Bill Davenhall: Your health depends on where you live

Summary

The speaker discusses how geographic information, such as environmental factors in the places we live and work, impacts health. After a heart attack, he questioned why his doctors never considered his 'place history' alongside lifestyle and genetics. Using personal experiences from living in high-risk areas, he emphasizes the need to include geographical data in medical records. This approach, termed 'geomedicine,' could help doctors better understand patient risks and make more informed health recommendations. The speaker advocates integrating location history into electronic health records for improved healthcare outcomes.

Takeaways

• 🚂 The speaker likens a heart attack to being hit by a train, emphasizing how unexpected and life-changing the event was.
• ❓ After the heart attack, the speaker began questioning why it happened and whether it could have been prevented by a doctor.
• 🧬 The formula for good health includes genetics, lifestyle, and environment, which together manage health risks.
• 📝 Doctors often focus on genetics and lifestyle but rarely ask about environmental factors, which the speaker believes are crucial.
• 🌍 Environmental factors such as air quality, water quality, and place history significantly affect long-term health, but they are not typically considered in medical evaluations.
• 🏠 The speaker reflects on living in various locations with poor air quality, which may have contributed to his health issues.
• 📍 Place history, or where a person has lived and worked, can offer insights into their health risks, but it is often overlooked by healthcare professionals.
• 📱 Technology, like tracking cell phone data, can provide a detailed map of a person's exposure to environmental risks, offering valuable information for health assessments.
• 🩺 The speaker advocates for including place history in electronic health records to better inform doctors and researchers about environmental impacts on health.
• 💡 The concept of 'geomedicine' emphasizes the importance of geographic data in healthcare, and the speaker calls for more programs to support this approach.

Q & A

What event led the speaker to reflect on their health and environment?

The speaker had a heart attack in 2001, which led them to reflect on their health and the factors that contributed to it, such as their environment.

What three main factors does the speaker say affect health?

The speaker identifies genetics, lifestyle, and environment as the three main factors that influence health.

What aspect of health does the speaker believe is often overlooked by physicians?

The speaker believes physicians often overlook the environmental aspect of health, such as the places where a person has lived and the environmental risks they've been exposed to.

Why does the speaker emphasize the importance of 'place history' in medical records?

The speaker emphasizes that 'place history'—the places a person has lived and their environmental exposures—can provide critical insights into health risks that are currently missing from medical records.

How does the speaker illustrate the impact of their environment on their health?

The speaker shares their personal experience of living in areas with high pollution, such as Scranton, Louisville, and Redlands, and how these environments may have contributed to their health issues, including their heart attack.

What example does the speaker give to demonstrate how technology could track environmental exposure?

The speaker gives the example of their colleague Paul, who allowed his cell phone to track his location every two hours for two years. This data was used to map his environmental exposure to toxins.

What does the speaker suggest could be included in future electronic health records?

The speaker suggests that future electronic health records should include a person's 'place history' to better understand their environmental exposures and associated health risks.

What is 'geomedicine,' according to the speaker?

Geomedicine is the study of how geography and environmental factors influence health, and the speaker argues that physicians should be educated on its importance.

How does the speaker propose that people could use geographic information to make healthier choices?

The speaker proposes that with access to geographic information, people could make more informed decisions about where to live or work to reduce their exposure to environmental health risks.

What are the two main actions the speaker recommends to improve health outcomes?

The speaker recommends two actions: 1) teaching physicians the value of geographical information and 2) ensuring that place history is included in electronic health records to aid both physicians and researchers.

Outlines

00:00

🚂 A Personal Health Journey: The Impact of Environment

The speaker shares a personal story about experiencing a heart attack in 2001, leading to an intense reflection on health. They question why it happened, exploring the factors of genetics, lifestyle, and environment as key contributors to health risks. While genetics and lifestyle are commonly discussed in doctor visits, environmental exposure is often overlooked. The speaker recounts their life in various places, including Scranton, Pennsylvania (high in sulfur dioxide), Louisville, Kentucky (near a plastics manufacturing plant), and Redlands, California (known for poor air quality). The recurring message is that doctors rarely inquire about 'place history,' missing a critical factor in health risks.

05:00

🗺️ The Hidden Impact of 'Place History' on Health

The speaker emphasizes the importance of 'place history' in understanding health risks. They explain that geographical factors, such as air quality and environmental exposure, are rarely considered in medical records. Maps showing regions with varying health risks are available globally, but this data is absent from personal health assessments. The speaker uses an example of a colleague named Paul, who tracked his movements via cellphone, revealing that he frequently visited areas with toxic releases. This data could be crucial for health assessments, but is not yet part of routine medical evaluations, highlighting the need for incorporating environmental data into health records.

Keywords

💡Geomedicine

Geomedicine refers to the use of geographic information to improve healthcare outcomes. In the video, the speaker advocates for integrating geographic data into medical records, highlighting how environmental factors, like the places people live and work, can significantly impact health. For example, the speaker's exposure to pollutants in different locations could have contributed to his heart attack.

