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Vol. 13, no. 1 1986

Spatial inequalities in mortality experience in Wales

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SPATIAL INEQUALITIES IN MORTALITY
EXPERIENCE IN WALES
G. MELVYN HOWE
G. Melvyn Howe, 1986: Spatial Inequalities in Mortality
Experience in Wales. Cambria 13 (1) pp. 131 to pp. 149.
Part III of Davies, W.K.D. (ed) Human Geography from
Wales: Proceedings of the E.G. Bowen Memorial
Conference. ISSN 0306-9796.
A brief survey of the changing concepts of diseases introduces a
discussion of the post-war changes in the causes of death in Britain.
The very different mortality patterns of diseases within Wales over the
1980-82 period is illustrated by the distribution of deaths from:
coronary heart disease, lung-bronchus cancer, female breast cancer and
'all causes'.
G. Melvyn Howe, Dept. of Geography, University of
'Strathclyde, 26 Richmond St. Glasgow, Scotland. Gl 1XH.
In Britain the medical profession and its organizations such as the Ministry of
Health, the British Medical Association, the British Empire Cancer Campaign, the British
Heart Foundation, etc., normally view the treatment of disease as a 'battle' in which
physicians, aided by scientific technology, hope to 'conquer' disease. Such a view depicts
disease as something beyond ourselves, an entity which attacks us, rather than something
which we might also create and sustain through our way of life. It can be suggested that
this view of disease as an entity (a battle to be won) is too simplistic. Two thousand four
hundred years ago Hippocrates pointed out the need to understand the causes of disease if
we are to control it. Yet only within the last century have we begun to make measurable
progress in this direction. The introduction of the germ theory of disease towards the end
of the nineteenth century shed light on the nature and causation of much of the illness then
prevalent. Since then many living and inanimate agents capable of inducing human disease
have been identified. The reductions in morbidity and mortality that have followed are clear
at least in those areas of the world fortunate enough to possess the resources to apply the
knowledge for the benefit of their population (Howe 1972a).
For many years after the beginning of this era of discovery the guiding medical
philosophy was that each human ailment had its own particular cause in much the same
way that each force has its own equal and opposite reaction. This philosophy was most
vividly expressed in the postulates of Koch a set of 'rules' that must be met or satisfied if
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