History and Main Research Currents in Polish Medical Geography

The aim of the study is to present trends in the development of medical geography in Poland. This was done by presenting the main research currents. The basic problem that was encountered is the fuzziness of boundaries between medical geography and disciplines dealing with similar issues. Therefore, it was decided that the bibliography of Polish medical geography would include those publications that meet simultaneously two conditions: (1) those which fall within the scope of this discipline thematically, (2) and those written by scholars with scientific degrees or titles in geography, or working in scientific institutions of a geographic character. The condition was introduced because there are many publications by epidemiologists, representatives of social medicine, demographers, etc. which also meet the requirements of being defined as medical geography

Especially analyses of the health situation or health-care resources in the spatial dimension or emphasising the man-environment relationships in the aspect of health situation of the population.

Considering the limited volume of the study, it was decided to omit the clarification of the specifics of medical geography, its history in the world, and so on. A whole range of publications are dedicated to these issues (May 1952, Pyle 1976; Eyles, Woods 1983; Meade, Emch 2010). Also, due to the limited volume of the article, it was decided to omit: (1) citing all available literature when discussing individual research trends in Polish medical geography and providing only examples, (2) and discussing relationships between Polish medical geography and other scientific disciplines in Poland.

The origins of Polish medical geography, just like world medical geography, are related to circles of doctors and social workers. Also, just as in the world, its origins are linked to a widely understood analysis of the health situation of the population (in this study called disease geography). It is only with much delay that studies concerning health appear (in this study called health geography)

This is a reference to the most common division of medical geography into two sub-disciplines (cf. Grochowski, Kowalczyk 1987, Mayer 1982, Rosenberg 1998).

Most probably, the first definition of medical geography in the Polish language was formulated by Krzywicki in 1887, who focused on its practical importance and linked its creation to colonialism. According to him, its main field of interest includes, on the one hand, the impact of climate, nutrition, and geological structure on the human body, and, on the other hand, resistance of different human races to diseases. He also predicted that in the future its field of interest would extend to social hygiene (Krzywicki 1959).

Research on the influence of the geographical environment on the population’s health was conducted by non-geographers (simplifying, this current of research can be called disease geography). Out of several currents of this research, the one connected with effects of the climate deserves special attention (e.g. Baranowski 1936, Radło 1938), but other studies were also carried out, for example, ones related to the influence of geological composition on health (e.g. Ciechanowski, Urbanik 1898). In contrast, there were hardly any studies falling within the scope of health geography.

In fact, until World War II there was no medical geography in Poland practised by geographers (Fleszar 1956; Jędrzejczyk 1997). In the case of health geography, this period is much longer, encompassing even the 1970s (Ilnicki 2014).

After World War II the share of geographers in this scientific discipline slowly becomes noticeable. The foundations are laid by the geologist Kolago, who published not only works of a theoretical character (1948, 1950), but also methodological (1947a, 1954) and empirical (1947b, 1952) ones. His great merit was also to edit the first collective work in the scope of medical geography in the Polish language (Kolago 1966). Despite this, it can be concluded that Polish medical geography practically did not develop till the mid-1980s (Nowosielska 1982). Jagielski’s opinion (1988) on the subject is significant here. Commenting on the Polish geography of population, he identified three groups of forgotten issues. One of them is the impact of environmental factors on health, morbidity and mortality of the population.

Looking at the monographs of cities written by geographers may be a good illustration of this thesis. Only since the mid-1980s have chapters on the perception of health hazards (e.g. Duś et al. 1992), the health situation (e.g. Zamojska, Dutkowski 1994; Przybylska et al. 2016) or health care (e.g. Rydz 1986; Pacuk et al. 2016) begun to appear. Another confirmation of this thesis can be found in the presence of maps with medical content in atlases. For example, in the publication “Atlas Świata” (“Atlas of the World”) (1964) there are no such maps, while in “Atlas Rzeczypospolitej Polskiej” (“Atlas of the Republic of Poland”) (1993–1997) there are already two such sheets containing several maps and graphs.

Powęska (1993–1997) and Zatoński & Tyczyński (1993–1997), although in the latter case, the authors of the sheet represent medical sciences.

The main research currents in Polish medical geography have been characterised in accordance with the already signalled division into disease geography (dealing with a spread of diseases and the influence of a broadly understood environment on the health of the population) and health geography (dealing with the spatial aspect of the functioning of health care systems). Studies of a theoretical and methodological nature have been distinguished as the third current of research.

