O conjunto de técnicas de Geomática tem sido um poderoso aliado no apoio à tomada de decisões e manipulação de dados espaciais. Nas últimas décadas tornou-se quase indispensável na gestão de recursos humanos e recursos naturais. Na área da Saúde, a Geomática tem viabilizado estudos sobre: análise da distribuição de pacientes; variações na ocorrência de epidemias; monitoramento de vetores; avaliação em tempo real de situações de emergência ou catastróficas, entre outros. A associação da Medicina com a Geografia é antiga. A associação entre a saúde e a espacialização das doenças deve considerar a estruturação física do espaço geográfico a partir da caracterização de cada parte componente do sistema como preconiza a perspectiva sistêmica na Teoria Geral de Sistema, pois a população é parte integrante do espaço geográfico no qual ocorrem determinados agravos à saúde. Nestes pontos recai a relevância da presente pesquisa. O estudo foi desenvolvido na área da Bacia Hidrográfica de Jacarepaguá no município do Rio de Janeiro. Com aproximadamente 295 km2 é composta por 19 bairros e tem uma população aproximada de 682000 habitantes. O estudo pretendeu estruturar uma metodologia para inserção das técnicas de Geomática na prática de análises de dados de saúde, apoiada na Teoria Geral de Sistemas, visando contribuir no processo de vigilância ambiental em saúde permitindo realizar um prognóstico de situações de risco de determinada população. A base cartográfica que apoiou o estudo foi construída através de cartas topográficas da DSG na escala 1:50000. Das cartas foram retiradas informações de planimetria relevantes ao estudo e as informações de altimetria que foram utilizadas na elaboração do modelo digital de terreno (MDT). Com o MDT foi gerado o mapa de declividade por grau que permitiu criar divisões em 5 classes para posterior geração de mapas temáticos com os dados de saúde. Os dados de saúde foram retirados do Sistema de Informações de Notificação de Agravos (SINAN) disponibilizado pelo Ministério da Saúde. A doença analisada foi a leptospirose. Os casos foram localizados pontualmente a partir dos endereços de residência. A hipótese aventada neste estudo era a existência de um alto grau de correlação entre as partes componentes representadas pela estruturação física do espaço e a ocorrência de leptospirose. Com os resultados comprovou-se a hipótese nula, pois somente ocorrem doenças em áreas associadas ao Fundo Chato da Baixada de Jacarepaguá e nos Declives Suaves dos Morros Isolados, também localizados no Subsistema Baixada. Isto demonstra que em termos desta doença existe uma ausência de população nesta componente espacial em áreas de maiores declividades. / The collection of Geomatics techniques has been a powerful allied to support space data decisions and handling. Last decade, it almost became essential to human and natural resources management. For health, Geomatics has made feasible some researches, such as: analyses about patients distribution, epidemics occurrence variation, vector tracking, assessment about emergency or catastrophic situations in real time, among others. The association between Medicine and Geography is old. The association between health and spacialization of diseases may consider the physical structure of geographic space from characterization of each systems component part as the systemic perspective spreads in General System Theory seeing that the population is part of geographic space which occur some health disorders. Therefore, these facts are the importance of this research that was developed in Baixada de Jacarepaguá, Rio de Janeiro. This place has approximately 295 Km2 and it is compounded by 19 neighborhoods which have an estimate of 682000 inhabitants. The research intended to structure a methodology to insert Geomatics techniques into practice of health data analyses, supported by General System Theory, aiming to contribute in the process of environmental monitoring in health which allows a prognosis about situations of risks of certain population. The basic mapping that supported this study was built by topographic charts of DSG on the scale 1:50000. From these charts, planimetry details were taken off and also altimetry information that were used in the development of digital terrain model (DTM). With DTM, the slope mapping by percentage was done and it allowed the creation of compartments in five classes for subsequent generation of thematic maps with health data. The data of this study were found in health information systems released by the Ministry of Health. The analyzed disease was leptospirosis. And its cases were located from addresses of residence. The hypothesis raised here was the existence of high correlation among component parts represented by physical structure of space and the occurrence of leptospirosis. By the results, it was proved the void hypothesis because diseases only happen in areas which are associated with plain area of the coastal bas of Jacarepaguá and the suave hillside of the hillock, both in subsystem coastal bas. It demonstrates that in terms of leptospirosis, an absence of population exists at this space component in areas of major steepness.

