A gathering of the dying

In our corporeal existence, all events occur at a time and place. From a clinical context, time measures are given the priority. Time before presentation of symptom onset, or door-to-needle or -balloon times are key factors influencing outcomes for acute ST segment elevation myocardial infarction. Perhaps our understanding of disease would be buttressed by also considering ‘place’. Geographical location of patients may reveal disease clusters. These data would be useful for everything from health resource allocation – placing cardiac rehabilitation clinics near those locations, for example – to planning the most efficient ambulance route for transfer to a tertiary care centre. This interaction of environment or place with health is known as medical geography. The ecology of human health and disease has also been studied under different banners: geographical pathology, medical topography, geographical epidemiology and geomedicine. The importance of location has been recognized for more than 2000 years: