24 GEOGRAPHY inhabitants ofRomeprovince lived. recorded where, inacity in2007, 67%ofthe means ofdetailedscreening, thechanges 1980 and2001inorder to investigate, by examine theevolution oflandusebetween we focus ofRome, where onthe city we followed substantiallydifferent trends. Then, and 32.6%ofdeathsin2007which neoplasms whichcaused, respectively, 38.4% system anddiseases ofthecirculatory factors. Particular attention isgiven to the risk causesofdeathand certain between provide suggestionsaboutthe relation the temporal andspatialanalysis, andwhich specific landusemapswhichcorroborate thematicmapsand medical-geographical 9.2 software, we have drawn upseveral have beenrecorded over time. UsingArcGIS showing themostrelevant which variations the province ofRomein1981and2007, ofthemaincausesdeathin overview interest intherole ofplacein shaping “have beensuccessfulinre-establishing For inhealthresearch someyears experts thematic maps, landusemaps, factors, GIS. risk system, neoplasms, medical-geographical 3 2 Cristiano Pesaresi 1* KEY WORDS: ABSTRACT. INTRODUCTION A GEOGRAPHICAL ANALYSIS 2007: 1981AND BETWEEN IN THE PROVINCE OF THE CAUSES OF DEATH Geography Unit,SapienzaUniversity ofRome, Piazzale AldoMoro 5,00185Rome, Geography Unit,SapienzaUniversity ofRome, Piazzale AldoMoro 5,00185Rome, ; Italy; Tel. [email protected] +390649913917;e-mail: Italy; Tel. [email protected] +390649693233,e-mail: Geography Unit,SapienzaUniversity ofRome, Piazzale AldoMoro 5,00185Rome, e-mail: [email protected]: (Corresponding author Italy; Tel. +390649913587,Fax +390649913874; In thispaperwe provideIn an causes of death, circulatory causes of death, circulatory 1* , Miriam Marta , Miriam 2 , Cosimo Palagiano .668]introduce p. amore etal. recentIn [2010, paperRainham [Cummins etal., 2007,p. 1825]. ‘contextually sensitive’ interventions” policy inorder toare deliver effective, important understanding howplacerelates to health academics “argue thattheseapproaches to peopleandplace”.between These reinforcing andreciprocal relationship they recognise there“that isamutually consider thisrole ofspacesignificant, because epidemiology, sociologyandgeography health andinequalities”. in Experts quality, inorder to therelative determine ofadverse air with adocumented history “were withresidents conducted ofanarea Hamilton, Ontario, Canada. The analyses in neighbourhood industrial in aurban environmental (re)action andcommunity risk explored (perceived) thelinksbetween aprevious paperotherresearchersIn ofindividuals”.activities as expressed bythespatialandtemporal an approach to operationalizingcontext also introduce theconceptofhealthscape “as modelsofhealth”. into contextual agency They to integrateecology asopportunities human oftimegeographycontributions andspatial health research, andinvoke thetheoretical in perspectives conventional place-based 3

“the needto move“the beyond ) influence of For thispurpose, we evaluate: Rome andtheoblastofMoscow. different areas of Europe, i.e. theprovince of ofthediseasesintwo time inthedistribution is to establish therole bothofspaceand socioeconomic conditions, agglomerations indifferent natural and Medical andgeographical analysisofurban approaches for project ourinternational The above paperspresent someinteresting al., 2001,p. 163]. environmental issue”particular et [Wakefield around civicaction this in decidingto take (sense ofbelonging inaneighbourhood) and socialtrust)       pp. 315–318];here we have usedGISto different scales [Palagiano, Pesaresi, 2011, showed theaddedvalueofanalysis at applicationsand discussed many practical GIS inourresearches on medical geography, already explored ofintroducing thepossibility Recently, inourbook of municipalitiesintheprovince ofRome. diseases inrelation to particulars selected maps, ofsome whichshowthedistribution in order to draw upandanalysevarious we have employed ArcGIS 9.2software As farasregards methodsandtools used,  Geografia medica equalitàdellavita,

the relationship people, between health the importance oftimegeography and the importance and space; the effective “contextually sensitive” policy spatial ecology; the contextual modelsofhealth; the contextual intervention; healthintheindustrialized areas; health ingreen areas closeto andincities the influenceofimmigration onhealth. and towns; social capital Lasalutenelmondo. whosemaingoal (networks, norms, (networks, place attachment

we have have we and 2007regarding themaincausesof which have beenrecorded 1981 between 510], inthispaperwe evaluate thechanges the techniques ofplanning[Morelli, 1983,p. facilities, besidesacontinual reflectionon development ofadequate socio-sanitary of encouraging asimilarprocess, andthe onalarge factors scale.risk With theaim the maincausesofdeathandrelated acquisition ofthisinformation isknowing p. componentsinthe 14].Oneofthekey ofHealth,2010, Ministry oflifequality [Italian the features oftheirenvironment andoftheir competences inorder to changeandimprove administrations to acquire information and which allowspeople, communitiesandlocal “Empowerment” isaprocess ofsocialactivity of Moscow. Europe, theprovince ofRomeandtheoblast differenthealth situationintwo areas of oftherelationshipsimilarities the between tothese projects showthedifferences and in Romeand Toronto. We intend to refer to amongFilipinosocial networks immigrants analysed thedemographic structuresand andDarden in2004,Cristaldi Likewise, UK. Lombardy andLancashire, inthe inItaly regions, industrial two between comparison madea (in collaborationwithMounfield) out.Forcarried example, in1963,Ortolani of comparative studyhasalready been kind thegeographic literature,In however, this analysis. provide inputfor and communalreflections 2007], for thesameproject. State University, etal., Russia[Malkhazova Faculty ofGeography, Lomonosov Moscow producedMoscow bycolleaguesofthe comparable withthoseoftheoblast of Rome[Pesaresi, inpress] willbe Marta, and theproblems shownfor theprovince ofGIS,themaps thanks to the characteristics layers. For ofourprojectand thepurposes can produce anumberofsuperimposed progressively updated and upgraded and organise awidedatabasewhichcanbe OF THE RESEARCH OF THE THE MAIN PHASES AND AIMS