💡Environment

In the context of the video, 'environment' refers to the physical locations where individuals live, work, and spend time, and the external factors in those places that influence health. The speaker explains how environments like Scranton, Pennsylvania, and Redlands, California, expose people to harmful chemicals and pollutants, which in turn affect health but are not typically considered in medical evaluations.

💡Place history

Place history is the concept of tracking where a person has lived and spent time, and understanding how these locations affect their health. The speaker emphasizes that while doctors ask about family history and lifestyle, they often overlook the importance of place history, which can provide insights into exposure to environmental risks like pollution or toxic substances.

💡Genetics

Genetics refers to the biological traits inherited from one's parents that can affect health outcomes. The speaker acknowledges that genetics is a well-understood component of health, regularly assessed by physicians through medical history forms, but contrasts it with the often-neglected environmental factors that also play a critical role.

💡Lifestyle

Lifestyle in the video refers to personal habits and behaviors, such as diet, exercise, and daily routines, which influence health. Like genetics, lifestyle is routinely discussed in medical assessments, but the speaker argues that it should be considered alongside environmental factors to get a complete picture of health risks.

💡Electronic health records (EHR)

Electronic health records (EHR) are digital versions of patients' medical histories, commonly used in modern healthcare. The speaker suggests that these records should be expanded to include place history, allowing doctors and researchers to assess environmental exposures that could affect health, thereby improving patient care.

💡Toxic release inventories

Toxic release inventories refer to data collected by the EPA on hazardous substances released into the environment. The speaker uses these inventories to demonstrate how environmental risks can be mapped, as shown in the case of his colleague Paul, who lived near areas with high levels of toxic emissions, potentially impacting his health.

💡Heart attack

A heart attack is a medical condition in which blood flow to the heart is blocked, causing tissue damage. The speaker experienced a heart attack, which he uses as a metaphor for his 'train wreck' in life. He explores whether his heart attack could have been predicted or mitigated by better understanding the environmental factors, or 'geography,' that contributed to his health.

💡Geographic variations in disease

Geographic variations in disease refer to the differences in health outcomes and disease prevalence depending on where a person lives. The speaker highlights that different regions have varying levels of environmental risks, such as pollution or toxic chemicals, which can influence the likelihood of diseases like heart attacks.

💡Dartmouth Atlas of Healthcare

The Dartmouth Atlas of Healthcare is a research project that documents how medical resources are distributed and used in the United States, focusing on geographic variations in healthcare. The speaker references a quote from Jack Lord, suggesting that geographic information can explain variations in health and wellness across different locations.

Highlights

The speaker suffered a heart attack and started questioning why it happened and if it could have been predicted.

The speaker introduces the concept of the formula for life and good health: genetics, lifestyle, and environment.

Doctors frequently ask about genetics and lifestyle but rarely inquire about environmental factors.

The speaker describes their life in various geographic locations and the environmental risks they faced, from sulfur dioxide to benzene.

They explain the long-term effects of environmental exposures from different places on their health.

There is a gap in medical history collection, as physicians rarely ask about 'place history'—the environments where patients have lived.

Countries spend billions on research to monitor environmental data, but this data is not integrated into patient health records.

The speaker highlights that environmental exposures, such as air quality and toxic substances, significantly impact health.

A personal case study using tracking data from a smartphone revealed environmental risks based on location history.

The speaker introduces the concept of 'geomedicine,' a growing field that studies how geography impacts health outcomes.

They argue that place history should be included in electronic health records to better inform both doctors and patients.

Having access to geographic health data would enable people to make informed decisions about where to live or work based on environmental health risks.

The speaker advocates for teaching physicians the value of geographic information to improve health care.

Geomedicine programs are in early development stages, and more support is needed to bring geographic data into health care practices.

The speaker concludes that geography always matters in health and believes that geographic information can lead to healthier lives.

Transcripts

Can geographic information

make you healthy?

In 2001 I got hit by a train.

My train was a heart attack.

I found myself in a hospital

in an intensive-care ward,

recuperating from emergency surgery.

And I suddenly realized something:

that I was completely in the dark.

I started asking my questions, "Well, why me?"

"Why now?" "Why here?"

"Could my doctor have warned me?"

So, what I want to do here in the few minutes I have with you

is really talk about what is the formula for life and good health.

Genetics, lifestyle and environment.

That's going to sort of contain our risks,

and if we manage those risks

we're going to live a good life and a good healthy life.

Well, I understand the genetics and lifestyle part.

And you know why I understand that?

Because my physicians constantly

ask me questions about this.

Have you ever had to fill out those long,

legal-size forms in your doctor's office?

I mean, if you're lucky enough you get to do it more than once, right?

(Laughter)

Do it over and over again. And they ask you questions

about your lifestyle and your family history,

your medication history, your surgical history,

your allergy history ... did I forget any history?

But this part of the equation I didn't really get,

and I don't think my physicians

really get this part of the equation.

What does that mean, my environment?

Well, it can mean a lot of things.

This is my life. These are my life places.

We all have these.

While I'm talking I'd like you to also be thinking about:

How many places have you lived?

Just think about that, you know, wander through

your life thinking about this.

And you realize that you spend it in a variety of different places.

You spend it at rest and you spend it at work.

