This report on the Vespucci Institute on health geography in 2013 emphasizes the importance of research that connects population, health, and place from a holistic perspective. We review important trends related to Health GIS and highlight directions for future research in this area that were identified at the Institute

Jacquez, Geoffrey

Kuhn, Werner

Raubal, Martin

Wilson, John

Journal of Spatial Information Science

English

University of Maine

JOURNAL OF SPATIAL INFORMATION SCIENCENumber 7 (2013), pp. 103–108 doi:10.5311/JOSIS.2013.7.158COMMUNITY ACTIVITY: WORKSHOP REPORTSynthesizing population, health,and placeSummary: This report on the Vespucci Institute on health geography in 2013 emphasizesthe importance of research that connects population, health, and place from a holistic per-spective. We review important trends related to Health GIS and highlight directions forfuture research in this area that were identified at the Institute.1 Vespucci InstitutesVespucci Institutes (http:www.vespucci.org) aim to advance Geographic Information inScience. Celebrating the fifth centenary of Vespucci’s discoveries [1], the Vespucci Initiativerecaptures his spirit of multi-disciplinary intellectual inquiry to explore new frontiers ofknowledge and new territories. To that end it organizes and conducts a range of researchand teaching activities, bringing together senior scientists and promising young researchersfrom around the world. This unique interdisciplinary mix creates what has been calledthe Medici Effect [2] and perhaps it is no coincidence that most Vespucci Institutes havebeen held in Florence, Italy since 2003. The topics covered in the past range from location-based services, spatial data infrastructures, geo-sensor web, and virtual globes to cognitiveand linguistic aspects of geographic space [4], environmental modeling, volunteered ge-ographic information, spatial simulation, and spatial ontology. Vespucci Institute partici-pants share a special interest in the locational aspects of societal challenges. These aspectsare being studied and exploited in the field of Geographic Information Science and are be-ing implemented within the GIS, GPS, location-based services (LBS) and related industries(see http:www.giscience.org, http:www.agile-online.org, http:www.ucgis.org).The Institutes and other events sponsored by the Vespucci Initiative are open to post-graduate researchers and graduate students at all stages of their careers in the academic,public, not-for-profit, and private sectors. Attendees get selected on a competitive basisthrough an open call for expression of interest. The unique atmosphere of the Institutescreates an environment where, in contrast to most conferences and other meetings, partici-pants are especially encouraged to be creative and challenge the status quo in the respectedarea. This is supported through facilitators, slow food for thought, and a flexible timeschedule.c© by the author(s) Licensed under Creative Commons Attribution 3.0 License CC©104 RAUBAL, JACQUEZ, WILSON, KUHNAfter ten successful years of Vespucci Institutes in Florence, Italy1, the Eleventh Insti-tute in 2013 involved a week on Population, Health, and Place that was held on CatalinaIsland, located 20 miles off the coast of Southern California. The week consisted of keynoteaddresses by invited speakers from academia, science organizations, and the private sector,short presentations from participants, and ample discussion time in a stimulating environ-ment.2 Trends in Health GISHealth research has taken a major spatial turn lately [5]. Progress in the areas of GIScience,spatial analysis, and geospatial technologies has led to increased intelligence in investigat-ing the outbreak, transmission, and treatment of diseases on both local and global scales.Furthermore, technologies such as geospatial services and sensor apps provide people withthe opportunity to monitor and influence their daily behavior with the goal of promotinga healthy lifestyle.During preparation for the Institute it was observed that traditional notions of spaceand place offer only a limited view of what is needed in practice and do not preparepeople for applications in the real world. To fill this gap, the Institute set out with thegoal to draw on real-life experiences in a global setting, contrasting the approaches usedby demographers, health, and spatial scientists.Several important trends related to Health GIS can be identified:1. the transformation of health data and its availability through new government ini-tiatives (such as those at the U.S. Department of Health and Human Services) thatseek to make data widely available and to encourage innovative use of the data—this, of course goes hand in hand with privacy concerns, for which solutions need tobe found;2. the development of new technologies for sensing of the environment related directlyto health exposures such as miniaturized, wearable sensors;3. new initiatives fostering development of cutting edge technologies for exploiting newdata sources and analytical approaches for improving human health;4. the emergence of games for health, that seek to encourage salubrious health behaviorsthrough gaming, social networks, and goal-orientation; and5. rapid advances in place-based “omics,” that are providing geographically-referenceddata on the genetic and biological determinants of human disease.The convergence of these trends may be viewed through the lens of “genetic GIS,” whichseeks to increase our understanding of human health as the interactions between genetics“omics” writ large); behavior (the mediator of disease-related exposures through the majorexposure routes, eating, drinking, breathing, and dermal); and the environments throughwhich individuals pass over their life course (e.g., Schaerstrom’s pathogenic paths [6]; daily,weekly, and life-long activity spaces).The keynote addresses at the Institute reflected these trends in health geography. Ge-offrey Jacquez presented a GIScience research agenda for Genetic GIS, centered on topics1The Vespucci Initiative on Cognitive and Linguistic Aspects of Geographic Space held in Las Navas delMarques in 2010 was the only exception to the rule.www.josis.orgSYNTHESIZING POPULATION, HEALTH, AND PLACE 105such as case control, biomarkers, and personal energy budgets. Progress in this areawill de-pend on how citizen science can be enabled by the various available sensors. Daniel Janiesintroduced the Supra Map Project (http:www.supramap.org). The goal of this project isto develop the means to analyze and share diverse types of data (e.g., genomic, evolution-ary, geographic) on organisms. Such a platform can, for example, help us to understandoutbreaks and spreads of illnesses through sequencing the genomes of the pathogens.New technologies for sensing the environment and health exposures were documentedby David Balshaw, Program Director at the National Institute of Environmental HealthSciences. They are most relevant in the context of exposure, a multi-scale problem tar-geting the analysis of the exposome, the “environmental” correlate to the genome. Thevision here is to integrate both exposure biology (through the development of technologyand biomarkers) and genetics (by identifying genetic variants) in order to provide deeperknowledge on the relation between genes, environment, and health. It was impressive tosee the diversity and power of newly developed devices and sensors that utilize locationfor temporal exposure data, ranging from personal aerosol sensors for children’s asthmato wearable sensors for pesticide exposures. Chantel Sloan demonstrated how geographycan be used as a tool for transdisciplinary research to advance our understanding of infec-tious disease such as human respiratory syncytial virus. A thorough overview of the widevariety of health games on the market was given by Ben Sawyer. Many of these games arebased on their own geography and supported by maps, suggesting that players appreciategeographic visualization. So far location, sensors, and data are emergent concepts, but notprevalent, and some games seek to motivate their players to engage in healthy lifestyles. Along-term vision of the role of games in health exploits their utility in promoting durable,salubrious health behaviors in appropriate places and settings. The final keynote addressby Myles Cockburn demonstrated how spatial science can support personalized (preven-tive) medicine and help in identifying at-risk populations using examples from cancerepidemiology and drawing on both the physical environmental and human behavioralperspectives.3 Directions for future researchDuring group work and also fueled by ideas from several lightning talks, Vespucci partic-ipants explored various new ideas and approaches for understanding human health anddisease. This resulted in four strands of potential future research directions.3.1 Health behavior and landscapeIn analyzing health behavior there is an obvious gap that needs to be filled, namely animpact analysis of environmental factors. Currently, the environment is dealt with ratherpoorly when studying people’s health behavior and the various diseases and their causesand outbreaks. Analytical studies that compare individuals with a specific disease withindividuals who do not have that disease (case-control studies) are not inherently spatial.Much richer (spatial) datasets could be utilized in the future to create so-called health land-scapes with several health layers to be analyzed with the help of GIS operations and tools.This could lead to a new level of personalized health services, which monitor people’sJOSIS, Number 7 (2013), pp. 103–108106 RAUBAL, JACQUEZ, WILSON, KUHNbehavior, performmulti-criteria analyses, and based on the results encourage their users tolive healthier lives by suggesting concrete actions and/or options.3.2 Spatial health marketplaceThe future is expected to bring us an unprecedented avalanche of data and services. Most ofthese datawill be gathered and communicated bymobile sensors and platforms, paving theway to personalized health information. How can we make sense of this data cloud? Howcan we best make use of the data? Which technologies will be needed? These questionsmust be answered in the context of a spatial health marketplace, driven by health informaticsamong other fields. The creation of such a marketplace brings with it obvious challenges,such as standards for data records, semantic interoperability, and importantly policies andprotocols for dealing with data privacy. It is seen as a great opportunity to bring togetherhealth people as the domain experts and other groups such as spatial