As leishmanioses são doenças consideradas antropozoonoses, ou seja, doenças primárias de animais que podem ser transmitidas ao homem. São causadas por microorganismos do gênero Leishmania e transmitidas através da picada de flebotomíneos, que são insetos alados da ordem Diptera (mesmo grupo das moscas, mosquitos e borrachudos). Apresentam-se sob duas formas clínicas: Leishmaniose Visceral ou Calazar (LV) e Leishmaniose Tegumentar Americana (LTA). As leishmanioses apresentam distribuição geográfica vasta pelo Velho e Novo Mundo, sendo estimado dessa maneira que aproximadamente 350 milhões de pessoas estejam sob iminente risco de contrair algum tipo de leishmaniose. No Brasil, as leishmanioses são encontradas em todas as unidades federadas, e o estado do Rio de Janeiro vem apresentando franca expansão dessas doenças em áreas urbanas, devido principalmente ao desmatamento ocasionado pela expansão não planejada da malha urbana. Nesse contexto, faz-se necessário desenvolver estudos sobre o espaço e o processo saúde-doença, relação estabelecida pela Geografia da Saúde, a fim de que se compreenda a correlação entre o homem e o ambiente vivido. / The leishmaniasis are diseases considered as zoonosis, primary diseases of animals which can be transmitted to humans. They are caused by microorganisms of the Leishmania genus and transmitted by the phlebotominaes pitch: these are winged insects from the Diptera group (Psycodidae;Plebotominae;Lutzomyia). They are presented in two clinical forms: Visceral Leishmaniasis or Kala-azar - VL and Cutaneous Leishmaniasis - CL. The leishmaniasis have wide geographic distribution throughout the Old and New World and it has been estimated that about 350 million people are under imminent risk of contagious of some type of leishmaniasis. In Brazil, the leishmaniasis are found in all the federated units, and the state of Rio de Janeiro has been presenting an increasing number of these diseases in urban areas, mainly due to deforestation caused by unplanned expansion of urban zones. In this context, it is necessary to carry out studies on space and the health-disease relationship established by the Health Geography, in order to explain the relationship between man and the environment, to determinate the spatial elements and social determinants that compose this relationship. Therefore, the main objective of this research is to discuss the health-disease process in the ambit of Geographic science in the actuality, looking up to demonstrate the distribution of the leishmaniasis in Rio de Janeiros state on the 2000-2010 period. It was verified at the end of the study that the VL-kind presents a regular standard of distribution in the state and the CL-kind are more likely an irregular default of distribution. Although, for the analyzed period, it has been pointed the presence of the CL-kind in areas like Rio de Janeiros Metropolitan and Costa Verde (Green Coast) Regions, a fact that deserves attention because of the high/expressive tourist vocation and activity of those.

