Lecture - Health GIS Geomedicine - AT76.9023

Geomedicine – Making GIS Personal Genetics + Lifestyle + Environment = Health Risk UC2010

Health and well-being usually begins here… UC2010

Health then continues in our communities… UC2010

Our dwellings can make us sick… UC2010

Our houses can make us sick… UC2010

Behaviors can make us sick… UC2010

Freeways can make children sick… UC2010

Dirty drinking water can make us sick…. UC2010

Nature can make us sick… UC2010

Medical services can make us sick... UC2010

Human waste can make us sick… UC2010

Disasters can make people sick…. UC2010

Accidents can make us sick… UC2010

The evidence is growing and convincing… … geography is linked to human health and social well-being • Air • Soil • Food • Water • Nature • Culture • Animals • Distance • Buildings • Accidents • Chemicals • Healthcare • Demographics … understanding the nature of complex relationships UC2010

The Geography of Health and Well-being… ? When geography matters UC2010

Scope of place • 9.1 trillion acres of water • 36.8 billion acres of land • 304 million lakes • 2.3 million cities and communities • 6.7 billion “personal spaces” • 2.1 billion households • 420 million commercial buildings …managing our environmental inventories UC2010

Scope of conditions • Carcinogens (cancer) • Teratogens (birth defects) • Developmental (reproductive) • Endocrine disrupters (hormonal) • Chronic conditions • Infectious diseases • Accidental death and injuries …managing our exposures UC2010

Scope of analysis • Physical proximity to toxic materials • Known impacts (80,000/15,000 tested) • Measuring exposures (time/duration) • Determining relative susceptibility • Determining lifetime burden • Symptom self-reporting …how will we do this accurately? UC2010

Citizen Epi – Geomedicine at Work UC2010

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Los Angeles Times - Friday, November 13, 2009 UC2010

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Acute Myocardial Infarction 31 Source: Dartmouth Atlas of Health 2005

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Data Sources • Toxic Release Inventory – TRI - US EPA - (since1987) – Private/Public entities (1987), Federal (1994) – 600 out of 80,000 chemicals monitored – Does not include auto/truck emissions /fertilizers/pesticides – Linked to NIH, NLM chemical profiles – 94,000 annual reports/25,000 establishments - Dartmouth Atlas of Heath Care – (since 1996) – US DHHS/CMS (claims data) – Medicare patients only …using data that has stood the test of time UC2010

Working definitions of geomedicine… • A inter-disciplinary academic approach that bridges knowledge between the natural (geologic) and man-made (as built) environment and human health and disease. • A information integration approach linking specific health impacts to specific geographical locations. • Can also include other fields of academic study such as medical geography and population health. UC2010

Future of geomedicine • Place histories common • Product use histories common • Personal – epidemiology • Rise of new sub-specialties • Unprecedented patient data flows • Increasing geographical transparency …managing our environmental inventories UC2010

What cancer experts are now saying… • Environmental causes underestimated • There is an unequal burden in society • Lifestyles matter in types of exposures • Medical care contributes a greater share • Significant contamination at military sites UC2010

Geomedicine - Digital Gears MyHealth 700 million visits/yr HelpMe MyPlace History 2.4 billion SE hits - Work Sites - Residences UC2010

Environmental Reference Hub NLM CCRIS TRI 12 million references UC2010

Medical Reference Hub Treatments Pub Med CliniTrials MedLine 18 million citations 775 million searches UC2010

Patient Health Hub MyHealth Treatment History 700 million visits/yr Medication History Genetic History UC2010

Health Resource Hub Hospitals HelpMe Physicians 2.8 billion web SE hits Therapists UC2010

What cancer experts are now saying… “ Medical professionals need to consider occupational a well as environmental factors when diagnosing patients” Reducing Environmental Cancer Risk, Presidents Cancer Panel, National Cancer Institute, National Institutes of Health, 2009

Geomedicine integrating geographically relevant health information Administrative – Financial – Operational Programs Facilities Roles Geographies Infants Providers Planning Counties Children Services Analyzing Cities Adults Offices Monitoring Seniors Schools Communicating Regions Special Employers Reporting Postal Village location the common denominator UC2010

Geomedicine… Geography + Medicine Health Destiny 2km UC2010