4 COVER STORIES Linking Health to Geography continued from cover During his presentation, “Can Geographic Information Keep You Healthy?” Davenhall suggested that a patient’s geographic (or place) history is as relevant to personal health as genetics and lifestyle. One reason for including geography is that where you live can expose you to environmental toxins. “I’ve lived in some of the most polluted areas in the nation,” Davenhall said. He went on to demonstrate his place history using a GIS map. For the first 19 years of his life, Davenhall was exposed to sulphur dioxide fumes from burning coal waste in Scranton, Pennsylvania. Then he moved to Louisville, Kentucky, where various industries spewed out multiple contaminants. In the 1990s, he relocated to California and breathed smog toxins produced in and around Los Angeles. Did these exposures contribute to his heart attack? Maybe not, but he made the point that a lifetime of environmental exposures should be considered when deciphering a patient’s health problems. Noting that the average physician office visit takes about eight minutes, Davenhall drove home the message that it’s too short a time for a physician to make a connection between where a patient has lived and a history of environmental exposures. The physician needs to consider many things, including a patient’s place history and its intrinsic context. Those contribute to a more complete picture of the person’s health. In and around Louisville, Kentucky, industries produce multiple contaminants. the concepts of geomedicine (the application of spatial analysis methods to medicine). To increase this understanding, Davenhall wants the education of health professionals to include training in geomedicine. The place history of a patient could become a clinical marker and eventually unlock everything known about a patient’s health risks related to toxic air, water, ground, and food exposures, as well as culture and demographics. “Ultimately,” Davenhall emphasized, “the goal is to help people stay healthy.” Obviously, Davenhall recovered from his heart attack. But his point about geography was made well enough that everyone in the audience craned their necks to see his display of a map showing heart attack rates across the United States. The question in everyone’s mind was, What’s the risk where I live? For Davenhall, risks were high in all three of his hometowns. After Davenhall’s presentation, Alexandra Carmichael, cofounder of CureTogether. com, listed Davenhall’s geographic approach as one of her Top 10 Innovations at TEDMED. Scientific American Bill Davenhall wrote: “Bill Davenhall . . . made a compelling plea to add (photo: Esri). a history of places to medical information that doctors review.” Heart attack risks for U.S. Medicare enrollees shown here in the contiguous United States, mapped by county. (Data source: Dartmouth More Information For more information, contact Bill Davenhall, Atlas of Health Care.) Esri (e-mail: bdavenhall@esri.com). Visit Davenhall noted, “All the rich data collected www.esri.com/geomedicine. by such organizations as the National Library of Medicine and the Environmental Protection About TEDMED Agency simply have not entered the picture when The original TED conference, held in 1984, it comes to our face-to-face encounters with our initiated conversations on technology, entertainment, and design. TEDMED 2009, held physicians. I think this needs to change.” According to Davenhall, the first step to October 28–30 in San Diego, was the fifth in a connecting a patient’s medical and geographic series that focused on health. TEDMED was crehistories could be achieved using an electronic ated by Marc Hodosh, consultant and entreprehealth record (EHR). The advantage of an EHR neur, and Richard Saul Wurman, author of more is that an accurate, full place history can be filled than 80 books including Information Anxiety. out just once and made available to physicians as Wurman was the organizer of the original TED needed. EHRs might actually lighten the burden conference and creator of the phrase “informaof massive record-keeping requirements on the tion architect.” Wurman’s newest project seeks to identify successful urban design models that modern physician’s office. However, the second step—the interpretation can be used to improve the lives of citizens livof geography and environmental exposures— ing in megacities. Visit tedmed.com. AN depends on a physician’s understanding of Sulphur dioxide fumes from burning coal waste in Scranton, Pennsylvania.