János Györffy, László Zentai
Department of Cartography, Eötvös University, Budapest

Presented on CAMP '94 Conference , September 13-15, 1994., Budapest, 90-94. o.


The European Community Atlas of "Avoidable Death" first time was published in 1988. It described mortality from 17 conditions in 10 countries in 1974-1978. The second edition describes "avoidable mortality" in the European Community (EC) in 1980-1984 and changes in "avoidable mortality" between 1974-1978 and 1980-1984 in two volumes. In the second edition, the 10 countries who originally collaborated on the project have been joined by Spain and Portugal. The statistics were collected and homogenized by an European Community Working Group and the two volumes were published by Oxford University Press in 1991-1992.

The EC atlas: aims and realization

Because of a growing interest in evaluating and monitoring the performance of health services Much effort has centered on rationalizing the enormous volume of data collected to produce a manageable series of measures of process and efficiency. The atlas represents an important step towards establishing outcome indicators to monitor health service performance, that are applicable nationally and internationally.
There are now numerous atlases which provide detailed ecological analyses of the geographical variation in the incidence of diseases both within individual countries and within regions of the world. This atlas of "avoidable death" is unique in that attempts to look systematically at the use of mortality data as a means of asking questions about the adequacy of health services provision.

The aim of the project were:

The atlas contains the maps (and of course all of the data in tables too) of standardized mortality ratios (SMRs), standardized to the average age-specific mortality rates both the EC as a whole and the individual country.

Two kind of map series were produced:

The base of graphical representation were the country maps with administrative boundaries and from all of these types of 12 country maps it was produced an EC map with the same administrative boundaries. The thematic maps were made by the INFOMAP mapping package (Claymore Ltd., 1988).
Two sets of maps produced in this way were designed to show up different aspects of mortality variations. Six shading intervals or colors (on region maps) were used for all maps. Histograms showing the distribution of SMRs are shown on each map.

Problems of data collecting in Eastern Europe (EE) atlas

Similar to EC atlas the main problem caused by the variability (and specially in EE atlas) the unmaturity of statistical data collecting. To compile an atlas of this kind is a major achievement in itself. The data presented are available in some form within each country. But to generate meaningful data in a standard and comparable form required major re-analyses in unique ways. This would only be possible through the co-operation and commitments of a number of researchers familiar with the data collection systems of their country. But because of the political and economical changes the problem of data collection became the main difficulties of finishing the atlas, especially in the countries of former Soviet Union and Yugoslavia.

The Eastern Europe Atlas of "Avoidable Death" is made on behalf of World Health Organization by the Központi Statisztikai Hivatal (KSH). To produce high quality maps for the atlas the Department of Cartography, Eötvös University were asked.
The enormous work of data collection is made by KSH. The data of each countries will show the situation of the end of late 80's, possibly 1990. Originally all of the former socialist countries were planned to include in the atlas, but because of the hopeless data collection some former Soviet Republic were discarded at the beginning (Georgia, Azerbaidian, Armenia, Moldova). For the moment the following countries probably will be included: Russia, Ukraine, Belarus, Hungary, Romania, Poland, Bulgaria, Slovakia, Czechia, Estonia, Latvia, Lithuania, Slovenia, Yugoslavia. Due to two different reasons Croatia, Bosnia (no response for data collection) and East Germany (unsuitable data structure) also will be excluded.
Knowing about this atlas two other countries (Austria, Finland) would be included but at the moments the right data of these countries hasn't arrived.

Problems of mapmaking

The atlas is planned after the EC Atlas so the structure of EE Atlas and the graphical representation will be similar. But the process of mapmaking and especially the look of maps will be different. We would like to produce only color maps and all of the maps will be professional looking maps, not like the EC Atlas maps (plotted maps with rough boundary lines). The process of mapmaking is planned at our department and the following problems were occurred:

1. It is essential to make the basemaps. It was not easy to get maps with administrative boundaries of each country, especially brand new countries (Estonia, Lietuva, etc.). Digitizing these basemaps we call the editors (Hungarian Central Statistical Office - KSH) attention to look at the difference of the extents of administrative units. The difference between the average extent of administrative units can be nearly hundredfold (very small e.g. in Lietuva, Slovenia, very big in Russia). It may cause problems only the maps of the whole region showing the thematic information: very small areas are nearly invisible and unidentifiable. The evident problems was because of the split of Czechoslovakia. Both new countries have two different levels of administrative boundaries, but the data were given based on different levels of Czechia and Slovakia which makes the data nearly incomparable.
The other problem was Russia. The data is given to the whole country (not only the European part). But the extent of some administrative units at the Asian part are larger than e.g. Ukraine. It was also the problem of region maps only so we decide not to describe the Asian part of Russia on the region maps.
In some cases it was not easy to get the right geographic information about administrative units especially looking at new countries.
Because of especially Russia we have to take the problems of different geographical projections into consideration. Examining and solving all of these problems the basemaps were digitized in AutoCAD.

2. Some of the countries of this region are quite new so most of them are nearly unknown. We suggested to the editor to include one topographic map of each countries before the thematic maps to show the extent of the country and some important details (major cities and rivers). The atlas will be published in English language so we have to choose about which form of geographical names will we use: English or national names. Of course not all of the geographic features has its own English name, but some of them has. We plan to use English names only for writing the names of administrative units (its necessary for a clear identification for users), but on the topographic maps we will use national names.
But using national names in this region can cause other problems:

3. The main problem of mapmaking was to choose the appropriate software. It was unambigous that we have to use that kind of software which is allow the user to link geographical and statistical data. GIS softwares are developed for solving these kind of problems and the wide variety (differerence in knowledge and in price) is avaliable on the market.
The other requarement is necessary for making professional looking maps. So the software must be able color separate the map and of course must allow the user to create special cartographic representations. Because of nowadays the GIS softwares are input oriented (there are only few options for creating different kind of outputs) it is not easy to find that kind of software which is capable to solve both problem. Of course the most powerful GIS softwares (ArcInfo and Microstation) would be good choice, but we have to consider some disadvanteges: Finally we choose a relatively inexpensive and simple GIS software: MapInfo for Windows. Linking (geocoding) maps and statistical data we can create color thematic maps. These maps will be imported into a graphical software (Aldus Freehand or CorelDraw) to enhance its outlook and prepare the maps for color separation (choosing the right color model: Cyan, Magenta, Yellow, blacK, creating registration marks).


The output capabilities of low-end GIS softwares nowadays are quite poor from a cartographic point of view. These feauteres are not necessary for ordinary users, but sometimes it's necessary to solve these kind of output problems using powerful graphic softwares.

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