Air pollution and other environmental exposures play a major role in community health, but they’re often left out of healthcare data (Matthew Parsanian/Unsplash).
Why Environmental Data Belongs in Healthcare
Over the past 20 years, healthcare organizations have become exceedingly good at collecting, storing, and organizing information for each patient. Walk into any modern hospital or clinic, and you’ll find digital systems capturing every vital sign, medication dosage, and diagnostic code. Yet despite this unprecedented data collection capability, healthcare organizations underutilize environmental information that could improve patient care.
While healthcare providers collect intimate information about their patients, they do relatively little to contextualize the environments in which these patients live and work. We know a patient’s blood pressure readings, but do we know about the air quality in their neighborhood? We track their diabetes management, but do we consider their access to green spaces for physical activity? We document their asthma symptoms, but do we account for industrial emissions near their home?
Environmental factors are not randomly distributed across geography—they create systematic patterns of exposure and interactions that profoundly influence health outcomes. Traditional population health research has focused on inferential testing methods that ignore this spatial and environmental context, assessing populations as if they exist in an environmental vacuum where every case of asthma is unrelated to those right next door, independent from the highway 100 yards away, unassociated with the pollen and particulate matter in the air.
Consider a child on Medicare living in South-Central Los Angeles; a teenager in Pasadena who lives next to Los Angeles National Forest; an infant born to a family in Victorville. While our Electronic Health Records (EHR) capture the intimate details of these individual’s proximate medical conditions, anyone familiar with the Greater Los Angeles area can recognize that each of these individuals lives in a very different world. Yet, the physician that sees them is given none of this context, despite overwhelming evidence that this information has bearing on their health.
The physician may not know where our child from South-Central actually lives, let alone that traffic on the 405 freeway makes it nearly impossible to get to the hospital in a timely manner between the hours of 8-10 a.m. or 4-6 p.m. The physician may not know that our teenager could have been exposed to airborne lead and asbestos in the January wildfires, or that the infant lives in an area of extreme heat, with parents who must endure a two-hour commute for each checkup with a specialist.
Environmental contexts like these are so often overlooked in our approach to healthcare. But in a world of ballooning costs and climate change, this information has the unique ability to provide both better care and reduce healthcare costs. My dissertation work focuses on the intersection of spatial statistics, population health, and environmental science—a typically strange place to be as a researcher. I aim to combine and synthesize perspectives and methodology from disparate fields that have their own experts with their own backgrounds and skill sets. However, each field offers vital perspective in coherently understanding environmental and geographic effects on health disparities.
Environmental health problems are inherently interdisciplinary, requiring expertise in environmental monitoring, health outcome measurement, statistical analysis, and policy intervention. The current state of the literature in this area can be scattered and the methodology often scattered, leaving actual care recommendations and policy insights muddled and hard to decipher. Setting a road map for clear analysis approaches, standardized reporting, and recommendations on best practices within this intersection is paramount to improving healthcare on both a neighborhood and national level.
Placing people in an environmental context allows for better screening of environmental health risks, and can reduce healthcare costs down the line. Fundamentally, environmental conditions are healthcare data, and treating them as such opens up entirely new possibilities for improving population health while addressing environmental justice concerns.
Healthcare organizations that begin integrating environmental data have a significant advantage in understanding their patient population. Placing people in an environmental context allows for better screening of environmental health risks, and can reduce healthcare costs down the line. Fundamentally, environmental conditions are healthcare data, and treating them as such opens up entirely new possibilities for improving population health while addressing environmental justice concerns.
Although technical barriers are rapidly diminishing in our healthcare system, barriers that are often organizational and cultural remain. Healthcare systems need to recognize that environmental health isn’t separate from healthcare—it’s fundamental to healthcare. Environmental exposures aren’t background factors to be controlled for in statistical models—they’re primary determinants of health that require direct intervention and policy action.
Working alongside partners at Children’s Hospital Los Angeles and researchers at the Spatial Sciences Institute, and with the support of the Wrigley Institute, has provided me opportunities to embrace innovative approaches to addressing environmental health disparities. The Wrigley Institute Graduate Fellowship, specifically, has shown me that the interdisciplinary collaboration in fields of environmental science are essential and underutilized in our healthcare system.
Andy Kampfschulte is supported by the USC Dornsife Wrigley Institute Graduate Fellowship