researchers, com-puter, social, and cognitive scientists. Spatial expertise is urgently needed in this processbecause everything is fundamentally spatial, and spatiotemporal analysis is different andlikely to provide important new insights and discoveries for the health domain.3.3 Latency and lag estimationDisease latency estimation has been identified as one of the key problems underpinningspace-time modeling in health geography. What is the relationship between space (e.g.,locations of causative exposures and health events) and the biological and physical pro-cesses that mediate disease latency? How can we quantify space-time patterns withouta fundamental understanding of disease latency? Such an understanding is required forus to have some idea of not only where to look but when to look. Several approaches arepossible ranging from data-driven statistical methodologies such as Bayesian modeling toprocess-based approaches that seek to incorporate mechanics of the underlying processesinto the model itself (e.g., compartmental analysis). Challenges include bridging the scalesof temporal lags, from genomic, to cellular, to individual, to population; incorporation ofgenomic and exposure information into the disease latency model; and the derivation ofappropriate modeling frameworks for capturing these diverse aspects. Domain expertiseis required on the genetic and biological bases of health and disease, causative exposures,and the geographic expression of disease processes at the population level. With process-based latency models in hand, we expect quantitative geographers will be able to constructpowerful models for predicting and mapping future population health outcomes, as wellas diagnostic tools for identifying the location and timing of exposure events.3.4 ExposureExposure studies provide important insights into how and why people present certaindiseases. Of particular relevance is the notion of the “exposome,” defined as the totalityof an individual’s exposure over the life course [3, 7]. Different exposures are of relevanceto different health outcomes, and studies in life course epidemiology will provide fertileground for advancing our understanding of exposure geography. Further work to docu-ment spatiotemporal footprints of people with regard to both activities and environmentsis needed so we can free ourselves from excessive reliance on place of residence (as a proxywww.josis.orgSYNTHESIZING POPULATION, HEALTH, AND PLACE 107for exposure) and build personal maps of exposure over varying time scales. Biologicalmarkers of exposure can thereby help to validate human exposure to a hazardous sub-stance. The resulting lifelines and spatiotemporal patterns of people will serve as a basisfor investigating various factors responsible for diseases. Challenges for such analysesinclude data integration from a semantic and statistical point-of-view and dealing withdata inaccuracies and uncertainty. To tackle the semantic issues, a group of participantsstarted planning for a community effort to generate shared vocabularies for annotatingand discovering exposure data.AcknowledgmentsThe authors are grateful to all other participants (Benjamin Adams, Ben Sawyer, CeciliaXia, Chantel Sloan, Craig Knoblock, Daniel Ervin, Daniel Goldberg, Daniel Janies, DavidBalshaw, David Lopez-Carr, Edward Pultar, Genevieve Dunton, Marta Jankowska, MichaelGould, Michael Hagenlocher, Myles Cockburn, Peter Kedron, Phaedon Kyriakidis, SheilaTripathy, Stephen McElroy) and the local organizers (especially Melissa Salido) for turningthis Vespucci Initiative into a success. The Vespucci Initiative was sponsored by the JointResearch Center (JRC) of the European Commission, the University of Southern Califor-nia’s Dana andDavid Dornsife College of Letters, Arts and Sciences, Esri, the Association ofGeographic Information Laboratories in Europe (AGILE), and the Association of AmericanGeographers (AAG).Martin RaubalETH Zu¨rich, SwitzerlandGeoffrey JacquezUniversity at Buffalo, USAJohn WilsonUniversity of Southern California, Los Angeles, USAWerner KuhnUniversity of Mu¨nster, GermanyReferences[1] FERNA´NDEZ-ARMESTO, F. Amerigo: The Man Who Gave His Name to America. RandomHouse, New York, NY, 2007.[2] JOHANSSON, F. The Medici Effect. Harvard Business School Press, Boston, MA, 2006.[3] NATIONAL RESEARCH COUNCIL. Exposure Science in the 21st Century: A Vision and aStrategy. National Academies Press, Washington, D.C., 2012.JOSIS, Number 7 (2013), pp. 103–108108 RAUBAL, JACQUEZ, WILSON, KUHN[4] RAUBAL, M., MARK, D., AND FRANK, A., Eds. Cognitive and Linguistic Aspects ofGeographic Space. Springer, Berlin, 2013.[5] RICHARDSON, D., VOLKOW, N., KWAN, M.-P., KAPLAN, R., GOODCHILD, M., ANDCROYLE, R. Spatial turn in health research. Science 339 (2013), 1390–1392.[6] SCHAERSTROM, A. Pathogenic Paths? Chartwell-Bratt, Bromley, UK, 1996.[7] WILD, C. Complementing the genomewith an “exposome”: The outstanding challengeof environmental exposure measurement in molecular epidemiology. Cancer Epidemiol-ogy, Biomarkers and Prevention 14 (2005), 1847–1850.www.josis.org

Synthesizing population, health, and place

Martin Raubal

Geoffrey Jacquez

John Wilson

Werner Kuhn

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Synthesizing population, health, and place

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