Ground-breaking work at the University of Canberra (UC) is combining geospatial data for individuals with health data to help drive healthier lifestyles, prevent chronic disease and reduce future demand on hospitals.
The Australian Geospatial Health Lab is a unique partnership between UC (one of Digital Health CRC’s university participants) and GIS global industry leader, Esri.
The Lab provides portal-to-portal collaboration that is secure at defence industry standards, enabling organisations that hold sensitive population data to work with the UC-Esri research team to analyse the relationships between place and health.
Through this approach, the team is exploring the causes of ill health – and how to reduce disease consequences – in the context of environmental determinants of health that vary spatially and geographically.
In another first, the Lab is also enabling the more accurate comparison of ‘apples with apples’ when expressing the spatial indicators that can impact people’s health – between suburbs, census units, regions and states of Australia, and even between countries.
“Through the Lab, we can identify the social, natural and built environment factors that contribute to an individual’s healthfulness, and their propensity to live a healthful lifestyle or to engage in behaviour that is riskier for their health” says Professor of Epidemiology from UC’s Health Research Institute, Mark Daniel (pictured).
“We can evaluate the features of their spatial environment that shape how they develop risk factors (like poor diet, physical inactivity, alcohol use and smoking), in conjunction with clinical measures and biomarkers, their disease outcomes, and disease consequences (like complications or hospitalisation).”
“Through this, we can better assess an individual’s risk of contracting – and how to better manage – conditions like obesity, metabolic syndrome, diabetes, cardiovascular diseases and cancers, based on their location.”
“We can then identify high-priority targets and decision-making tools to help deliver more targeted clinical and public health interventions, as well as support broader efforts for planning healthful environments.”
“Ultimately, this will help prevent the rise of chronic disease and the cost to the health system of treating it.”
‘Layering the cake’ of an individual’s environment
Professor Daniel says the Lab can aggregate a wide range of environmental, spatial and health data in building a picture of an individual’s way of life and how that contributes to their health – or ill health.
“We can tie together many different datasets to understand environmental influences for radii around where you live, where you work, how you get there, and the activity you undertake over the course of a day” he says.
“We can then express these influences at different spatial settings, not just for census administrative units.”
“We integrate many different datasets covering satellite images, public open space, vegetation, road networks, transportation grids, property values, census information, local businesses, crime and safety, access to healthcare, and healthcare costs – the list goes on.”
“All of these datasets can be layered. So if you can imagine a layered cake and you put a pen down through the middle of it that is, in the simplest sense, the ‘x,y’ co-ordinates of where you live – and the layers are different datasets each describing different dimensions of your surrounding social, built and physical environments that ultimately shape your lifestyle and healthfulness.”
“This type of research has been pursued in the scientific literature for about 20 years, but it has been bogged down because there has been no basis for standardised, comparative cross-jurisdictional work, and there have been major blocks in linking sensitive health outcome datasets with the spatial environment datasets that we are utilising.”
“We’ve overcome those limitations with the Australian Geospatial Health Lab.”
Developing more healthful environments
Through the Lab’s work, the research team is also seeking to influence the development of policies that support healthful environments.
“This will be through better urban design, more efficient public transportation which gets people out and moving, gets people out of their cars, and creates better access to public open spaces, healthful food source options, and accessible health and medical care” Professor Daniel says.
“As an example, we have been doing some work in Adelaide and with colleagues in Melbourne around those cities’ concepts of a 20-minute neighbourhood – which is all about ‘living locally’ and giving people the ability to meet most of their everyday needs, including access to primary if not acute medical care, within a 20-minute walk, cycle or local public transport trip from their home.”
Your idea of healthy may not be that healthy
Professor Daniel says your idea of healthy is ultimately socially shaped by where you live.
“A large part of that is due to your local community’s norms” he says.
“Our work has shown that norms vary geographically and spatially across different locations – so if you live in an area where the prevalence of overweight and obesity is high, this has a direct bearing on your lifestyle behaviour and your cardio-metabolic risk, above and beyond built environment features and what you do as an individual.”
“In other words, if the norms in your local community are largely unhealthful, your risks are going to be higher relative to other communities – even if you are living more healthily than others in your community.”