In thisway,In we

25 GEOGRAPHY 26 GEOGRAPHY basis useful for: basis usefulfor: elaborations produced form acognitive Therefore, thedigital cartographic diseases. particular dueto the increase ordecrease inmortality changes whichcouldhave to contributed allows usto evaluate themostimportant pollution sources; thissurgical screening or activities death andproximity to certain the eventual relation causesof between 1980and2001inorderbetween to examine which we analysetheevolution oflanduse focus ofRome, ourattention for onthecity land usebyemployingaspecificlegend, we andshowingtheeffective the municipality atthescaleof defining generalframeworks 2007,p. Denike, 76].Moreover,[Koch, after the researcher’s response to aproblem” process are understood andemployed in which assumptionsembeddedinananalytic encourage “map this way, through we can mapmaking, to investigate factors. thepotential In risk temporal andspatialanalyseshelp mapswhichfacilitate medical-geographical using GISwe practice, createdIn many p. 78]. [Rubinoetal., factors risk to particular involving localcommunitieswhichare exposed analysisandfollow-up studies of making was demonstrated, suchastheimportance dataover time and municipalmortality the relevance ofrecording theprovincial diseases. Ontheotherhand, many years ago andmetabolic causes; endocrine, nutritional otherconsequencesofexternal and certain system; injury, poisoning of therespiratory system; neoplasms; diseases the circulatory diseasesof showing thehighestvaluesfor: are theaxes andthemacro-areas currently of Rome;subsequently, we indicate which death inthemunicipalitiesofprovince  

discovering anomalousornotablediscovering identifying theareas which present the modifications recorded over time; death; highest valuesfor specificcausesof thinking , themethodby 1983, apps/icd/icd10online. sion for 2007 (S00-T98). See http://apps.who.int/classifications/ 10 Problems Health Related and Diseases of tion Classifica- Statistical International the of that from is different causes external of consequences other certain and poisoning 1 in seventh placewe finddiseases ofthe longer found inthefirstten places. Presently findings, notelsewhere classified, are no signs clinical andlaboratory andabnormal are place, always infifth whilesymptoms, andmetabolicdiseases Endocrine, nutritional have position. to passedfrom fourth sixth   other consequences of external causes other consequencesofexternal placeandinjury, poisoningandcertain sixth digestive system have moved to from fourth system, whilediseasesofthe the respiratory third placewe continueto finddiseasesof regular increase [Pesaresi, inpress]. In Marta, and trend ofneoplasmsshowsamarked them,because the in thedistancebetween asignificant reduction 1981, we canobserve thedataof2007withthat comparing was thecasein1981(Fig. 1).Nevertheless, neoplasms were thesecond(11,684),as causeofdeath(13,758deaths)and primary system wereDiseases ofthecirculatory the recorded intheprovince ofRome. data for municipalities– 35,849deathswere ofStatistics(ISTAT)Institute provided the 2007–thelastyear forIn whichtheNational  IN 1981 AND 2007 AND 1981 IN THE MAIN CAUSES OF DEATH We would point out that the ISTAT the that (V01-Y89) out code injury, point for We would

high populationdensity. planning phases, above allinareas with avoiding program the faultsduring hoc qualitative datafrom are-elaboration present ofRome, this deriving inthecity potential dangerous elementswhichare drawing ofthe ananalyticframework strong; very municipalities where thisrelation isnot mining activities,waste, etc.) andthe (industries, factors death andsomerisk there isarelation causesof between inwhichmunicipalities observing of theofficiallandusemaps; th Revision Ver- ad 1

2 system nervous tion of Classifica- Statistical International the of that from is different Diseases and Related Health Problems 10 tions/apps/icd/icd10online. http://apps.who.int/classifica- See (G00-G99). 2007 for Version disorders, to whichhave to beaddedan municipalities, andmental andbehavioural andinnearby immigrants livinginRomecity related to the substantialincrease in and parasiticdiseases, whichcanbealso positions we findrespectively infectious ninthandtenth In and thepuerperium). zero deathsdueto pregnancy, childbirth alsobythemade inthisfield(asconfirmed progressesbecause important have been areperiod nolongerinthe firstten places while conditionsoriginating intheperinatal system continueto beineighthposition, in 1981. The diseasesofthegenitourinary The ISTAT code (G00-H95) for diseases of the nervous system system nervous the of diseases for ISTAT (G00-H95) The code Fig. 1. The mortality due to the different causes of death, in 1981 and 2007, in the . of 1981 province 2007, in the and in death, of causes different the to due 1. mortality The Fig. 2 , whichwere inninthplace Source: data on elaboration ISTAT th Revision  thefollowingaffirm (Fig. 2): to themainsixcausesofdeath,we can due Regarding thepercentage ofmortality day tense conditions. caused bystress, trafficandotherday to systemincrease indiseasesofthenervous

[Pesaresi, inpress]; Marta, convergence 30years withinthenext points anditsuggestsapossible closer in 1981isnowreduced to 5.8percentage which amounted to 17.4percentage points 25.8% to 32.6%).Consequently, thegap by almostseven percentage points(from while therelevance ofneoplasmsincreased percentage points(from 43.2%to 38.4%), system decreased byalmostfive the relevance ofdiseases ofthecirculatory