The number of publications concerning theoretical and methodological issues is not too large. However, in this framework, we can distinguish studies devoted to a widely understood theory of medical geography (Kolago 1948, 1950; Grochowski, Kowalczyk 1987; Mazurkiewicz, Wróbel 1990; Mazurkiewicz 1993b, 1994; Michalski 1999, 2001b; Łęcka 2004a, 2006; Kretowicz 2013), its application possibilities (Parysek 2002; Kretowicz 2014) or associations with other sciences (Michalski 2012). Looking at the methodological aspect, what is surprising is the lack of publications devoted to the application of behavioural methods in medical geography and conceptual models (Michalski 2011), while studies concerning the application of statistical methods and formalised models are fairly widely represented. Yet, they are much more frequent in the case of health geography (Ogryczak, Malczewski 1987, 1989; Malczewski, Ogryczak 1988; Malczewski 1989b, 1990b; Grochowski 1990a; Kretowicz 2011a; Stępniak 2013; Kisiała 2013, 2016) than disease geography (Parysek 1987, 1991; Michalski 2002).

There are relatively numerous publications in disease geography. With great simplification, they can be divided into those related to the impact of the environment on the health situation of the population and those focused on the diversification of the health situation of the population. In the former case, one can see that the research on the influence of the natural environment (with varying degrees of degradation) on the health of the population is relatively well developed (e.g. Kolago 1952; Zemła 1979, 1983, 1985; Zemła, Kołosza 1981; Biernacki 1995; Szczygielski 1995; Poniży 1997, 2006, 2008; Łęcka 1999, 2000; Pilarska 2014), but the impact of the climate/weather conditions on health takes special place

Bioclimatology also deals with very similar issues (Kozłowska-Szczęsna et al. 2004), but these relationships are not discussed in the present article.

Among the publications counted as health geography, studies on the multi-faceted analysis of the accessibility of health-care facilities dominate. In comparison with other fields of geography, a very small number of studies at a national scale is symptomatic (e.g. Kisiała 2012; Kretowicz, Chabetko 2012); also those with the regional coverage are relatively scarce (e.g. Rydz 1999, 2002; Tarkowski 2002; Kazimierczak, Matykowski 2017). In most cases, there are micro-scale studies on agglomerations or parts thereof (e.g. Grochowski 1988; Kowalczyk, Grochowski 1988a, b; Malczewski 1989a, 1990a, b; Parysek 1995; Powęska 1990; Kisiała 2008; Kaczmarek, Kisiała 2011), and less often on rural areas (e.g. Mackiewicz 1983; Kowalczyk 1987a, b). Of course, these are not all the currents of research, because there are also publications on, for example, the influence of the EU funds on health care (Kisiała 2009) or the role of the local government in widely understood health prophylaxis (Michalski 2009).

In addition to these three main currents of research, there are several smaller ones. Relatively numerous are studies on the borders of sociology. These studies essentially concern the perception of ecological hazards in the context of the perception of one’s own health (e.g. Duś, Magda, 1992; Duś 1993; Magda 1994, 1997). Studies conducted on the border of the geography of the population

This idea has not been discussed in depth as there are many studies devoted to the output of the Polish geography of the population.

Furthermore, looking at the spatial range of publications in the realm of Polish medical geography, in the vast majority they are limited to Poland, much less to Europe. There are very few publications about other parts of the world. Exceptions include studies on Africa (e.g. Łęcka 1999, 2000, 2004b, 2005a, 2011; Powęska 1991; Miastowska 2005; Massam, Malczewski 2016) or globalisation (e.g. Łęcka 2005b, 2007, 2009).

Medical geography in Poland, in comparison to other branches of socio-economic geography (Chojnicki 1996; Dutkowski et al. 1999; Czyż 1996, 2004; Korceli 1996; Maik 1996, 2005; Matykowski 1996; Stryjakiewicz 1996; Czapliński 2007; Ilnicki 2014), is relatively poor. For the vast majority of researchers it is a secondary discipline in their scientific output (which seems to be proved by the fact that they deal with it for only part of their professional activity, most often when writing a Ph.D. dissertation).

Its characteristic features include a very small number of analyses that take into account gender differences (with an exception of, for example, Malczewski 1990c; Stępień 2010, 2014) and little interest in HIV/AIDS at the time when the disease incited great social emotions (with an exception of, for example, Parysek 1988, Michalski et al. 1996).

An illustrative example of its weakness is the lack of atlases fully devoted to geo-medical issues. Aside from the publication by Szczygielski (1994), there are atlases created by representatives of medical sciences (e.g. Zatoński, Becker, 1988; Tukiendrof et al. 1997; Zemła et al. 1999; Wojtyniak et al. 2012).

Looking to the future, one can expect that studies on ageing should play an increasingly important role in Polish medical geography. Although the beginnings of such a research are already noticeable in disease geography (e.g. Grzelak-Kostulska, Hołowiecka 2013; Klima et al. 2014; Janiszewska 2015), they have not been seen yet in the case of health geography.