The health and medical literature is filled with thousands of studies that link poverty to health status, especially among children and young adults -- the evidence says that a "poor" start in life is a major health determinant -- as the public health experts refer to it. Poverty is also not evenly spread across ethnic, racial or demographic groups, nor is poverty just about how much money people have at their disposal. Sometimes the impact of poverty on health is hidden from our view like low performing public schools with high truancy and low graduation rates, all contributing to poor health.
A good example of what I am talking about is the school performance web site created by the Washington Post that provides public access to the Washington DC's public school "score cards" including their physical and structural adequacy, health violations, availability of qualified teachers, etc. If education is a marker for the future health of our children, then a physician knowing more about the likely educational outcomes of a child might inform their treatment decisions and ultimately impact a prognosis. Another good example of this type of street address discovery is the New York City Mayor's Office web site that contains a Neighborhood Statistics interactive web application -- enter your street address and get a wealth of information about what is happening in your neighborhood -- from public health and safety to education and community resources.
Much like a blood test provides useful clues to underlying health problems that doctors can't always see at the surface, your street address can provide valuable contextual information, medically speaking. This is possible because of a vast system of linked data from the U.S. Census Bureau's enumeration program. The Census Bureau's programs helps market research organizations to better understand what is happening around you -- from retail transactions at your local pharmacy to what you and your neighbors like to eat and watch on TV. Knowing something specific about the composition and likely behaviors hidden in your neighborhood is unlocked when you provide your physician with your street address. A physician advising a patient to eat more fresh fruits and vegetables when there is no grocery store offering these foods within a reasonable distance (by walking or by low cost public transportation) will probably have a non-compliant patient on their hands.
My argument is straight forward -- physician's do not use all the information that patients, like me, routinely provide (like my street address) for clinical purposes -- relying instead only on what they observe and probe for in the standard examination. My street address, however, contains important clues about my economic and social context -- clues that could help my physician diagnose, treat and advise me. My physician could know most of this about me even before he walks through the exam room door!
The challenge of equipping my doctor with useful geographically relevant information is great. My physician recently suggested to me that she would have little time for making assessments of such "non clinical" information -- "just something else to clutter up my charts and more importantly I have not been trained to understand how to use it." And she is right -- physicians in the United States don't have adequate information delivery systems nor medical training experiences that help them learn how to leverage this type of information in a very useful way. This is where geomedicine comes into play, by creating new ways to "see" the patient's surrounding environment -- both now and in the past. Accessing and using data that adds intelligence to the medical encounter should be the driving force behind modernizing our health information technology.
When it comes to my health, I want my doctors to use all the information I provide to them -- not be guessing about my ability to follow their instructions and seek recommended treatments and therapies. I also want them to be acutely aware of my potential ability in following through with their advice -- physically, culturally and economically. Gleaning valuable information from something as simple as my street address has been around for decades and yet medicine has failed to incorporate it into my medical record in useful ways.
I believe it's time we help them do this elegantly by beginning to build into their medical informatics technologies better ways to link to rich data that adds new value. The tidal wave of personal health data that is headed to our doctors' offices as the result of real time biomedical and environmental monitoring sensors leaves medicine -- and my own physician -- little choice but to attempt to harness these new data streams to benefit my personal health.
As always a second opinion is always appreciated.