27 GEOGRAPHY 28 GEOGRAPHY  

the relevance of diseases of the respiratory the relevance ofdiseasestherespiratory century. the dynamicofmaincauses ofdeath percentage points; causesdecreased by0.7external otherconsequencesof and certain percentage pointsandinjury, poisoning and metabolicdiseasesdecreased by1.1 percentage points, endocrine, nutritional digestive system decreased of two point, therelevance ofdiseasesthe system decreased byonepercentage the mostproblematic disease ofthe21 neoplasms whichappearto bebecoming general reduction,withtheexception of in theprovince shows, on percentage, a Fig. 2. The percentage of mortality due to the main six causes of death, in 1981 2007, in and death, of causes six main the to due mortality of percentage The 2. Fig. Source: data on elaboration ISTAT in the province of Rome. st

3 modifications are themostrelevant. andto seeimmediatelycomparisons which for 1981and2007,inorder to facilitate the cause ofdeath,thefive classesare thesame provincial valuesof1981and2007.For each central onehasbeenthoughtto includethe We have always considered five classesand the thematic mapsadoptingastandard scheme. changes. Thus, we have drawn upseveral specific which municipalitieshave recorded the principal 1981 drawn upamapfor thepercentage dataof For thefive maincausesofdeath,we have present municipality of . of municipality present IN 1981 AND 2007 PER PER 2007 AND 1981 IN THE MAIN CAUSES OF DEATH In the maps of 1981 the municipality of Rome includes the 3 andanotherfor 2007,inorder to illustrate MUNICIPALITY difference thepercentage between dataof order toIn showmore theamountof clearly (66.7%). and Equo (80.0%),, SanGregorio daSassola, maximum valuesare recorded inMarano of (65.9%)inthenorth-west. The east oftheprovince (Fig. 5), with suchahighvaluefell to 11,mostly inthe while in2007thenumberofmunicipalities more than55%ofdeathsin26municipalities system provoked the diseasesofcirculatory in 26municipalities. Atthesametime, in 2007 theycausedmore than45%ofdeaths 45% ofdeathsin62municipalitieswhile system caused moreof thecirculatory than system (Figs. in1981thediseases fact, 3–4).In dueto diseasesofthecirculatory of mortality decrease inthepercentageoverall marked map of1981andthat2007showsan thethematic between The comparison Diseases ofthe system circulatory Fig. 3. The percentage of mortality due to diseases of the circulatory system, in 1981, in system, circulatory the of diseases to due mortality of percentage The 3. Fig. in the municipalities of the province of Rome. with theaddition Source: data on elaboration ISTAT 1981 1981 dei Cavalieri (–42.6),Gorgadei Cavalieri (–38.3),Civitella (–49.4), (–46.4),SanPolo (–56.1 percentage points), (–50.0), The maximumdecreases were in: points, and8more than20percentage points). increase 3.1and20percentage (15between and23asubstantial a notappraisablevariation percentage points),14municipalitiesrecorded points, –20and–3.1 and64between the classwithvalueslessthan–20percentage substantial decrease (17municipalitiesare in the following: 81municipalitiesrecorded a 20 percentage points). The mainresults are points), andalarge increase (more than increase 3.1and20percentage (between –3and3percentagebetween points),afair (conventionally a notappraisablevariation –20and–3.1percentage(between points), than –20percentage points),afairreduction have shown:alarge (valuesless reduction another mapto indicate whichmunicipalities 1981 and2007(Fig. 6),we have elaborated

29 GEOGRAPHY 30 GEOGRAPHY palities of the province of Rome. The municipalities with more than 40,000 inhabitants (on the basis basis (on the inhabitants 40,000 than more with municipalities The Rome. of province the of palities Fig. 4. The percentage of mortality due to diseases of the circulatory system, in 2007, in the munici- 2007, in the in system, circulatory the of diseases to due mortality of percentage The 4. Fig. Fig. 5. The municipalities of the province of Rome with the highest percentage of mortality due to to due mortality of percentage highest the with Rome of province the of municipalities 5.The Fig. of the Census data of 2001) are indicated in the map to provide some geographical information. geographical some provide to map the in 2001) of indicated are data Census the of diseases of the circulatory system, in 2007, with the addition of Rome city. Rome of addition the 2007, in with system, circulatory the of diseases Source: data on elaboration ISTAT Source: data on elaboration ISTAT (Figs. 7–8).Particularly, in1981neoplasms dueto neoplasms percentage ofmortality increase inthe shows agenerallyremarkable the thematicmapof1981and thatof2007 between system, thecomparison circulatory thesituationforUnlike diseasesofthe Neoplasms thesame.in itsprovince ispractically evaluated inpercentages and inRomecity system due to diseasesofthecirculatory torespect theprovince. Thus mortality denoting areductionslightlysmallerwith system hasdecreased from 42.5%to 38.3%, dueto diseasesofthecirculatory mortality As for ofRome, thedatashowsthat thecity Affile (32.2),andSant’Angelo Romano(31.8). Gregorio daSassola(39.4),Allumiere (35.1), Equo(55.0percentage in: Marano points),San increases have beenrecordedmost worrying San Paolo (–37.7),Agosta (–32.2).Instead, the Fig. 6. The differences between the data of 1981 and 2007 for the percentage of mortality due to dis- to due mortality of percentage the for 1981 of 2007 and data the between differences The 6. Fig. eases of the circulatory system in the municipalities of the province of Rome (percentage points). (percentage Rome of province the of municipalities the in system circulatory the of eases Source: data on elaboration ISTAT –3.1 percentage points),11 municipalities percentage points, –20and and10 between are intheclasswithvalues lessthan–20 a substantialdecrease (4 municipalities are the following: 14municipalitiesrecorded of 1981and2007(Fig. 10),andthemainresults the differences thepercentage between data system, wecirculatory have created amapof thesameway asforIn thediseasesof Vallinfreda (66.7%). are recorded , byMandela, and aligned alongit. The maximumvalues(Fig. 9) municipalities axis canbetracedwithvarious intheeast,wheredistributed alongitudinal such ahighvaluehadincreased to 11,all in 2007thenumberofmunicipalitieswith 45% ofdeathsonlyin2municipalitieswhile neoplasms were thecauseofmore than municipalities. Contemporarily, in1981 caused more than35%ofdeaths in47 municipalities whilein2007neoplasms caused more than35%ofdeaths in10