And if you're like me, you're in an airplane a good portion of your time

traveling some place.

So, it's not really simple

when somebody asks you, "Where do you live, where do you work,

and where do you spend all your time?

And where do you expose yourselves to risks

that maybe perhaps you don't even see?"

Well, when I have done this on myself,

I always come to the conclusion

that I spend about 75 percent of my time

relatively in a small number of places.

And I don't wander far from that place

for a majority of my time,

even though I'm an extensive global trekker.

Now, I'm going to take you on a little journey here.

I started off in Scranton, Pennsylvania.

I don't know if anybody might hail from northeastern Pennsylvania,

but this is where I spent my first 19 years

with my little young lungs.

You know, breathing high concentrations here

of sulfur dioxide, carbon dioxide

and methane gas,

in unequal quantities -- 19 years of this.

And if you've been in that part of the country,

this is what those piles of burning, smoldering coal waste look like.

So then I decided to leave that part of the world,

and I was going to go to the mid-west.

OK, so I ended up in Louisville, Kentucky.

Well, I decided to be neighbors to a place called Rubbertown.

They manufacture plastics. They use large quantities chloroprene

and benzene.

Okay, I spent 25 years, in my middle-age lungs now,

breathing various concentrations of that.

And on a clear day it always looked like this, so you never saw it.

It was insidious and it was really happening.

Then I decided I had to get really smart,

I would take this job in the West Coast.

And I moved to Redlands California.

Very nice, and there

my older, senior lungs, as I like to call them,

I filled with particulate matter, carbon dioxide and very high doses of ozone.

Okay? Almost like the highest in the nation.

Alright, this is what it looks like on a good day.

If you've been there, you know what I'm talking about.

So, what's wrong with this picture?

Well, the picture is, there is a huge gap here.

The one thing that never happens in my doctor's office:

They never ask me about my place history.

No doctor, can I remember, ever asking me,

"Where have you lived?"

They haven't asked me what kind of the quality

of the drinking water that I put in my mouth

or the food that I ingest into my stomach.

They really don't do that. It's missing.

Look at the kind of data that's available.

This data's from all over the world --

countries spend billions of dollars investing in this kind of research.

Now, I've circled the places where I've been.

Well, by design, if I wanted to have a heart attack

I'd been in the right places. Right?

So, how many people are in the white?

How many people in the room have spent the majority of their life

in the white space?

Anybody? Boy you're lucky.

How many have spent it in the red places?

Oh, not so lucky.

There are thousands of these kinds of maps

that are displayed in atlases

all over the world.

They give us some sense of what's going

to be our train wreck.

But none of that's in my medical record.

And it's not in yours either.

So, here's my friend Paul.

He's a colleague. He allowed his cell phone to be tracked

every two hours, 24/7,

365 days out of the year

for the last two years, everywhere he went.

And you can see he's been to a few places around the United States.

And this is where he has spent most of his time.

If you really studied that you might have some clues

as to what Paul likes to do.

Anybody got any clues? Ski. Right.

We can zoom in here, and we suddenly see

that now we see where Paul has really spent a majority of his time.

And all of those black dots are all of the

toxic release inventories

that are monitored by the EPA.

Did you know that data existed?

For every community in the United States,

you could have your own personalized map of that.

So, our cell phones can now build a place history.

This is how Paul did it. He did it with his iPhone.

This might be what we end up with.

This is what the physician would have

in front of him and her when we enter that exam room

instead of just the pink slip that said I paid at the counter. Right?

This could be my little assessment.

And he looks at that and he says,

"Whoa Bill,

I suggest that maybe you not decide,

just because you're out here in beautiful California,

and it's warm every day,

that you get out and run at six o'clock at night.

I'd suggest that that's a bad idea Bill,

because of this report."

What I'd like to leave you for are two prescriptions.

Okay, number one is, we must teach physicians

about the value of geographical information.

It's called geomedicine. There are about a half a dozen programs in the world right now

that are focused on this.

And they're in the early stages of development.

These programs need to be supported,

and we need to teach our future

doctors of the world

the importance of some of the information

I've shared here with you today.

The second thing we need to do

is while we're spending billions and billions

of dollars all over the world

building an electronic health record,

we make sure we put a place history

inside that medical record.

It not only will be important for the physician;

it will be important for the researchers

that now will have huge samples to draw upon.

But it will also be useful for us.

I could have made the decision, if I had this information,

not to move to the ozone capital

of the United States, couldn't I? I could make that decision.

Or I could negotiate with my employer

to make that decision

in the best interest of myself and my company.

With that, I would like to just say that Jack Lord said

this almost 10 years ago.

Just look at that for a minute.

That was what the conclusion

of the Dartmouth Atlas of Healthcare was about,

was saying that we can explain the geographic variations

that occur in disease, in illness, in wellness,

and how our healthcare system actually operates.

That was what he was talking about

on that quote.

And I would say he got it right almost a decade ago.

So, I'd very much like to see us begin to

really seize this as an opportunity to get this into our medical records.

So with that, I'll leave you that

in my particular view of view of health:

Geography always matters.

And I believe that geographic information

can make both you and me very healthy. Thank you.

(Applause)