Geographical and environmental issues

1. Presenter: Dr. Rudresh S A

2.  Climate
 Topographical
 Demography
 Political
 Legal
 Sources of services
 Manpower
 Access to public services

3.  Extreme weather events impact the operation of health services through the effects on
built, social and institutional infrastructures which support health and health care, and
also because of changes in service demand as extreme weather impacts on human
health.
 Strategic planning for extreme weather and impacts on the care system should be
sensitive to within regional variations.
 Adaptation will require changes to built infrastructure systems, not only by making
individual buildings, such as hospitals, more resilient, but also by action to modify the
whole network of infrastructure supporting the health care system, so research on the
impacts of extreme weather and resilience of utilities, transport and communications
systems needs to be brought to bear in adaptation of health services to climate
change

4.  Bearing capacity of soil, level of underground water table and quality of water
 Riverbed rock- Erosion,, landslides, flooding
 Excessive slope- constructing additional supports for the structure, costly, possibility of
landslides due to heavy or continuous rainfall
 Power line
 Natural rainwater flow corridor
 Air traffic corridor
 Nearby water/forest reservoirs
 Crowded/ densely populated

5.  Age
 Race
 Ethnicity
 Gender
 Income
 Education
 Employment

6.  Politics, for better or worse, plays a critical role in health affairs.
 Regions that spend more on public services, and regions with lower income
inequalities have better self-rated health and lower mortality.
 Favours towards particular ideology/parties- beneficial/detrimental

7.  Regulations Building Permit and Licenses (From the Municipality)
 No objection certificate from the Chief Fire Officer
 License under Bio-Medical Management and Handling Rules, 1998.
 No objection certificate under Pollution Control Act.
 Narcotics and Psychotropic substances Act, 1985
 Drugs & Cosmetics Act, 1940
 Electricity Act, 1998
 Urban Land Act, 1976
 Vehicle Registration Certificates (For all hospital vehicles.)
 Atomic energy regulatory body approvals (For the structural facility of radiology dept, TLD
badges, etc)
 Boilers Act, 1923(If applicable)

8.  Power
 Water
 Communications
 Commercial services, etc.,

9.  Finding right clinicians might be hard in some areas so as other technical staff.
 Hospital must offer physician’s salary guarantees, referral network, administrative
support etc.,
 The existing physician population must be studied as a major source of support ( for
referrals, Locum assistance, etc.)
 Availability of schools for children education is another strong motivating factor. These
may serve s strong staff retaining factors and help in reduce the staff turn over ratio.

10.  Road connectivity
 Public transport
 Cinema halls
 Malls
 Parks
 Others

11.  Geographic heterogeneity:
 It refers to the uneven distribution of various concentrations of each species within an
area
 Public health often examines human behavioral variability across geographic settings
such as geopolitical units, urbanicity and other
 “Everything is related to everything else, but near things are more related than distant
things” (Tobler 1970).

12. Fig:2. Neonatal and under-five mortality rate in Indian districts with reference to
Sustainable Development Goal 3: An analysis of the National Family Health
Survey of India (NFHS), 2015–2016
Fig:1. Spatial heterogeneity of climate explains plant richness distribution at
the regional scale in India
Geographic heterogeneity: Examples

13.  Uneven distributions of population and health-care providers lead to geographic
disparity in accessibility for patients and varying workload for staff in hospitals.
 Uneven distributions of population inequality in utilization of health-care
 Uneven distributions of health-care providers stress level of health-care
professionals and quality of care.
 Example: Three-Step floating Catchment Area (3SFCA) method, a modification of the
simple gravity model.

14.  Defining a scientific geographic unit for health-care market is critical for researchers,
practitioners, and policy makers to evaluate health-care delivery, and geographical
information enables us to define the units e.g. primary care service areas, hospital
service areas, and cancer service areas.
 Aside from various optimization objectives around ‘efficiency’, it is as important to plan
the location and allocation of health-care resources towards maximum equality or
minimum disparity in health-care access. This is an understudied area with important
implications for public health policy and planning