“A very simple example is our work showing that living in an area with a greater density of fast food outlets is associated with greater cardio-metabolic risk and mortality relative to areas with lesser densities of fast-food outlets, even accounting for all kinds of individual behavioural factors.”
“Compared with a peer in another area, you might be inclined to eat more fast food because the norms of your community support that. So you might live more healthily than your immediate neighbour, but less healthily than a peer in an area with less fast food outlets.”
“Much of the work to-date has been on census-type data relating to ill health. We are going beyond a purely social census-based perspective to look at what is happening (or not happening) on the ground, and in the built environment, that is associated with the evolution of ill health over time.”
“Through the Australian Geospatial Health Lab, we can model you as an individual to show how the geospatial and socio-demographic environments in which you live and work shape your health-related behaviour, physiological risk factors, disease and healthcare costs.”
“This will have a significant role in the clinical management of disease, shaping social and health policy, and designing programs that support healthful living and help avoid chronic disease.”
“It’s a bit like smoking was back in the ‘40s, when the tobacco companies said there’s no evidence that smoking leads to cancer. We’re seeking to provide the hard, scientific evidence around the need for healthier lifestyles as shaped by healthful environments. These factors might seem inherently obvious, but without the evidence it’s hard to argue for them in a policy sense, and to generate support for prevention – even secondary and tertiary prevention – over acute care, hospital-based intervention.”
The research team has been able to negotiate the inclusion of a set of questions in the next National Health Survey to be conducted by the Australian Bureau of Statistics, enabling them to potentially tie in data from the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme to understand how people’s environment is shaping their health over time.
Breast screening – at the shopping centre or hospital?
The research team has been working with the NSW Cancer Institute on a fascinating project that considers the impact that access to, and the location of, breast cancer screening clinics has on the uptake of breast screening in locations across the state. The aim of this work is to optimise the placement of fixed and mobile screening clinics.
“We haven’t just been assessing distance from screening clinics, but also things like traffic flow and speed in getting there – and even the setting in which the clinics are located” Professor Daniel says.
“While this is a work in progress, an early finding is suggesting that a screening clinic is more likely to be utilised if it is co-located with shops, than if it is co-located at a hospital where it’s difficult to park.”
“We have also been taking into account the demographics of specific areas, to determine whether the social composition and norms of particular communities are having an impact on screening uptake.”
Other projects with Primary Health Networks and an NHMRC-funded 10-year biomedical population cohort in South Australia has seen the team assessing how healthy lifestyles and chronic disease risk are impacted not just by socio-demographics but also by spatial factors like traffic flows, access to fast food, and public open space (or a lack of it).
The team has just completed a full outcomes evaluation of the state-wide $45 million Obesity Prevention and Lifestyle (OPAL) initiative in South Australia to prevent obesity in children, and will be issuing a final report on this by the end of June – in which the role of environmental factors features prominently.
Additionally, through a project funded by the NHMRC and Australian Research Council, the team is working with over 100 remote Indigenous communities in the Northern Territory to look at the impact of built environment infrastructures on outcomes like cardiovascular mortality and infectious disease.
“We’ve been able to show things that might seem eminently obvious, but there hasn’t been good data on it before – for example, that overcrowding at a household level and poor community infrastructures are associated with greater rates of common infectious and chronic diseases” Professor Daniel says.
“No-one’s ever done a study of this scale in Australia before. There have been smaller studies that have only involved about 10 communities, but through our much larger study we’ve got lots of different health data outcomes. The idea is to provide an evidence base for progressive social policy in support of more healthful infrastructure in these communities.”
An opportunity for collaboration
The Australian Geospatial Health Lab will be officially launched in October, and the UC-Esri partnership will be seeking formal collaboration arrangements with additional partners, including non-government organisations and governments.
“It really is a win-win situation, because we get access to health outcomes data and our partners get the benefits of outcomes analyses enriched with spatial data – this helps them to do what they do better” Professor Daniel says.
“Health research is getting increasingly sophisticated and our work is a great example of novel ways to apply digital health and geomatics technology.”
For more information on the Australian Geospatial Health Lab, please click here:
University of Canberra and Esri Australia case study video
Australian Geospatial Health Lab webpage
Contact Professor Mark Daniel via email at [email protected]