31 GEOGRAPHY 32 GEOGRAPHY Fig. 8. The percentage of mortality due to neoplasms, in 2007, in the municipalities of the province of Rome. of province the of municipalities 2007, in the in neoplasms, to due mortality of percentage The 8. Fig. Fig. 7. The percentage of mortality due to neoplasms, in 1981, in the municipalities of the province of Rome. of province the of 1981, in municipalities the in neoplasms, to due mortality of 7.Fig. percentage The Source: data on elaboration ISTAT Source: data on elaboration ISTAT Fig. 10. The differences between the data of 1981 and 2007 for the percentage of mortality due due mortality of percentage the for 1981 of 2007 and data the between differences 10. The Fig. to neoplasms in the municipalities of the province of Rome (percentage points). Fig. 9. The municipalities of the province of Rome with the highest percentage percentage highest the with Rome of province the of municipalities 9. The Fig. of mortality due to neoplasms, in 2007, with the addition of Rome city. Rome of addition the 2007, in with neoplasms, to due mortality of Source: data on elaboration ISTAT Source: data on elaboration ISTAT

33 GEOGRAPHY 34 GEOGRAPHY the percentage of mortality causedbythis the percentage ofmortality just afew lessthanintheprovince andalso neoplasms increased from 26.5%to 32.5%, dueto thecaseofRome city,In themortality “negative” oftheother. onecanseemthe and insomeaspects neoplasms, opposingconditions showtwo system anddiseases ofthecirculatory thedataof1981and 2007,forbetween themapsofdifferences practice, In San Polo (44.4),andAgosta deiCavalieri (40.6). points), Roccagiovine (46.7),Sambuci(45.5), increases were: Vallinfreda (55.6percentage The municipalitieswiththemostrelevant Equo(–25.0). diRoma(–33.3),Marano Cervara and RoccadiCave (–40.0percentage points), the mostappreciable decreases were: percentage points). The municipalitieswith 20 percentage points, and22more than20 a substantialincrease 3.1and (71between recorded and93 anotappraisablevariation Fig. 11. The percentage of mortality due to diseases of the respiratory system, in 1981, in munici- the in system, respiratory the of diseases to due mortality of 11.Fig. percentage The palities of the province of Rome. Source: data on elaboration ISTAT more thanhalf(35)were themunicipalities values lessthan–10percentage points. Afew (–15.8) plusanothersixmunicipalitieswith (–16.4)andSan Vito Romano (–18.2), RoccaCanterano (–16.7), Tiberina Equo(–25.0),(–24.1), Marano Torrita points), (–33.3),(–30.0), especially: Vallepietra (–50.0percentage many ofthemshowed significant diminution, values (atleast–1.1percentage points)and 60municipalitiesrecordedfact, adecrease in decreases. In municipalities withimportant system (Figs.respiratory 11–12)showsseveral data of1981and2007for diseasesofthe A comparative analysisofthepercentage nutritional andmetabolic diseases causes, andendocrine, of external poisoning andcertain other consequences Diseases ofthe respiratory system, injury, and initsprovince. ofRome thesameincity disease isnearly diseases of the respiratory system decreaseddiseases oftherespiratory causedby ofRome, mortality the city In 10.1%and15%). (between high (more than15%)ormedium-high values low valuesbutalsosomemunicipalities with number ofmunicipalitieswithlowormedium- the eastofprovince hasaconsiderable municipalities withmedium-lowvalues, while values. The coastalzone especiallyincludes 5.1% and7.5%) medium-low (between of mainlylow(beloworequalto 5%)and of2007showsasituation The generalpicture 1 percentage points). changes (conventionally –1and between there slight were 23municipalitieswithvery andNemi(12.5).Finally, Roma andPisoniano (16.7), (20.0),Mandela di Cave (50.0percentage points),Cervara values have beenrecorded in:Roccadi percentage points),andthemostsignificant with increases invalues(atleast1.1 Fig. 12. The percentage of mortality due to diseases of the respiratory system, in 2007, in the munici- 2007, in the in system, respiratory the of diseases to due mortality of percentage 12. The Fig. palities of the province of Rome. Source: data on elaboration ISTAT Therefore, withdiseases incomparison (13.3), (12.5)andGorga (11.7). Percile (20.0), Torrita (16.7),Ciciliano Tiberina (–11.1), and, for increases, Filacciano (42.9), (–12.1), (–11.7)and Poli Castel SanPietro Romano(–14.3),Colonna Romano(–18.8), (–15.4), (–20.0percentage points), significant were: variations for decreases, points). The municipalitieswiththemost –1and1percentagelittle change(between percentage points)and39showed very points), 34recorded increases (atleast1.1 decrease invalues(atleast–1.1percentage indicates that45municipalitiesshowed a percentage dataof1981andthat2007 (Figs. the between 13–14),acomparison causes other consequencesofexternal As regards injury, poisoningandcertain province. aligned withthose oftheto bestrictly from 7.3%to 6.3%,andthevaluescontinue

