What GIS Mapping Technology Can Tell You About the Health of Your Neighborhood and Your Risk for Illness
San Bernardino, a city on the eastern edge of Los Angeles' exurban sprawl, is a veritable "food desert." For every grocery store or otherwise "healthy" food outlet, the city has eight fast-food joints, convenience stores and other junk food purveyors -- along with rampant heart disease, lung cancer and diabetes rates and a life expectancy eight years shorter than the average Californian.
With such looming health issues and relatively few parks and recreational spaces, San Bernardino places near the bottom in state quality of life rankings. But, in one respect, the city is ahead of others grappling with epidemic lifestyle-related illnesses: It's aiming GIS or "geographic information systems" at the problem.
While the rest of the world is using the technology to map everything from real estate transactions to bike-sharing stations, San Bernardino is charting illness and cross-referencing it against the locations of food deserts and crime hotspots, as well as parks and bike paths.
"It's one thing to know what a food desert is. But to see it on the map is totally different," says Cynthia Luna, who leads San Bernardino's Latino Health Collaborative, one of several advocacy groups and public agencies that have come together to improve the health of the city's 200,000 residents.
"Having the data actually sustains us and helps shape our advocacy," says Luna, of the project supported by the city's mayor, Patrick J. Morris, a 73-year-old running enthusiast, as well as healthcare organizations and a private foundation that chipped in to pay for a 100-plus page "environmental scan" last year that has brought the city's health challenges into sharper focus.
Marrying Place and Health
What's happening in San Bernardino is part of the burgeoning new field of "geo-medicine," which emphasizes the many ways that place impacts health. The technology is not new (even before it was discovered by the likes of the real estate site, Zillow, the fossil fuel industry has long used GIS mapping to explore for the next big oil field). But the tools have matured in recent years. As they've gotten better at turning knowledge stored away in databases into more user-friendly soundbites and infographics, physicians and public health officials have begun to embrace them.
The trend is also ushering in a new era of "citizen epidemiologists," says Bill Davenhall, a healthcare manager with the geographic information systems software developer Esri. And around the country, experiments are underway to, among other things, pair geo-mapping with patient medical records to help doctors personalize treatment.
At Loma Linda Medical Center, which serves San Bernardino and three other counties, Esri is installing geo-coding software that automatically verifies patient addresses. Dora Barilla, the center's director of community health development, says once the project is operational, she envisions computer dashboards that would allow doctors and other care providers to "see" where a patient lives and what kind of neighborhood stores and social services they could tap upon discharge from the hospital. For instance, locating pharmacies or farmers markets within walking distance, or helping elderly patients enroll in public transit services to get them to their next doctor's appointment.
The trend is also allowing people to "quantify the self" as never before. One new company, Asthmapolis, has attached a GPS sensor atop asthma inhalers to allow patients and their doctors to track and map attacks and gain new insights into what triggers them. Once the data is "de-identified" to protect patient privacy, it'll be sent to researchers investigating the causes of the condition.
"People are realizing the limitations of the silo mentality and the value of integrating information," says Davenhall, whose company offers a free iPhone app that uses GIS mapping to cross-reference everyplace you've ever lived to the pollution problems and associated illness and death rates in those places. Davenhall sees geo-medicine as part of a shift toward a more holistic approach to healthcare.
Ending the Silo Mentality
At the community level, the first step is coaxing public officials into frank conversation about community health problems and how to, say, reduce obesity-related deaths and improve physical fitness, says Angelica Baltazar, an Ersi executive who until last year, spent five years coordinating Healthy San Bernardino, a county-wide initiative that has grown to involve 16 of its 24 jurisdictions.
The city of San Bernardino, she says, "was one of the last to come aboard but they have really come together so strong."
The public health crusade has already made inroads in improving the county's health. This year, San Bernadino moved up the ranks from 50th to 46th place (out of 56 California counties) examined by the County Health Rankings, a national GIS-powered project that compares counties across 28 different indicators of health and wellbeing. But Karen Odegaard, a community engagement specialist with the University of Wisconsin project, cautions it can take years to turn around lifestyle-related ailments such as obesity, diabetes and heart disease.
"The things that make a community unhealthy didn't happen overnight" and "take a long time to change," says Odegaard, whose organization offers advice, and this year launched the Roadmaps to Health Prize that will award up to six communities $25,000 apiece for their efforts.
Scanning for Healthy Outcomes
Mark Hoffman, who authored the city of San Bernardino's environmental scan, says it took hundreds of hours of work to build accurate database that contributed to the report.
"We tapped just about every government entity to pull this information together. The databases didn't exist. It all had to be coded and double- and triple-checked," says Hoffman, who is now working on turning the report into a series of policy briefs to bring to the city council and city departments.
A few ideas under discussion include how to make the city more walkable; and promoting joint operating agreements between school district and parks department officials who manage the city's relatively few recreational spaces. While San Bernardino boasts rugged vistas of snowcapped mountain and borders a national forest, it has far less parkland than the state average, according to the scan, which has won a couple of awards since it was released last fall. Hoffman says he's now beginning work on another environmental scan for four nearby communities.
The Grocery Gap
While they can be time-consuming and costly (Luna estimates the scan cost between $30,000 and $50,000), such detailed reports can help communities recruit allies in their efforts to improve community health and quality of life.
Veronica Saldaña says the scan helped her understand the extent of the grocery gap in San Bernardino. Saldaña works for the California FreshWorks Fund, a private-public partnership loan fund that has raised more than $260 million to help retailers finance new grocery stores in communities that have a shortage of healthy food options.
"There's such a dire need in San Bernardino. We'd love to finance a grocery store there," says Saldaña, whose fund has helped finance about a dozen stores since its inception last summer.
So far, however, she says a retailer has yet to show an interest in the city, a situation that highlights a conundrum: More knowledge doesn't necessarily lead to solutions.
Lillian Lamas, a San Bernardino activist and mother of two, says it's discouraging that her neighborhood still lacks safe walk-to-school routes three years after she and other parents first began demanding the city install more sidewalks.
"The kids have to walk by the side of the road with cars passing at 40 miles per hour," Lamas says.
For now, the city's advocates have started small: working to expand parks activities, walking clubs, farmers markets and community gardens. Eventually, they hope to tackle bigger issues like the rewriting the zoning rules to encourage more walkable neighborhoods, expand bike lanes and otherwise encourage a more physically active citizenry.
"There are a lot of good efforts happening" around the city, Luna says. "Our mission is to connect the dots between programs and then coordinate them and really create a vision. If we can do this, then we will have something that's long lasting."