This thesis examines the susceptibility of human health to climate-related stresses in the rural municipality of Addington Highlands, Ontario. Human health is sensitive to climatic variations and change, and public health systems play a role in managing climate-related risks. Canada is generally deemed to have considerable capacity to adapt to vulnerabilities associated with climate change, yet there is variability among communities in their exposure and ability to manage health risks. This thesis examines the health-related vulnerability of the community of Addington Highlands. Drawing upon data gained from key informant interviews and newspaper articles, as well as other secondary data sources, the thesis documents climate-related health risks, outlines the programs and services available to deal with those risks, and assesses the capacity of the community to adapt to future climate conditions and risks. Conditions such as storms, heat stress and forest fires currently present health risks in the area, and they are expected to become more prevalent with climate change. The health risks of Lyme disease, West Nile virus and algal blooms are likely to increase in the future as the climate continues to change. Adaptation to these risks is evident in several of Addington Highlands public health and emergency management programs. The community’s adaptive capacity is strengthened by its social networks and institutional flexibility, but it is constrained by its aging population, limits to the availability and access to health care services, and challenges relating to the retention of service providers. An important strategy to assist adaptation to climate change risks to health is the promotion of public awareness, a strategy to which this research contributes. This thesis research serves to identify and better understand vulnerabilities, and help stimulate actions toward preparing Addington Highlands for possible future climate-related risks.

Cette thèse ambitionne de contribuer à la compréhension de l’accès aux soins des bamakois selon leur statut migratoire. En effet, malgré la part importante de la population de Bamako d’origine migrante, nous avons très peu de connaissances sur leur accès aux soins. A partir des données récoltées sur le terrain et auprès des institutions maliennes et en nous basant sur des outils et des méthodes géographiques et géomatiques, nous avons pu analyser l’accès aux soins des bamakois selon leur statut migratoire.S’il est incontestable que les services de santé et en particulier ceux de base sont abondants et bien répartis à Bamako, il faut noter qu’ils souffrent de plusieurs problèmes comme la question de disponibilité permanente de personnel qualifié, la qualité des services et les dysfonctionnements entre structures de santé. Malgré l’abondance de l’offre de soins à Bamako, le taux de recours y reste trop faible. Cela confirme encore que l’accès aux soins ne se limite pas à la disponibilité physique des structures de santé. Le renoncement aux soins s’explique par une imbrication de facteurs même si la perception de la gravité de la maladie, la position dans le ménage et la profession apparaissent plus. Si l’étude n’a pas relevé de différences notoires dans l’accès aux soins selon le statut migratoire des populations, elle a tout de même montré que les stratégies de recours et l’état de santé évoluent avec la durée de résidence à Bamako / This thesis aims to contribute to the understanding of Bamako people’s access to healthcare according to their migratory status. Indeed, despite the large share of Bamako’s populations of migrant origin, we have little knowledge of their access to health services. With geographic and geomatic tools and methods, we were able to study access to health services for native and migrant populations of Bamako. While it is undeniable that health services and especially basic services are abundant and well distributed in Bamako, it should be noted that this offer suffers from several problems such as the permanent availability of qualified personnel, the quality of services offered and the dysfunctions between health structures. Despite the abundance of healthcare in Bamako, the recourse rate remains too low. This shows that access to care is not limited to the physical availability of health facilities. The renunciation of care is explained by an interweaving of factors even if the perception of the severity of the disease, the position in the household and the profession appear more. If the study did not find notorious differences in the access to the care according to the migratory status of the population, it nevertheless showed that recourse strategies and health status change with length of residence in Bamako

This thesis examines the role of primary health care delivery in rural India but specifically focuses on aspects from Karnataka state. It broadly reflects on the differences that exist between urban and rural populations' access to healthcare. The concept of primary health care appears to have lost its lustre at present, it was once enthusiastically promoted in the late 1970s and 1980s but as chronic problems appeared to affect the smooth delivery of healthcare and nowadays major global bodies like the WHO and IMF have relegated primary health concept to a lower level. However in countries like India, which adopted this concept although its implementation has been riddled with complex ongoing problems, there are not sufficient grounds to abandon it completely. These problems are mainly due to the slow implementation, which has left a vast rural population with