many practical applications and the techniques of planning [Morelli, 1983, p. showed the added value of analysis at 510], in this paper we evaluate the changes different scales [Palagiano, Pesaresi, 2011, which have been recorded between 1981 pp. 315–318]; here we have used GIS to and 2007 regarding the main causes of death in the municipalities of the province observing in which municipalities of Rome; subsequently, we indicate which there is a relation between causes of are the axes and the macro-areas currently death and some risk factors (industries, showing the highest values for: diseases of mining activities, waste, etc.) and the the circulatory system; neoplasms; diseases municipalities where this relation is not of the respiratory system; injury, poisoning very strong; GEOGRAPHY and certain other consequences of external causes; endocrine, nutritional and metabolic drawing an analytic framework of the 26 diseases. On the other hand, many years ago potential dangerous elements which are the relevance of recording the provincial present in the city of Rome, deriving this and municipal mortality data over time qualitative data from a re-elaboration ad was demonstrated, such as the importance hoc of the official land use maps; of making analysis and follow-up studies involving local communities which are exposed avoiding program faults during the to particular risk factors [Rubino et al., 1983, planning phases, above all in areas with p. 78]. high population density. In practice, using GIS we created many THE MAIN CAUSES OF DEATH medical-geographical maps which facilitate IN 1981 AND 2007 temporal and spatial analyses and help to investigate the potential risk factors. In In 2007 – the last year for which the National this way, through map making, we can Institute of Statistics (ISTAT) provided the encourage “map thinking, the method by data for municipalities – 35,849 deaths were which assumptions embedded in an analytic recorded in the province of Rome. process are understood and employed in the researcher’s response to a problem” Diseases of the circulatory system were the [Koch, Denike, 2007, p. 76]. Moreover, after primary cause of death (13,758 deaths) and defining general frameworks at the scale of neoplasms were the second (11,684), as the municipality and showing the effective was the case in 1981 (Fig. 1). Nevertheless, land use by employing a specific legend, we comparing the data of 2007 with that of focus our attention on the city of Rome, for 1981, we can observe a significant reduction which we analyse the evolution of land use in the distance between them, because the between 1980 and 2001 in order to examine trend of neoplasms shows a marked and the eventual relation between causes of regular increase [Pesaresi, Marta, in press]. In death and proximity to certain activities or third place we continue to find diseases of pollution sources; this surgical screening the respiratory system, while diseases of the allows us to evaluate the most important digestive system have moved from fourth to changes which could have contributed to sixth place and injury, poisoning and certain the increase or decrease in mortality due to other consequences of external causes1 particular diseases. have passed from sixth to fourth position. Endocrine, nutritional and metabolic