35 GEOGRAPHY 36 GEOGRAPHY Fig. 14. The percentage of mortality due to injury, poisoning and certain other consequences of of consequences other certain and poisoning injury, to due mortality of percentage 14. The Fig. Fig. 13. The percentage of mortality due to injury, poisoning and certain other consequences consequences other certain and poisoning injury, to due mortality of 13. percentage Fig. The of causes, external in 1981, in the municipalities of the province of Rome. external causes,external in 2007, in the municipalities of the province of Rome. Source: data on elaboration ISTAT Source: data on elaboration ISTAT of external causesdecreased fromof external 5.2%to otherconsequences poisoning andcertain dueto injury, ofRome, themortality thecity In (more than10%)ormedium-highvalues. interspersed withmunicipalitieshigh low (beloworequalto 2%)valueswere where aggregations ofmunicipalitieswith oftheprovince,recorded part intheeastern while allthemostdivergent caseswere 6.1%and10%)values,high (between 4.1%and6%)ormedium- medium (between of thecoastalzone showalmost exclusively system. the respiratory The municipalities situation compared to thatofdiseases The mapfor 2007showsamore variegated less remarkable. the amountofthesechangesisgenerally than –10percentage points)issmallerand more than10percentage pointsandless (values municipalities withhighvariations system, the numberof of therespiratory Fig. 15. The percentage of mortality due to endocrine, nutritional and metabolic diseases, in 1981, in in diseases, metabolic and nutritional endocrine, to due mortality of 15. percentage Fig. The the municipalities of the province of Rome. Source: data on elaboration ISTAT (25.0percentage points), (–14.3) andRiofreddo(–13.3);for increases, (–18.4), CamerataNuova(–18.2),Mandela points), (–25.0),Castelnuovo diPorto decreases, Roccagiovine (–40.0percentage cases, wesituation. Asindicate: for particular more orlessistheopposite oftheprevious increase (atleast1.1percentage points),that points) and43municipalitiesshowed an decrease invalues(atleast–1.1percentage the past. Then, 35municipalitiesshowed a continued to record valuescloseto thoseof number ofmunicipalities, thatisto say 40, asimilarhigh fact, causes. In of external otherconsequences poisoning andcertain istheopposite tosome aspects thatofinjury, of 1981and2007showasituationwhichin diseases (Figs. 15–16),thethematicmaps to andmetabolic endocrine, nutritional As due regards thepercentage ofmortality province. 4.4%, incloseparallelwiththevaluesof

37 GEOGRAPHY 38 GEOGRAPHY province. nearto thoseofthe once againvaluesvery decreased from 5.7%to 4.3%,showing andmetabolicdiseases endocrine, nutritional dueto ofRome, themortality thecity In or equalto 2%)values. proximity to municipalitieswithlow(below values were to beseen,alsoinclose 6.1% and10%)orhigh(more than10%) municipalities withmedium-high(between number of in theeast,where acertain while allthedifferent caseswere recorded 2.1%and4%),medium-low values(between 4.1%and6%) only medium(between situation, butthecoastalzone featured The mapfor 2007showsavariegated 10 percentage points. municipalities withvaluesmore than Civitella SanPaolo (13.6)andotherfive Arcinazzo RomanoandFilacciano (14.3), R di Cervara Fig. 16. The percentage of mortality due to endocrine, nutritional and metabolic diseases, diseases, metabolic and nutritional endocrine, to due mortality of percentage 16. The Fig. oma and (20.0), oma andMarano in 2007, in the municipalities of the province of Rome. Source: data on elaboration ISTAT cities. Nowadays citieshousemore thanhalf prerequisites for asustainablelifestyle in Health isoneofthe fundamental importance. would beofprimary 67% oftheinhabitantsitsprovince lived, where, inacity in2007, economic activities location ofpollutionsources ornoxious peculiar features, andthe factors therisk evolution ofthe over time, aknowledge onthelanduseandits and inparticular outascreening ofRome, onthecity carry for numberofinhabitants). Consequently, to area andabove all (bothinsurface the city data asaneffect ofthe “giant” role played by stronglyRome city influencestheprovincial lead usto theconclusionthatdataof ofRomeanditsprovincethe valuesofcity between All inall, thecontinuingsimilarity ROME PROVINCE RISKS IN URBAN AREAS: THE CASE OF HEALTH THREATS AND ENVIRONMENTAL resources, greenhouse gasemissions, lossofnon-renewable loss ofbiodiversity; or water pollutionfrom waste dumping; precipitation andozone plumes); land pollution; ecological damagefrom acid (soil erosion; deforestation; water inversions,thermal resource degradation and mitigation),heatislandeffects and of inadequate attention to prevention natural andhumanaccidentsbecause wastes), physical hazards (traffichazards, (air pollution,water pollution,hazardous biological pathogens, chemicalpollutants and theprovince ofRomeincluding Different ofhazard types affect thecity of peopleinthecity. promote thehealth,safety andwell-being conditionsthat creatingactively certain water, orsocialproblems.isabout It such astraffic, thepollutionofair, soil, only aboutminimizingadverse factors solutions. isnotThe aimofahealthy city problems theyare alsoto expected offer However where citiesposeenvironmental in size andnumber. ten millioninhabitants, willcontinueto grow increases. Megacities, thosewithmore than places,into urban andnaturalpopulation the transformation ofruralsettlements decades, aresult migration, ofruralto urban two growth inthenext worldwide expected roughly 95percent ofthetotal population world, ontheotherhand, willabsorb of thepopulation.Citiesdeveloping already accountfor three-quarters nearly Among industrialized nations,dwellers city 2007]. [WHO, for humanwell-being andtheenvironment is unprecedented, with vastimplications growth, especiallyinthedeveloping world, ways ofliving. The recent rate ofurban environmental pointofview)andhealthy inhabitants (from aneconomic, socialand role inpromoting better conditionsfor their reason why areas urban have animportant in thefuture [UN-Habitat,2006]. This isthe populationwillcontinueto increaseurban populationbuttheamountof of theworld rate andscale. Changesinlanduseaffect are thelanduseatanunprecedented altering organizations.international Humanactivities the focus ofmuchscientificendeavour and use andlandcover changehasbecome change onglobalchange, thestudyofland ofland-use awareness oftheimportance change [Dale, 1997; Turner, 1994]. With the recognition driver ofenvironmental asakey Land useandlandcover changeisgaining of thecity. resourcesRome, oneofthemostimportant citizens andto protect thelandscapeof increase thehealthandlife ofRome quality a concrete priority. to isnecessary This effort other policiesinorder environment to make to includeenvironmental inallthe concerns neededforThe effort Romeinthefuture is life moresmake incity sustainable. resources from populationgrowth and of scaleto reduce pressures onnatural settlement patterns, canoffer economies visionRome,long-term asotherdense transportation. With proper planningand and waste management,increase ofpublic improveconstruction, ofenergy efficiency are: innovationsinbuildingmunicipality Local Agenda 21ofRomeprovince and Rome. The mainissuesaddressed bythe Local Agenda 21. This isalso the caseof throughbest practices theinitiative of areworld environmental experimenting degradation. Many citiesallround the protect theenvironment andprevent its goalsandpoliciestocross-cutting of Romeisthelackeffective and pollution affecting thecity, theproblem from thedifferentApart forms of increased transport. private forms ofairpollutionastheresult ofthe severeair pollution.Romeexperience as inmany areas, othervasturban is One ofthemore urgent issueinRome, chemicals. ozone-depleting stratospheric THE CASE OF ROME PROVINCE ENVIRONMENTAL QUALITY: LAND USE CHANGE AND

