Contenu du sommaire

Geography of the epidemiological transition. The three stages of the Omran's epidemiological transition concept (E.T.) are presented, with examples and case studies in developing countries. But it seems appropriate to propose a fourth stage because of the recent decline of chronic diseases mortality related to changes in behaviours and life styles in developed countries during the last decades. Important social and spatial inequalities in various scales (regional, urban, inner city) express the relationship between the E.T. and the expectancy of life with large gradients according to social and regional specific life styles.

The improvement in quality of life, the migration of a large part of active population from country and agriculture to towns and tertiary occupations, especially public services, the increase of medical assistance, ensure a general improvement of public health, a lowering of death rate, particularly of infant death rate and a longer life expectancy. The principal necessity is now information by education and in the media, especially for the struggle against excessive consumption of alcohol. But, at length, the growth of expectation of life introduces other problems of health, similar to those of developed countries, and especially of metropolitan France.

The wind is an essential element of the mediterranean climate. Every weather pattern (regional northerly or southerly winds, local breezes) has a specific impact on the various physiological and mental processes both in healthy man and diseased subjects. In this respect the most important environmental factors are air temperature, humidity, air velocity, electrostatic field and air ionization. However, not only do all these factors affect the body simultaneously, but the effect of any of them depends on the level of the others.

A question is posed : how can harmonization result between the distribution of Health services and the regional structure of the geographical space ? A second question is how can we arrive to avoid competition between the interests of private and public sector ? These problems are studied in Europe and in America and more specifically in the cases of England and the United States. If England has kept a marked segregation by a strong control through government agencies, in the U.S.A., we can recognize what can be considered as a "vertical integration of the medical-industrial-financial-complex". However the necessity imposes certain norms for public services and utilities as well as certain dimensions for the organization of the geographical units responsible for the health services. But, the spatial projection of medical and hospital needs does not correspond with the administrative divisions.