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For assignment 1.1, please discuss the following questions:
1. What are possible reasons locations in epidemiological research have not been incorporated as much as other components in epidemiological research? How can spatial epidemiology be considered as an interdisciplinary science?
2. Explain why it is widely recognized that the place where an individual lives or works should be considered as a potential disease determinant and give some examples? -
1. The reasons that locations in epidemiological research have not been incorporated as much are
– Lack of appropriate databases, such as the data was not collected for further analysis, the data were collected differently from different sites, or the quality of the data is not good enough to be analyzed in spatial epidemiology.
– Insufficient appropriate software, such as GIS software that can partially perform statistical analysis, or fully integrated statistical analysis tools in GIS software.Spatial epidemiology can be considered an interdisciplinary science because it includes both social sciences and physical and environmental science. Spatial epidemiology works with both the government and the industries and needs various expertise, such as public health, environmentalist, and scientist to get the best solution to overcome the challenges.
2. There are many factors that determine the individual’s health, but one cannot directly control them. According to World Health Organization, the determinants of health include
– The social and economic environment
– The physical environment
– The person’s individual characteristics and behaviors.One of the important determinants is the physical environment. The physical environment, such as water sources, air quality, workplaces environment, housing security, communities, and transportation can affect one’s health. For example, people who live in are which often has wildfire has a higher risk of chronic obstructive pulmonary disease or people in an area that higher traffic density tends to expose to more air pollution.
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1. Two main reasons that locations have not been incorporated in epidemiological research compared to other components are 1) availability of the health data associated with locations; 2) quality of the data, including accuracy and validity. However, as the computational and GIS technologies evolved rapidly. Data availability and quality have been gradually increased in the past decades. Spatial epidemiology incorporates spatial statistics, socioeconomy, anthropology, geography, biology and genetics to explain complex relationships between environmental and health. Thus, spatial epidemiology is an interdisciplinary science.
2. A place where individual lives or works represents relationships of the individual and environments which could be used as a potential disease determinant. For example, a high-income individual is likely to live and work in medium to high-socioeconomic areas and have different lifestyles compared to a low-income individual. Compared to the low socioeconomic areas, medium to high socioeconomic areas would have good locations closer to all amenities, safer and better sanitation. Thus, the potential health risks of these two individuals are likely to be different.
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1. The difficulty to collect location data is the possible cause of why epidemiological research not use the geographical data. If the collection of geographical data is easily than in the past, the epidemiological data may be one of the factor that include to analysis in the research papers.
2. Some infectious disease occur in some place such as melioidosis that frequently occur in north-east region in Thailand. If patients in this region came with the problem such as arthritis, liver or splenic abscess, melioidosis is the considerable differential diagnosis of that patients.
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1. The main reason that location in epidemiology research has not been incorporated as much is the lack of knowledge about how to conduct GIS-related epidemiology research and how to used GIS software. Researchers need to know the concept of GIS-related epidemiology, the GIS software, and the well-design methodology to collect, analyze, and visualized the spatial data appropriately.
Spatial epidemiology is widely considered an interdisciplinary science because it has been used to incorporates other aspects such as socio-economy, biology, and public health, etc. to find the solution to the problem.
2. The crucial factor that influences the outbreak of infectious diseases is geographical data. Some diseases occur in specific places. If the geographical data haven’t been used, the diseases control measures will be less effective. For example, if the movement of dengue patients in communities is tracked, the control measures will be operating at the place that has a risk of exposure to infected mosquitoes.
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1. What are possible reasons locations in epidemiological research have not been incorporated as much as other components in epidemiological research? How can spatial epidemiology be considered as an interdisciplinary science?
– Location can be under-recognized for associations, without correct tools. And, even with the tools, analyzing spatial associations still contain many pitfalls. That’s why it is both difficult and had to be studied separately.
– Spatial epidemiology has to be studied, to discover more tools, and consider more of nitty-gritty of spatial research. Technological advances may also help, but had to be studied further.
2. Explain why it is widely recognized that the place where an individual lives or works should be considered as a potential disease determinant and give some examples?
– The place where an individual lives involves being nearer to the risk factors, which may also be an area or point estimate, where, the nearer, the more risky.
– For example, being closer to a factory causing risks in contacting chemical wastes. Or, being in a close quarter, where people migrate often, is a risk factor to human-human communicable diseases. However, one must also consider how risk factors travel. Airborne? Short-lived droplets? Eating and drinking?
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1. What are possible reasons locations in epidemiological research have not been incorporated as much as other components in epidemiological research? How can spatial epidemiology be considered as an interdisciplinary science?
There are four main reasons why locations have not been incorporated as much as other components in epidemiological research: unaware of the relationship between place and people health, no available data or poor quality of data, the difficulty of data analysis and data privacy issues. Firstly, some researchers may not be aware that location can make an impact on health well-being and disease surveillance. The second possible reason is limited data and poor quality of data. In the past, the location might not be collected in health database and the information system was also not well-developed in some locations, leading to missing data and poor quality of data. Without proper data, the researcher could not analyze and interpreter the result. It leads to the third reason: the difficulty of data analysis. Poor quality of data makes it is hard to find the appropriate analysis method that can minimize bias and control confounding well. The last reason is data privacy issue. Location is considered as one of high-restricted personal information. Nowadays, many people prefer not to provide their personal information to outsiders. To collect that information, the research and health organizations need to consider the consent and ethical issue carefully, which can create some complexities for them.
Spatial epidemiology can be considered as an interdisciplinary science because it explains holistic relationships between geography, physical factors, environment, demographics, and health. In order to do so, there are multiple aspects to be considered such 1) Social and environmental science to understand lives, factors and environments, 2) Public health to understand the nature of disease and health dominates, 3) statistics and data management for data analysis, tools and managing data, or even 4) communication and journalism for data visualization or disease mapping.