39 GEOGRAPHY 40 GEOGRAPHY 17). In addition it is worth notingthatmore additionitisworth 17). In high(Tab. 1,Fig.areas isnotparticularly metropolitan areas theamount ofbuilt-up withother comparison areas 35.17%. In rural areas cover 50.46%andnatural ofRomeprovince while the total surface Today landusecovers 14.37%of artificial health ofinhabitants. area andcanhave agreater effect onthe arehuman activities muchstronger inthis ofRomebecause humanpressurescity and or worse. We focused theattention onthe areconditions ofthecity becomingbetter and 2001to findoutiftheenvironmental 1980 of Romebetween of landuseinthecity As asecondstep we analysedtheevolution analysis. ofRomeasaresultquality oflandcover to evaluate theenvironmentalto try of Romeprovince, whichisour casestudy, areas, we decidedto studythelandcover in promoting humanwell-being inurban elementenvironmental isakey quality andsince healthandcity between Since we wantto analysetherelationship decreased orincreased. whether theenvironmental has quality land cover changecanhelpininvestigating areas ofurban whiletheanalysisof quality a usefultool to studytheenvironmental The analysisoflandusecan,indeed, be built-up areas. conversion ofruralandnaturalareas into areas allover andtheprogressive theworld onthesprawl affectingconcern urban there isagrowing particular In activities. environmenttime between andhuman directed inspaceand bytheinteraction conversion oflanduseandcover are [Meyer, Turner, 1991]. The modificationand and functions,globalclimaticsystems and water quality, ecosystem processes resources throughonsoil theirimpacts consequencesforhave natural important on environment. Changes different implicationsoflandusepractices environmental becauseofthe quality in land coverin land effects ofclimate change. which lessenairpollutionand mitigate the area features ahighpercentage offorests province (Fig. notingthatthe isworth 19). It high level ofenvironmental inRome quality areas, a role inpreserving have animportant natural areas, includedinprotected often On theotherhand, asignificant amountof insomeareas.risks aconcentrationofhealth of planningisoften management. The consequenceofthislack into account inlandplanningand taken are oftheseactivities notsufficiently impacts areas (Fig.extraction 18). The environmental units,as industrial dump sites, mineral with highpressure onhumanhealth,such areain thecity ofRome, hostsites for activities oftheRomeprovince, especially Some parts environment. increase ofhumanpressure onthephysical resulting inmarginal areas, andthe and lossofruralnaturalareas, often increase intrafficflows, thefragmentation built-up areas andcommercial areas, an anunprecedenteddetermining growth of areas have beenaffected sprawl byurban thelastfew During Hills. decadesthese area oftheprovince, thearea oftheAlban area, ofRomeandthesouth-east thecity ofthethe coastalzones, inthewestern part agricultural areas. areasThe mostcritical are iscovered by than halfofthetotal surface Table 1. The main land use types of Rome province Rome of types use land Table 1. main The oa ufc 76.64 5.13 7.74 23.48 Total surface 5.46 Coniferous forest 26.05 forest Deciduous 4.39 Olive trees 4.49 Permanently land irrigated arableland Non irrigated fabric Discontinuous urban fabric Continuous urban adcvrcass% Land cover classes Fig. 18. Sites of activities with high pressure on human health. Fig. 17. Built-up areas of Rome province.

