“Geography is destiny in medicine.” –Jack Lord, MD

In my undergrad English lit courses, I heard a lot about “character is destiny”. Which is a fancy way of blowing things out of proportion – e.g., Romeo and Juliet didn’t die via the quality of being “star-crossed”, but because they were super emo.

Well, this week, I watched a TED talk by Bill Davenhall (below) that claimed “geography is destiny”.

This idea is not so exaggerated. Just watch it (9 min.):

What it says: Where you’ve lived may determine how healthy you are.

There’s the classic equation:

health = genetics + lifestyle + environment

and of the three aspects, Davenhall argues that “environment” has been ignored for far too long by physicians.

He cites the fascinating example of his own heart attack. Having lived for a considerable period in each of Scranton, Pennsylvania; Louisville, Kentucky; and Los Angeles, California–all places with poor-quality air–he argues that he shouldn’t have been surprised to be at high risk for a health train wreck.

If only his health providers had had this information, they might have advised him to take preventative measures.

But they didn’t have it.

Geo-medicine and EMR?

Davenhall says it’s time for geo-medicine – the movement to incorporate place history into health care. And I believe this is a tremendous idea.

Think about it. At the doctor’s office, we fill out tons of forms about our genetics and our lifestyle, but we rarely get asked about our geographical or “place” history. This could be important!

For example, just a few days ago I realized that there was actually a thick (opaque!) layer of minerals at the bottom of my trusty hot water carafe—the result of dirty Toronto water… And I think it’s been building up there for more than a year. Toronto also can get so smoggy in the summer that you can barely see a large chunk of the CN Tower. It’s a big difference from my hometown on the East Coast, which has the most wonderful water and air I’ve ever experienced.

So let’s get this place history into our medical records.

We need a geo- layer in the EMRs of the future.

It doesn’t have to be very complicated. Consider a Google Map with balloons indicating places where you’ve lived and the length of stay. More sophisticated information could be favourite vacation spots and hobby information. In the TED talk, Davenhall gave the example of a colleague who frequented the major ski destinations in the US, a pattern that would show up in his EMR.

How about adding a social aspect?

You know me; I can’t let this go without talking about where social media might fit in. Here are some ideas:

• Community-driven overlays: How do we combine your place history with risk factors?Where do we get the data? Well, governments actually collect a lot of data on environmental factors and summarize it in nice maps. Some governments are even allowing citizens to request data and visualizations! (For US, see Data.gov). For the ones the government doesn’t cover, maps could be pulled from scientific literature and even the news. This should become easier as Science 2.0 and open data projects gain momentum.
• Automatic location detection and reporting: iPhone GPS apps are obvious. Location-sharing services like FourSquare could also be mashed up with Google Maps if the temporal and spatial resolution ever gets to that point

The second actually brings me another point…

Finally, what about privacy?

I pitched my geo-medicine ardor to a friend and he said it sounded like a privacy nightmare. He said that if it gets anywhere near tracking location in real-time, there is going to be information we want to keep to ourselves.

I agree—real-time is the tricky part. But health-relevant information should be retrievable from the “macro” level – i.e., only the places in which we’ve spent a considerable period of time. Most realistically, this data would be populated by self-report, and updated only when you move somewhere new.

I’m up for it – how about you?

• For further reading, check out MobiHealthNews’s post.

Related posts:

• Google Wave for Medicine 2.0
• The Search for Better Search in EMR
• On the (Selective) Persistence of Paper
• Mount Sinai Hospital’s VitalHub, the Latest in iPhone + EMR