Would Geomedicine Have Saved Walter Payton’s Life?

February 16, 2022
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This is my 34th article for Directions Magazine. Thirty-four was also the jersey number of Walter Payton, arguably the greatest professional football player ever, both because of his skills on the field and his dedication to his communities in Chicago and Mississippi. He died on November 1, 1999 of a rare liver disease.

Payton grew up in rural Mississippi and went to Jackson State, an HBCU in Jackson. Did the rare liver disease that ended his life have anything to do with environmental factors that affected his home cities? How could such a healthy person succumb to such a random illness at age 45?

In this article we’ll explore how geospatial technology can and is being used to contribute to public and environmental health. I have written about social and environmental justice before, but this piece delves deeper into the environmental geography of public and individual health.  

One of the most challenging modules in my environmental law and policy course is the one on environmental justice. I have students find a case study and share it in class. It can be awkward and uncomfortable to discuss race and class in a college classroom, but that is what upper-level courses are about, to challenge and foster critical thinking.

Not only do students need to cite two sources about their topic, they also need to include a map. All students in our environmental sciences program are required to take two GIS courses, which I also teach, so this exercise allows me to explain how these two topics are interrelated.

It is a rigorous exercise for a 100-level course. They have to execute spatial and tabular selections, as well as spatial and tabular joins and relates. The exercise teaches them functional skills, but just as important, if not more so, it illustrates how GIS and maps can integrate disparate data to tell a meaningful story. Our program director has developed several exercises on public health as examples, including one on the proximity of our city’s schools to stores that sell tobacco.

One of our students took this exercise further and overlaid economic data on top of it to tell yet another story, and not a happy one. Without getting political, it is an empirical fact that people who are poor suffer more from environmental factors than people who aren’t. Schools in less affluent parts of the city have more stores that sell tobacco within a ten-minute walking distance than they have parks within that same distance. The analysis was done with a cost-path model, not just a simple distance buffer. The model also included safe walking areas (where there were sidewalks and lights) and accessible entries to parks.

The Nature Conservancy has a powerful story and infographic on this that illustrates how the richest segment of the population contributes most to climate change but suffers the least, while those who contribute the least suffer the most.

Crisis and awareness can lead to progress.

The Cuyahoga River in Cleveland, Ohio caught fire thirteen times before citizens had enough. This led to the establishment and passage of the Clean Water Act, enacted by a bipartisan Congress. However, it took a cover story in Time Magazine to mobilize Congress to actually take action. (The river has since been cleaned and is now a safe and popular recreation site.)

The same is true with the coronavirus pandemic; however, that could be an article unto itself. Right now there is simply too much noise to delve into details, but it is encouraging to see that, along with first responders and frontliners, there are so many geospatial professionals who are part of the solution.

While the Cuyahoga fire was a local incident that led to national action, COVID-19 is a global crisis that has led to national action as well. One of the many reasons for national (and global) action is awareness and dissemination of data, including spatial data. Again, there is that running theme of the power of maps. As we’ve all seen in our careers, the public, our peers, our students and others are much more likely to spend time with a map than a spreadsheet.

USAFacts.org, a not-for-profit, nonpartisan organization whose mission is “making government data easy for all Americans to access and understand,” has an interactive map of Covid-19 using fact-based sources. Other trusted institutions, including Johns Hopkins, the Mayo Clinic, and the Centers for Disease Control and Prevention, also offer interactive maps that are updated on a regular basis, along with infographics that show such factors as transmission rates, total reported cases and daily new cases from the global scale to individual counties. 

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A lot of correlation and a lot of association.

Years ago, when I was with Esri, I had the opportunity to present on a tour of public health organizations in Washington and Oregon. (I think we did six meetings in seven days!) Geospatial technology was only beginning to be discovered by health organizations, so my team and I were out there evangelizing. We met with people at hospitals, universities, governments, and community groups.

We were under the leadership of Bill Davenhall, who first used the term "geomedicine" in a TEDMED talk in 2009, after he had a heart attack. He was presenting on the lack of spatial information in health care, specifically in a patient’s locational history. You see, Bill had lived in some of the most polluted places in the U.S. — Scranton, Pennsylvania; Louisville, Kentucky; and Redlands, California. He understood all too well that where a person lives can have a tremendous effect on their health. And while Bill may not have been the first person to use the term “geomedicine,” he certainly brought it to the attention of a larger audience.

Geomedicine focuses on taking location and environment into account when analyzing individual and public health. Over the years, my students have presented some powerful stories on this topic, exploring the anxiety caused by living next to an airport and constantly hearing loud noises, and the ill-effects of living downwind from a nuclear test site or downstream from a mine tailings pond.

Fortunately, there are many people who are using geospatial technology (GST) to address these problems.  This field is still fairly nascent, but as awareness is raised and GST becomes easier to use, geomedicine will surely become a more common tool. The power of GST is that we can integrate spatial and tabular data (the G and the I in GIS) to make a story that can be understood by all. Will it solve the problem? Of course not, but it will make data more digestible.

Loma Linda University in Southern California is one of the first colleges to offer courses and degrees in geomedicine and has built its Health Geoinformatics Laboratory to cross-pollinate students and faculty in both health sciences and GIS.  (At a more granular level, another example of geomedicine is a GPS-enabled asthma inhaler.)

Thanks to Bill Davenhall’s work, Esri has a robust health care industry group and, at the virtual 2021 conference, offered over 23 presentations with topics as diverse as Building Health GIS Capacity in the Workforce, Maps and Apps for Quick Success, and contact tracing, with presenters on a global scale, from Alabama to Africa to New Zealand. They are also offering a conference in May this year, with registration notices pending.

Living in a rural area, I understand the challenges of quality health care when one has to drive dozens or, maybe, hundreds of miles to see a physician, let alone a specialist.  This is particularly true on tribal lands in the western U.S., where many households are without reliable transportation and far from medical services.  

Tribal Epidemiology Centers offer GIS trainings on the essentials of how to find and download data, share it with the community, and use the maps and data for decision-making. An AGOL map shows Healthcare Facilities and Service Boundaries of the Indian Health Service. Upon initial inspection, the data seem coarse and not well vetted, but it does paint a national-scale picture and offers a template for further refinement.

It’s not all bad news.

In 1987, working-class Blacks and whites united in Columbia, Mississippi — Walter Payton’s hometown. There was an industrial plant that exploded, but only after decades of industrial pollution that led to cancer and other ailments in people of all races, classes and colors. The citizens of Columbia found a common cause because they cared for their families.

In my environmental law and policy course, I emphasize the concept of the commons. We all breathe the same air; we all need clean water. Healthy ecosystems make healthy people, and healthy people are less expensive to society. There are still disparities between rich and poor, but these are examples of how people can work together to make our home planet a healthier and safer place, following number 34’s example of selflessness.

We miss you, Walter!


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