little or no access to healthcare. Primary health care strongly promotes equity of access hence is vital in many developing nations. Recruiting highly skilled personnel to work in rural health centres has been an ongoing problem, which hinders the effective delivery of healthcare. A policy followed by Karnataka state tries to rectify this problem by offering postgraduate positions to junior doctors who are willing to work in rural areas. The efficacy of this policy is closely examined from two perspectives. Those who consume healthcare in rural areas are given an opportunity to voice their concerns and also the doctors who work there represent the views of the providers of healthcare. This study was conducted in Bidar district, which lies in the north of Karnataka. Bidar is identified comparatively as a less developed district that has many problems associated with poverty and poor health status. In the process of conducting research a variety of interesting aspects have been highlighted. My hope is that relevant authorities identify with the problems and take measures that could benefit many people's lives. Interestingly it transpires from the views expressed by the rural population that they have a good grasp of what they think they will need to access a better form of healthcare from the existing system. However it appears that there is almost a universal fatalistic acceptance of them being helpless and voiceless about making any to change by their suggestions nor did most of them have a hope of influencing future prospects. The studies also indicated that where there is a better level of provision there the people tend to access healthcare from authentic sources as opposed to unregistered and unqualified personnel. The doctors suggested that the policy is very useful provide certain intrinsic changes are made. On the one hand they did accept that their cost benefit and academic value of this policy is great. On the other hand they suggested the hurdles put in the course of achieving the postgraduate position are arduous and often vague sets of guidelines are imposed, making it very hard to make a straightforward transition from working in rural areas to getting a postgraduate position of choice. The doctors working on temporary contracts appeared to suffer genuine discrimination especially due to number of years they spent trying to get permanent position, years which were not counted towards their ambition of further education. Where it appears there is very little difference in the roles and responsibility between permanent and temporary contract doctors the question of why it does not occur to the authorities to redress this issue is discussed.

A constatação de que muitos cemitérios, a maioria públicos, apresentam problemas e impactam o meio ambiente, poluindo o solo e as águas subterrâneas com contaminantes diversos, tem levado ao aumento dos estudos sobre essas potenciais fontes de poluição. No entanto, apesar de existirem metodologias para a constatação de contaminação do solo e das águas subterrâneas, não existem metodologias específicas, ou mesmo consagradas, para os processos de investigação e estabelecimento da área efetivamente contaminada, fazendo com que muitos sejam os critérios adotados para a investigação e diversificadas sejam as conclusões obtidas. Ainda, em relação à espacialização das plumas de contaminantes, raros são os resultados conclusivos, levando inclusive à preocupação sobre o comportamento dos vários contaminantes já conhecidos no solo, seu caminho até as águas subterrâneas e a real extensão dos impactos, em área e em efeitos deletérios à saúde pública. Este estudo visa demonstrar que a expansão da pluma de contaminantes, e sua área de abrangência, é agravada pela influência de fatores ambientais, físico-geográficos, a partir das características pedológicas, geomorfológicas e climáticas, associadas, dos locais onde estão (ou serão) implantados os cemitérios. Através de levantamento bibliográfico e de pesquisas empíricas foram correlacionadas determinadas características de relevo, clima e solo, presentes nos locais dos cemitérios, elaborando-se cenários de espacialização das plumas de contaminantes e sua possível escala de contaminação e de riscos socioambientais. Três áreas modelo foram selecionadas pelas suas características físico-geográficas diferenciadas e por trabalhos anteriores que definiram seus potencias de contaminação e algumas características físicas (geologia, hidrogeologia e outras): O cemitério de Vila Nova Cachoeirinha (PACHECO, 1991 e MATOS, 2001) e o cemitério de Vila Formosa (PACHECO, 1991), no município de São Paulo, e o cemitério de Areia Branca (PACHECO, 1991), no município de Santos. Concluímos que há influência dos fatores ambientais, físico-geográficos, principalmente do solo e da pluviosidade, na espacialização das plumas de contaminação oriundas dos cemitérios. / The finding that many cemeteries, mostly public, present problems and impact the environment, polluting the soil and groundwater with various contaminants, has led to an increase in studies on these potential sources of pollution. However, although there are methods for the realization of soil and groundwater contamination, there are no specific methodologies, or even dedicated to the research process and establishment of effectively contaminated area, causing many criterias to be the adopted for the research and diversifieds reached conclusions. Still, in relation to the spatial distribution of the plumes of contaminants, there are very few conclusive results, leading even to the concern about the behavior of