00:16Can geographic information make you healthy?

00:22In 2001, I got hit by a train. My train was a heart attack.

00:29I found myself in a hospital, in an intensive-care ward, recuperating from emergency surgery...

00:36...and I suddenly realized something. That I was completely in the dark.

00:41I started asking my questions. Well, why me? Why now? Why here?

00:45Could my doctor have warned me?

00:48So what I want to do here in the few minutes I have with you, is really talk about what is the formula for life and good health.

00:56Genetics, lifestyle, and environment.

00:59That's going to sort of contain our risks and if we manage those risks we're going to live a good life and a good healthy life.

01:07Well, I understand the genetics and lifestyle part.

01:10And you know why I understand that?

01:12Because my physicians constantly ask me questions about this.

01:17Have you ever had to fill out those long legal-sized forms in your doctor's office?

01:22I mean, if you're lucky enough you get it to do it more than once, right?

01:26Do it over and over again and they ask you questions about your lifestyle and your family history...

01:31...your medication history, your surgical history, your allergy history.

01:36Did I forget any history?

01:39But this part of the equation I didn't really get and I don't think my physicians really get this part of the equation.

01:48What does that mean, my environment?

01:51Well, it can mean a lot of things.

01:53This is my life. These are my life places. We all have these.

01:58While I'm talking, I'd like you to also be thinking about how many places have you lived?

02:04Just think about that you know, wander through your life thinking about this.

02:08And you realize that you spend it in a variety of different places.

02:12You spend it at rest and you spend it at work...

02:14...and if you're like me you're in an airplane a good portion of your time traveling someplace.

02:19So it's not really simple when somebody asks you where do you live, where do you work, and where do you spend all your time...

02:25...and where do you expose yourselves to risks that maybe perhaps you don't even see?

02:32Well, when I have done this on myself, I always come to the conclusion...

02:36...that I spend about 75 percent of my time relatively in a small number of places.

02:43And I don't wander far from that place for a majority of my time, even though I'm an extensive global trekker.

02:52Now, I'm going to take you on a little journey here.

02:54I started off in Scranton, Pennsylvania.

02:56I don't know if anybody might hale from northeastern Pennsylvania.

02:59But this is where I spent my first 19 years with my little young lungs.

03:04You know, breathing high concentrations here of sulfur dioxide, carbon dioxide, and methane gas, in unequal quantities.

03:12Nineteen years of this, and if you've been in that part of the country, this is what those piles of burning, smoldering coal waste look like.

03:21So then I decided to leave that part of the world and I was going to go to the Midwest.

03:26Okay, so I ended up in Louisville, Kentucky.

03:29Well, I decided to be neighbors to a place called Rubber Town.

03:33They manufacture plastics. They use large quantity of chloroprene and benzene.

03:38Okay, I spend 25 years in my middle-age lungs now, breathing various concentrations of that...

03:46...and on a clear day it always looked like this so you never saw it.

03:50It was insidious and it was really happening.

03:53And then I decided I could get really smart.

03:55I would take this job in the West Coast and I moved to Redlands, California.

04:01Very nice, and there my older, senior lungs, as I like to call them...

04:07...I filled with particulate matter, carbon dioxide, and very high doses of ozone, okay?

04:13Almost like the highest in the nation, right? This is what it looks like on a good day.

04:17If you've been there, you know what I’m talking about.

04:20So what's wrong with this picture?

04:23Well, the picture is there's a huge gap here.

04:25The one thing that never happens in my doctor's office, they never ask me about my place history.

04:32No doctor can I remember ever asking me where have you lived?

04:37They haven't asked me what kind of the quality of the drinking water that I put in my mouth...

04:42...or the food that I ingest into my stomach. They really don't do that. It's missing.

04:48Look at the kind of data that's available.

04:51This data is from all over the world.

04:53Countries spend billions of dollars investing in this kind of research.

04:57Now I circled the places where I've been.

05:00Well, by design, if I wanted to have a heart attack, I've been in the right places. Right?

05:08So how many people are in the white?

05:10How many people in the room have spent the majority of their life in the white space? Anybody? Boy you're lucky.

05:17How many have spent it in the red places? Oh, not so lucky.

05:22There are thousands of these kinds of maps that are displayed in atlases all over the world...

05:29...to give us some sense of what's going to be our train wreck.

05:34But none of that's in my medical record and it's not in yours either.

05:38So here's my friend Paul. He's a colleague.

05:41He allowed his cell phone to be tracked every two hours...

05:46...24/7, 365 days out of the year for the last two years, everywhere he went.

05:52And you can see he's been in a few places around the United States, and this is where he has spent most of his time.

06:00If you really studied that, you might have some clues as to what Paul likes to do.

06:06Anybody got any clues? Ski. Right.

06:10And we can zoom in here and we suddenly see that now we see where Paul has really spent a majority of his time.

06:16And all those black dots are all of the toxic-release inventories that are monitored by the EPA.

06:24Did you know that data existed?

06:27For every community in the United States, you could have your own personalized map of that.

06:33So our cell phones can now build a place history.

06:36This is how Paul did it. He did it with his iPhone. This might be what we end up with.

06:41This is what the physician would have in front of him and her when we enter that exam room...

06:48...instead of just a pink slip that said that I paid at the counter. Right?

06:51This could be my little assessment and he looks at that and he says, Whoa, Bill.

06:57I suggest that maybe you not decide just because you're out here in beautiful California...

07:02...and it's warm every day, that you get out and run at 6:00 at night.

07:07I'd suggest that that a bad idea Bill, because of this report.

07:14What I'd like to leave you for are two prescriptions.

07:17Okay, number one is, we must teach physicians about the value of geographical information.

07:23It's called geomedicine. There's about a half a dozen programs in the world right now that are focused on this...

07:29...and they're in the early stages of development.

07:32These programs need to be supported and we need to teach our future doctors of the world...

07:39...the importance of some of the information I've shared here with you today.

07:43The second thing we need to do is...

07:45...while we're spending billions and billions of dollars all over the world building an electronic health record...

07:53...we make sure we put a place history inside that medical record.

07:57It not only will value the...be important for the physician...

08:00...it'll be important for the researchers that now will have huge samples to draw upon, but it'll also be useful for us.

08:09I could have made the decision if I had this information, not to move to the ozone capital of the United States, couldn’t I?

08:17I could make that decision.

08:18Or I could negotiate with my employer to make that decision, in the best interest of myself and my company.

08:28With that, I would like to just say that Jack Lord said this almost 10 years ago.

08:34Just look at that for a minute.

08:36That was what the conclusion of the Dartmouth Atlas of Health Care was about...

08:41...was saying that we can explain the geographic variations that occur in disease and illness and wellness...

08:48...and how our health care system actually operates.

08:51That was what he was talking about on that...on that...quote.

08:55And I would say he got it right almost a decade ago...

08:59...so I'd very much like to see us begin to really seize this as an opportunity to get this into our medical records.

09:06So with that, I'll leave you the, in my particular view of health, geography always matters.

09:13And I believe that geographic information can make both you and me very healthy.

09:17Thank you.