41 GEOGRAPHY 42 GEOGRAPHY ae ois839 5.63 –53 4 14 4 859.26 20.20 5 23 707.44 833.91 56 8543.76 43.19 –16 2457.96 26 –32 680.24 1296.75 19 2964.84 7522.65 2361.33 –14 22 1853.89 100.41 99 Water bodies 251.90 waters Inland 1235.51 2400.71 Hygrophilous forest 3771.46 27 Broad-leaved forest 27 1405.33 1185.99 23 61557.24 119.59 Coniferous forest 3253,.31 200.08 Sclerophyllus vegetation 1386.77 Transitional woodland shrubs 5514.86 Reforestation areas 1178.12 71669.76 12635.97 Sparsely vegetated areas 2658.36 14672.43 10884.70 Complex cultivationpatterns 696.97 Permanently arableland irrigated arableland Non irrigated 9912.28 Cemeteries 11539.66 8865.24 andleisure facilities Sports Green areas fabric Discontinuous urban fabric Continuous urban Road andrailnetworks Table 2. Diff Table 2. aduecasshcas18 etr 01%var. 80-01 2001 hectars 1980 hectars Land useclasses erent land use types in 1980 and 2001 and % variation (80-01) in the city of Rome of city the in (80-01) %variation and 2001 1980 in and types use land erent Fig. 19. High environmental quality areas. quality 19. environmental Fig. High and arelevant coverage ofgreen areas almost onethird ofthewholemunicipality, amount ofprotected areas, representing the otherhand, Romehasasignificant resources consumption(water, energy). On presentscity higherlevels of trafficand European cities(www.urbanaudit.org) the withother comparison gas emissions. In non-renewable resources, greenhouse degradation, lossofbiodiversity, lossof traffic hazards, heatislandeffect, resource and water pollution,hazardous wastes, world. isaffected byair,The city land other metropolitan areas ofthedeveloped similarto ofRomeistoday the city very The situationofenvironmental in quality 1980 and2001 Land cover between changeinRomecity Fig. 20. Land cover in Rome in 1980. surface area (Figs. surface 20–21). arevegetation types alsoincreasing of interms of 77%.However, notingthatsome itisworth landsshowed agrowth same period, artificial decreasedpatterns by32%(Tab. the 2).In and 2001,by14%,whilecomplexcultivation arablelandsdecreased,irrigated 1980 between of agricultural landsinto built-up areas. Non theprogressiveRome isdetermining conversion of inthecity The landusechangeoccurring the maineconomiesofcity. are, activities Building andtourist infact, approval Plan oftheNewMaster (2005). sprawling processes accelerated bythe residential andcommercial areas, both compromised bythedevelopment ofnew istodayenvironmental ofthecity quality (15%) andagricultural lands(50%). The

43 GEOGRAPHY 44 GEOGRAPHY of Romeallowsusto produce detailed spatial the mainfive causesofdeathintheprovince The analysisofquantitative dataregarding healthier ways ofliving. better livingconditionsfor dwellers and city planninginorderland useandcity to offer has to becomethemaingoaloffuture The improvement sustainability ofurban sprawl.of urban areas, inorder to offset thenegative effects and restoration ofnaturalandagricultural to increase aneffort thesafeguardingmake to area.of theurban However itisnecessary rule inimproving theenvironmental quality areas ofRomehasanimportant ofthecity The significant amountofgreen andforest CONCLUSIONS Fig. 21. Land cover in Rome in 2001. are respectively the first and the second causes respectively thefirstand secondcauses are system andneoplasms,circulatory which For thediseasesof whatitconcerns – – – useful for: and temporal frameworks, whichmay be

and their impacts onotherlocal problems.and theirimpacts order to decrease for risks humanhealth future planningofeconomicactivities,in for sickperson; of services of life inhabitantsandthelevel ofthecity environment andto increase thequality social purposes, inorder to improve the search factors; thepossiblerisk andinducetoprovincial characteristics showthelocal and these frameworks purposes, since andgeo-medical sanitary 2 Cummins, S.,Diez-Roux, A.V., S.,Curtis, Macintyre, S.(2007)Understandingandrepresent- 2. F., Cristaldi, Darden, J.T. anddifferences (2004)Similarities indemographic structuresand 1. – maps were elaborated to show: legend oftheofficiallandusemaps. Our derived from are-elaboration step, thenext weIn produced somemaps – – synthetically thefollowing: the percentage dataof1981and2007are regarding theamountofdifference between example theresults bythemaps derived for the dataatscaleofmunicipality; we showed andevolution thedistribution of thematicmaps, medical-geographical various reduction. an important Then, through system andneoplasms recordedcirculatory therelevancebetween ofdiseasesthe from 25.8%to 32.6%. Therefore, thegap of neoplasmsinthesameyears increased 1981, to38.4%,in2007, system decreasedcirculatory from 43.2%,in First ofall, therelevance ofdiseasesthe different very trends. two we observed too,of deathinRomeprovince andinItaly REFERENCES

area of the Alban Hills; area oftheAlbanHills; coastal zones, ofRomeandthe thecity areasmost critical represented bythe the spread ofbuilt-up areas, withthe 93 asubstantialincrease. recorded and anotappraisablevariation a substantialdecrease, 11municipalities for neoplasms, 14municipalitiesrecorded increase; and23asubstantial appraisable variation decrease, 14municipalitiesrecorded anot 81 municipalitiesrecorded asubstantial for system, thediseasesofcirculatory pp. 1825–1838. ing ‘place’ inhealthresearch: Arelational approach, in “Social ScienceandMedicine”, 65(9), Rome, 4,pp.Italiana, 211–225. approach, IGU-HomeofGeography PublicationA life-course Series, SocietàGeografica F. J. Cristaldi, Fortuijn Droogleever (eds.), Gendered Cities:identities, activities, networks. amongFilipinosocial networks immigrant women inRomeand Toronto, inG.Cortesi, while ther ad hoc elevance of the 5–6 andrelating sub-paragraph. wrote paragraphs (paragraph 7);M.Marta andtheConclusionssub-paragraphs C. Pesaresi wrote paragraphs 2–4,relating and wrote (paragraph 1); theIntroduction authors, C.Palagiano coordinated theresearch Even ifthepaperwasdevisedtogether bythe advantageously collaborate. where geography andmedicinemay researches interdisciplinary and to conduct recordedthe variations in thecausesofdeath may provide neuralgic inputsto investigate municipalities andprogressively updated changes above allifanalysedfor several ), andsomevegetation types. These ofthecity,the southwest neartheRiver part Portuense and Via Cristoforo Colombo (in built-up areas, i.e. along theaxe between Via increases are recordedimportant bothin large where scaleinacontext analysis atvery and 2001to provide anexemplification of 1980 between cover changeinRomecity Finally, we focused theattention ontheland have aninfluenceonhumanhealth. ofecosystem theintegrity and or preserve theseare fact, elementswhichcanthreatenIn – – ACKNOWLEDGEMENTS