various contaminants known on the ground, their way to the groundwater and the actual extent of impacts in the area and harmful effects to public health. This study aims to demonstrate that the expansion of the contaminant plume, and its coverage area is exacerbated by the influence of environmental, physical and geographical factors, from soil, geomorphological and climatic characteristics associated, on the places where cemeteries are (or will be) deployed. Through literature and empirical research were correlated certain prominent land relief, climate and soil characteristics, present in local cemeteries, creating spatial scenarios of contaminants plumes and their possible contamination scale and environmental risks. Three model areas were selected for their different physical-geographical characteristics and previous works that defined their potential contamination and some physical characteristics (geology, hydrogeology and others): The Vila Nova Cachoeirinha cemetery (PACHECO, 1991 and MATOS, 2001) and Vila Formosa cemetery (PACHECO, 1991), in São Paulo, and the cemetery of Areia Branca (PACHECO, 1991), in the city of Santos. We conclude that there is influence of environmental factors, physical geography, especially soil and rainfall, in the spatial distribution of contamination plumes coming from the cemeteries.

Introdução. O uso de tecnologias computacionais em pesquisas na área de saúde pública é cada vez mais acentuado devido às facilidades providas ao pesquisador. Em particular, o SIG (Sistema de informação geográfica) auxilia na fusão de dados dispostos em tabelas e mapas contendo aspectos geográficos do local de estudo, através da sobreposição de camadas. Tal fusão possibilita uma nova leitura dos dados associados à dimensão do espaço. Neste aspecto, os programas SIG são ferramentas ideais para estudos de geografia da saúde. Em estudos ecológicos de causa/efeito envolvendo variáveis ambientais e os efeitos deletérios à saúde humana, as tecnologias de geoprocessamento constituem um interessante recurso para gerar hipóteses para estudos mais aprofundados sobre o tema. Objetivo. Este estudo objetivou a construção de um SIG que agregou elementos para verificar a correlação entre os produtos da queima de palha de cana-de-açúcar (Saccharum sp) e a incidência de problemas respiratórios em regiões de entorno afetadas por tais produtos, através das técnicas de análise espacial possíveis com recursos computacionais de geoprocessamento. Metodologia. O desenvolvimento deste trabalho consistiu em coletar e organizar dados de queimadas e internações por afecções respiratórias no período de 2000 a 2004, seguindo da estruturação de um SIG em duas abordagens. Na primeira, considerou-se a abrangência do estado de São Paulo. Foram criadas cartas temáticas das variáveis e identificadas áreas de interesse para estudos em escala local. A segunda abordagem consistiu na construção de um SIG abrangendo a meso-região de Bauru, utilizando a técnica buffer para observar a intersecção dos agravos de saúde em áreas de queimada. Resultados. Foram elaboradas cartas temáticas e uma análise das correlações espaciais encontradas nas duas abordagens e observou-se maior incidência de doenças respiratórias em regiões onde há ocorrência da prática de queimadas em culturas canavieiras. Assim sendo, o material produzido constitui um conjunto de dados que permite ao pesquisador checar hipóteses para subsidiar posteriores estudos no âmbito da saúde ambiental. / Introduction. The use of computational technologies in researches on public health field is more and more present due to easier tolls available to researchers. In particular, GIS (Geographic Information System) helps to merge tables and maps which contain geographic aspects of the site being studied by overlapping layers. Such merging makes a new understanding of the data linked to the dimension of space possible. Concerning GIS, it is an ideal tool for studying the health geography. Ecological researches analyze causes and effects involving environmental variables and the deleterious effect to human health. Geoprocess technologies are an interesting resource to generate hypotheses for future deeper studies on the subject. Objective. This study aimed at the construction of a GIS that added elements to verify the correlation between the products of the sugar-cane straw burning (Saccharum sp) and the incidence of respiratory problems in the neighborhood and near regions affected by such products by using special techniques analysis with computational resources of geoprocess. Methodology. The development of this work consisted of the collection and organization of data on such burnings and the incidence of respiratory diseases officially registered from 2000 to 2004 in the studied regions. After that, GIS structure was accomplished on two approaches. Firstly it covered the State of São Paulo. Thematic maps based on the variables have been created and, thus areas of interest, in local scale, have been identified. The second approach consisted of the construction of a GIS which covered the meso-region of Bauru by using buffer technique to observe the intersection of the harmful effects on health in such regions. Results. Thematic maps have been elaborated as well as the analysis of space correlations found in both approaches. As a result, higher incidence of respiratory diseases in regions where such fires had occurred has been observed. Thus, the resulting data will enable any hypothetical researcher to check hypotheses in order to assist his or her further studies in the scope of the environmental health.

