Presenters' Abstracts

Charles H. King, MD

Microscope to Macroscope - Using GIS to understand environmental complexity in disease causation

For more than a century, medical scientists have focused on cells, microbes, and even tiny changes in key molecules in order to explain the ‘causes’ of human disease. This reductionistic approach has provided powerful insights into underlying pathogenesis. In practice, however, it has become ever more apparent that disease control and prevention require further attention to patient context, including social, economic, and environmental factors that go beyond the mere presence or absence of molecular disturbance or microbial infection. When routine precautions fail to prevent disease, or when standard treatments fail to cure, the reasons usually lie in the ecosystem in which disease occurs; in determining risk, the varied settings in which patients are exposed to disease can be as important as their individual traits. Advances in ecological and statistical sciences and in data management now allow us to carefully reexamine the impact of environmental setting for many health care problems. By integrating large datasets on potential environmental risk factors, Geographic Information Systems (GIS) provide the means to re-examine their likely impact on health outcomes. Focused interventions, (targeted in space and over time using the GIS) hold the potential to maximize the benefits of health interventions, and provide even greater benefits in terms of disease prevention.