large part oftheRomeprovince.large part protected a areas), whichcharacterise (above allforest, othernaturalareas and the highenvironmental areas quality pressure onhumanhealth; withhigh the locationofsites ofactivities 

45 GEOGRAPHY 46 GEOGRAPHY 9 NP (n.d.) 19. UNEP UN-HABITAT18. London. (2006)State cities, ofthe world Earthscan, 17. Turner, B.L. (1994)Globallanduse/landcover change:towards anintegrated study, in 16. Rubino, G.F. etal. chepossonoinfluenzare (1983)Analisidialcunifattori ladistribuzione D.,Rainham, D., Mcdowell, I.,Krewski, Sawada, M.(2010)Conceptualizing thehealthscape: 15. Pesaresi, M.(in press) Peculiarità nellaprovincia geografiche C.,Marta, dellecausedimorte 14. Palagiano, C.,Pesaresi,13. C.(2011)Lasalute nelmondo. Geografia medicaequalitàdellavita, M.[incollaborationwithP.R.Ortolani, 12. (1963).Lombardia Mounfield] eLancashire. Saggio di 11. Morelli, P. esviluppoaRoma,inG.Arena sanitaria (1983)Riforma (ed.), AttidelPrimo Se- 10. Meyer, W.B., Turner aglobalperspective, B.L. (1991)Changesinlanduseandcover: 9. oblast, atlasoftheMoscow S.M.etal. (2007)Medical-demographic Malkhazova, ofHealth(2010)Piano Nazionale2011–2013,Bozza 5 provvisoria, Sanitario Ministry Italian 8. ISTAT (2007)Bilanciodemografico epopolazioneresidente, http://demo.istat.it. 7. ISTAT (1981)Censimento generaledellapopolazione, Istituto NazionalediStatistica,Rome. 6. Koch, T., (2007)Aaron’s K. Denike, Solution,Instructor’s Problem: Teaching Analysis Surface 5. Danida Workshop Papers Environment theUrban (2000)Improving andReducingPoverty, 4. Dale, V.H. (1997) The relationship landusechangeandclimate between change, in “Eco- 3. “Ambiology”, 23,pp. 91–95. Geografia RUX,Perugia, Medica, pp. 69–78. inG.Arena (ed.), di geografica inItalia, AttidelPrimo deitumori Internazionale Seminario health research, in “Social ScienceandMedicine”, 70(5),pp. 668–676. oftimegeography,Contributions locationtechnologies andspatialecologyto placeand di Roma. Carocci, Rome. geografia comparata,in industriale digeografia economicaeantropica”,“Memorie Naples. diGeografia RUX,Perugia, Medica, Internazionale minario pp. 505–512. Press, University Cambridge Cambridge. Lomonosov State University, Moscow Moscow. Novembre 2010,http://www.salute.gov.it. Using GIS,in “Journal ofGeography”, 106(2),pp. 69–77. Copenhagen. logical Application”, 7,pp. 753–769. www.unep.org. Environmental Summary, Pollution onPublic Health,Report and Impacts 1 WHO 21. Wakefield, S.E.L.,Elliott,S.J., Cole, D.C., Eyles, J.D. (2001)Environmental and(re)action: risk 20. Settings. and Place”, 7(3),pp. 163–177. air quality, health,andcivicinvolvement neighbourhood, in industrial inanurban “Health (2007) Ourcities, ourhealth,future, Report Cosimo Palagiano Professor isEmeritus atSapienzaUniversity isyoung researcher Marta of Miriam atSapienzaUniversity CristianoPesaresi Studi eRicerche diGeografia”. boardmember oftheeditorial oftheJournal “Semestrale di Union (IGU).HeistheEditor oftheJournal “geografia” andheis Geographicaland Environment Commission oftheInternational GroupWorking onGeography ofHealthandtheninthe Health Geography inthe andfor years hehasworked abouttwenty ofMedical of Rome. Seminary Heorganised 10International GIS andlandscapeanalysis, environmental education. sustainability,concerns landscapeecology, land-usechange, ofRome.proposal Biosphere ofUrban Reserve Teaching activity Italiana” andmemberofthejointresearch group for the boardeditorial oftheJournal “Bollettino dellaSocietàGeografica diGeografia Insegnanti (AIIG). Sheismemberofthe Italiana Rome. Sheisin charge of ofRome.Sapienza University geotecnologie” and “Applicazioni GISperl’analisigeografica” at Studi eRicerche diGeografia”. Teaching concerns activity “GIS e oftheJournal (AIIG). secretary HeistheEditorial “Semestrale di Systems ofRome.University Heisincharge of for the Associazione Italiana Insegnanti diGeografiafor Insegnanti theAssociazione Italiana isresearcher inGeography atSapienza of the Knowledge Network onUrban Network of theKnowledge Environment for theAssociazione Geographical Information

47 ENVIRONMENT