Au cours des vingt dernières années, la santé de la reproduction s’est imposée comme une priorité d’action pour le développement des pays du Sud. Au Sénégal, et dans le département de Saint-Louis, d’indiscutables progrès ont été réalisés mais certaines statistiques restent accablantes et les inégalités de santé, loin de se réduire, demeurent et se creusent. Lorsque ces disparités sont appréhendées au prisme du territoire, des configurations particulières se dessinent et font apparaître des fractures spatiales qui dépassent l’opposition classique entre la ville et la campagne. Désormais, certains quartiers et villages partagent de mêmes préoccupations sanitaires, tandis que des localités rurales acquièrent progressivement des équipements et des comportements que l’on réservait autrefois en ville. Comprendre et mesurer les inégalités territoriales de santé de la reproduction pour pouvoir travailler à leur réduction, tel est le sens de cette étude. / For the past twenty years, reproductive health has been a top priority for the developing countries. In Senegal and in The Saint-Louis department, undeniable progress has been achieved but some statistics remain bleak and health inequalities, far from decreasing tend to grow. When we look closer at these disparities over the studied region, one can observe particular configurations with layouts highlighting spatial splits which go beyond the known urban/rural divide. From now on urban areas and villages share the same sanitary concerns, while rural communities gradually acquire equipment and new habits previously reserved for towns. To understand and estimate the territorial reproductive health inequalities in order to get them to decrease, such is the goal of this study.

Introdução. O uso de tecnologias computacionais em pesquisas na área de saúde pública é cada vez mais acentuado devido às facilidades providas ao pesquisador. Em particular, o SIG (Sistema de informação geográfica) auxilia na fusão de dados dispostos em tabelas e mapas contendo aspectos geográficos do local de estudo, através da sobreposição de camadas. Tal fusão possibilita uma nova leitura dos dados associados à dimensão do espaço. Neste aspecto, os programas SIG são ferramentas ideais para estudos de geografia da saúde. Em estudos ecológicos de causa/efeito envolvendo variáveis ambientais e os efeitos deletérios à saúde humana, as tecnologias de geoprocessamento constituem um interessante recurso para gerar hipóteses para estudos mais aprofundados sobre o tema. Objetivo. Este estudo objetivou a construção de um SIG que agregou elementos para verificar a correlação entre os produtos da queima de palha de cana-de-açúcar (Saccharum sp) e a incidência de problemas respiratórios em regiões de entorno afetadas por tais produtos, através das técnicas de análise espacial possíveis com recursos computacionais de geoprocessamento. Metodologia. O desenvolvimento deste trabalho consistiu em coletar e organizar dados de queimadas e internações por afecções respiratórias no período de 2000 a 2004, seguindo da estruturação de um SIG em duas abordagens. Na primeira, considerou-se a abrangência do estado de São Paulo. Foram criadas cartas temáticas das variáveis e identificadas áreas de interesse para estudos em escala local. A segunda abordagem consistiu na construção de um SIG abrangendo a meso-região de Bauru, utilizando a técnica buffer para observar a intersecção dos agravos de saúde em áreas de queimada. Resultados. Foram elaboradas cartas temáticas e uma análise das correlações espaciais encontradas nas duas abordagens e observou-se maior incidência de doenças respiratórias em regiões onde há ocorrência da prática de queimadas em culturas canavieiras. Assim sendo, o material produzido constitui um conjunto de dados que permite ao pesquisador checar hipóteses para subsidiar posteriores estudos no âmbito da saúde ambiental. / Introduction. The use of computational technologies in researches on public health field is more and more present due to easier tolls available to researchers. In particular, GIS (Geographic Information