2. Explain why it is widely recognized that the place where an individual lives or works should be considered as a potential disease determinant and give some examples?
The place should be considered as a potential disease determinant because the place does not only refer to where the people live, but it also reflects people’s behavior, socioeconomic factors, physical factors such as surrounding environment, and other risk factors they are facing with. The combination of those factors relates to people’s well-being. For example, people who live in tropical and temperate zones are more likely to get Malaria than people living in other locations because they are living in areas at risk of Plasmodium exposure.
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In my opinion, when we talk about location in epidemiological, we often thinking of them as static maps of sick people instead of locations that people actually living in. Incorporating social study in spatial epidermiology enables us to understand how disease occurred and spread, for example, in the heavily populated urban area in which people commute from rural to the center for work and study, we can implement disease control and prevention based on social settings.
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Great comments. I really enjoy what you mentioned!
The literature uses the phrases which you might come cross in the future, e.g., geographical epidemiology, spatial epidemiology, and medical geography, to describe a dynamic body of theory and analytic methods concerned with the study of spatial patterns of disease incidence and mortality. Interest in spatial epidemiology began with the recognition of maps as useful tools for illuminating potential “causes” of disease.
I totally agree with you all that it is clear where people live can be of great importance in identifying patterns of
disease. Nonetheless, investigations in public health need not pertain solely to geographical distributions of disease. The spatial distributions of the socioeconomic structure, occupational patterns, and environmental exposures of a population are also of particular importance.It is part of human nature to try to discover patterns from a seemingly arbitrary set of events. We are taught from an early age to “connect the dots,” learning that if we connect the right dots in the right way, a meaningful picture will emerge. Spatial information may be a ‘missing dot’ in public health research due to the various reasons you mentioned!, and as a component of the pattern observed, the location where an event happens may provide some indication as to why that particular event occurs.
In public health, identification and quantification of patterns in disease occurrence provide the first steps toward increased understanding and possibly, control of that particular disease. Next week we will conceptually discuss the next component of why we need analytical tools for discovering knowledge in spatial health data we start having in the past decades. Can’t wait to hear more from you all… Cheers!!! 🙂
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1. What are possible reasons locations in epidemiological research have not been incorporated as much as other components in epidemiological research? How can spatial epidemiology be considered as an interdisciplinary science?
One of the possible reason is the lack of expertise in some LMICs. Most of the epidemiologists in LMICs are not trained in geographical or spatial epidemiology. Another possible reason is the lack of opportunity to be trained in spatial epidemiology. In my country, there are only two master’s program on epidemiology. One is public health epidemiology, and the other is clinical epidemiology. None of the two programs are offering courses on spatial epidemiology so it necessitated me to enroll in this course so I can have at least a formal course with credit on spatial epidemiology. Even if we have collected complete data with spatial information and stored in our public health databases, if we do not have the expertise, we will not be able to produce any quality output. There could be very few researchers in our country who are working on spatial epidemiological projects, but most of us did not attend any formal course. We just received training on how to create maps in GIS (ArcGIS, QGIS) using point and areal data and attended short trainings or research internship on spatial epidemiology.
Spatial epidemiology is an interdisciplinary science because it entails expertise from different fields such as geography, social science, public health, epidemiology, biostatistics, etc. The mere fact that experts of different fields collaborate on a spatial epidemiological project, it is already a reflection that spatial epidemiology is interdisciplinary. Moreover, some who are working on spatial epidemiological projects are formally trained not specifically on the field of epidemiology but other field such as statistic, geography, etc.
2. Explain why it is widely recognized that the place where an individual lives or works should be considered as a potential disease determinant and give some examples?
I would like to quote Tobler’s First Law of Geography, which states that “everything is related to everything else, but near things are more related than distant things”. When the atomic bomb was dropped in Hiroshima during the World War II. Those who are living nearby had suffered from the immediate effect of the radiation. Those who lived and were spared from the immediate effect of radiation were followed through. Later on they developed the long term effect of radiation such as the development of cancers. People who were living several miles away from Hiroshima were spared not only from the immediate but also from the long-term sequelae of radiation. From this example, we can see how location can be a determinant of disease occurrence.
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As you all mentioned and agreed, this field is interdisciplinary, there are lessons I have learned and continue to learn… That would be great and I would be honored if this class can be a part of what you need in your work. So please feel free to raise any concerns and hope your fellow classmates can help and support each other. 🙂
Like mentioned above about the Tobler’s First Law, the concept is the foundation of autocorrelation we will encounter in spatial modeling and cluster detection in next sessions… This is already a good start and I look forward to what you all will do in your assignments and class project! Best wishes!
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1. There are many reason that location in epidemiological research have not been incorporate as much as possible. Actually, location is one part of description in epidemiology that compose of place time and person. Availability of data, data quality, and incomplete data cause researcher can’t bring it of analysis. Other reason is about the knowledge or practice of the researcher and practitioner. Some field epidemiology practitioners are interested for spatial analysis but they don’t have enough knowledge or don’t have the experience in spatial program analysis. Some of them think that spatial analysis need special program that hard to do or learning.
Good and wide attitude building in spatial epidemiology for use in research of multidisciplinary science. Short courses or training in concepts and using spatial epidemiology can raise the attitude, knowledge, and practice. However, for the field practitioner, their organization support is important. Not just the financial support but also opportunity support.
2. There are three important factors that determine potential of the disease including person, environment, and agent. The place where an individual lives or works should be considered because it related with the environment. Example in a infectious disease, each location has different environmental data such as temperature, humidity, light intensity directly affect virus–host interactions. People in the same place share the same environmental factors such as the water pump in Cholera epidemic.
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