System) helps to merge tables and maps which contain geographic aspects of the site being studied by overlapping layers. Such merging makes a new understanding of the data linked to the dimension of space possible. Concerning GIS, it is an ideal tool for studying the health geography. Ecological researches analyze causes and effects involving environmental variables and the deleterious effect to human health. Geoprocess technologies are an interesting resource to generate hypotheses for future deeper studies on the subject. Objective. This study aimed at the construction of a GIS that added elements to verify the correlation between the products of the sugar-cane straw burning (Saccharum sp) and the incidence of respiratory problems in the neighborhood and near regions affected by such products by using special techniques analysis with computational resources of geoprocess. Methodology. The development of this work consisted of the collection and organization of data on such burnings and the incidence of respiratory diseases officially registered from 2000 to 2004 in the studied regions. After that, GIS structure was accomplished on two approaches. Firstly it covered the State of São Paulo. Thematic maps based on the variables have been created and, thus areas of interest, in local scale, have been identified. The second approach consisted of the construction of a GIS which covered the meso-region of Bauru by using buffer technique to observe the intersection of the harmful effects on health in such regions. Results. Thematic maps have been elaborated as well as the analysis of space correlations found in both approaches. As a result, higher incidence of respiratory diseases in regions where such fires had occurred has been observed. Thus, the resulting data will enable any hypothetical researcher to check hypotheses in order to assist his or her further studies in the scope of the environmental health.

<p>The purpose with this essay is to explore the social changes in relation to changes in mortality for the two largest ethnic groups in Estonia; ethnic Estonians and the Russian minority. Since this is a geographical essay, my purpose is also to explore these changes in relation to the country’s internal geography. As these changes appear over time in space, the content is partly rooted in a time geographical point of view. It is also rooted in a regional geographical point of view, since I have been comparing the mentioned changes between different areas in Estonia (with considerations on developments abroad).</p><p>Two different development lines can be seen as a consequence of the social changes taking place in the 1990s. While the ethnic Estonians situation has improved, the Russian minority’s situation has instead declined regarding to social existence and health. As a result the mortality has increased enormously for the Russian minority. The ethnic Estonians had also a mortality increase in practically all studied causes of death in all studied areas, but this increase wasn’t as high as for the Russian minority. Nevertheless, when comparing two different counties with each other as well as with the country as whole, the pattern seems to be more complicated. The Russians living in the western county of Läänemaa, have been affected more favourably by the social change than those living in the north-eastern county of Ida-Virumaa. Except for mortality by alcohol poisoning, the Russians living in Läänemaa had a much lower mortality increase than those living in Ida-Viruma and even compared with the country as whole.</p><p>It seems as those Russians living in the western parts of Estonia have been affected more favourably than those living in the north-eastern parts. These structures are very much depending on the history, since most of the Russians living in the north-eastern area immigrated during the Soviet era, while the western parts had a much earlier immigration of Russians. Considering the time and place of the Russian immigration, one can divide the Russian minority in two groups; those in the west, and those in the east.</p>