Statistical, Mapping and Digital Approaches in Healthcare

By Gilles Maignant and Pascal Staccini

Statistical, Mapping and Digital Approaches in Healthcare addresses all health territories, starting from the analysis of geographical data (health data, population data, health data systems and environmental data), to new health areas (Health 3.0), i.e. digital health territories. Specific tools are used to question environmental changes, such as health statistics, mapping, mathematical models, optimization models and serious games.

• Uniquely combines the approaches of mathematicians, geographers and physician to the analysis of health territories
• Presents views that are based on an interdisciplinary framework, proposing a new look on health
• Ideal for both clinicians and policymakers

• Language: English
• Publisher: Elsevier Science
• Release date: Nov 19, 2018
• ISBN: 9780081019627

Gilles Maignant

Gilles Maignant is a research fellow at the CNRS at University Nice Sophia Antipolis and a Geographer at the laboratoiry ESPACE (UNS)

Book preview

Statistical, Mapping and Digital Approaches in Healthcare

Gilles Maignant

Pascal Staccini

Territory Management and Digital Healthcare Set

coordinated by

Gilles Maignant

Table of Contents

Cover image

Title page

Copyright

Introduction

1: From the Territory to Health Territories

Abstract

1.1 Territory: originally a geographic and administrative concept

1.2 Health territories

1.3 Health of territories

1.4 Understanding the links between environment and health within a territory

1.5 From the environment to health: a question of exposure

1.6 Exposure to fine particles and respiratory problems: from hospitalization to mortality

1.7 Air pollution in the city, impact on health of vulnerable populations and overall perception

2: The Contribution of Statistics to the Understanding of Health Issues in a Territory

Abstract

2.1 Statistics: a historical contribution to the understanding of phenomena

2.2 On the relevance of the indicators

2.3 Data sources: Big Data and its use in health

2.4 Problem of data alignment: the issue of usable formats

2.5 Ethical issues surrounding data

3: Contribution of Cartography to the Understanding of Health Issues

Abstract

3.1 Reflection on cartography and its contributions

3.2 A few helpful elements in cartography

3.3 The MAUP and the problem of data aggregation

3.4 What are the constraints in the area of health?

3.5 Example of the development of an environment–health platform

3.6 Optimization of emergency services during times of crisis: the application GÉOSAMU

4: Contribution of Digital Technology to the Understanding of Health Issues in a Territory

Abstract

4.1 Consumer health informatics: what are the benefits for the patient, and what are the drawbacks?

4.2 E-health: a new development in health in the world

4.3 Health itineraries and differentiated vulnerability

4.4 From model sets to serious games models

4.5 Connected medical consultations: how will medicine be practiced in tomorrow’s world?

5: The Territory as an Issue of Integration into a Process of Optimization

Abstract

5.1 Territories as a catalyst for the development of Smart cities

5.2 A new theory of the optimum: constructal theory – a step towards a possible transfer into other sciences

5.3 Issues in terms of health

Conclusion

Bibliography

Index

Copyright

First published 2018 in Great Britain and the United States by ISTE Press Ltd and Elsevier Ltd

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address:

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

For information on all our publications visit our website at http://store.elsevier.com/

© ISTE Press Ltd 2018

The rights of Gilles Maignant and Pascal Staccini to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

British Library Cataloguing-in-Publication Data

A CIP record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library of Congress

ISBN 978-1-78548-211-3

Printed and bound in the UK and US

Introduction

La pensée du moyen pour construire devient le moyen de penser

Paul Valéry [SIG 00]

This book is born from the coming together of an environmental mathematician/researcher with an interest in health-related issues, and a public-sector doctor and university lecturer, specializing in medical information processing, both teaching at the Department of Risk Engineering and Health IT (IRIS – département d’ingénierie du risque et informatique de santé) in the Faculty of Medicine, at the University of Côte d’Azur (UCA). The authors have previously collaborated on writing a collection of MCQs in mathematics and biostatistics, aimed at first-year university students taking the classes common to all medical students, published by Ellipses.

No branch of the sciences has its own unique topics; rather, each discipline offers its own point of view of subjects which might also be examined by other disciplines [CHA 03]. The paradigm of complexity invites a rethinking of the interactions bringing together the different facets and angles of observation of the same subject. Indeed, complexity is invisible in disciplines which fragment or isolate the subject. Hence, it is necessary to make connections. When we are dealing with a rich, multidimensional subject, it is not enough simply to stack the contributions of the various disciplines to derive meaning [MOR 02]. To borrow an expression from Basarab Nicolescu, another theorist of transdisciplinarity, the understanding of complex subjects requires a disciplinary big bang, the aim being to transform a pluridisciplinary thought – Morin refers to this idea when he mentions the insufficiency of adding together the disciplines into a transdisciplinary thought, which is at once amongst, through and beyond the disciplines [NIC 94].

Given its position at the very heart of the interdependence between human beings and their environment, and given the diversity of the factors and cofactors upon which it depends, health is a research topic which has produced numerous collaborations between disciplines. However, the singularity, the uniqueness, of each such discipline is simultaneously the condition for their complementarity and the source of the contradictions, misunderstandings and methodological discord between them. Thus, in a transdisciplinary depiction of the issues of the environment and health, neutral ground needs to be found – meeting points, where we can weave together the numerous dimensions of the interactions between the two domains. The territory is one such meeting point.

This book offers a new perspective on health data in connection with environmental issues – in particular, air pollution – considering different spatial and temporal scales. It is aimed at anyone interested in the evolution and processing of territorial health data. In writing it, the authors opted for systemic reflection, using concrete examples from the environmental field, rather than trying to write a coursebook, although reminders are presented in each chapter. Whilst the book follows a logical plan based on the historical evolution of uses of health and/or environmental data, each chapter can be read and understood independently of the others.

The different chapters deal with the various methods used in processing and representing health data, supporting the discussion with a review of the academic literature produced in recent years. The goal is not to give an exhaustive treatment of all methods used but rather to open readers’ eyes to the pros and cons of each method. Interested readers can gain more information about the subjects of each of the larger chapters (statistics, cartography, digital technology) by consulting the numerous references mentioned in the text and in the bibliography. This book situates the complexity of these approaches within a broader framework – that of territories, and more specifically, of cities, because it is in cities that health, environmental and social issues are concentrated.

The first chapter introduces the concept of a territory – a term which is, by nature, polysemic and multifunctional. It touches on the links between the environment and health in a multi-scale approach, both in spatial and temporal terms, and defines a new field: the environment–health space. Through the lens of examples taken from the academic literature, it also deals with the question of exposure, whether through monitoring cohorts or through models. It plays on the expressions territories of health and health of territories.

Chapter 2 discusses data, and in particular the contribution made by statistics (the first element in our triptych) to understanding questions of health within a territory. Using various examples to illustrate certain statistical techniques, this chapter should give the reader a degree of perspective on the use of data with a view to understanding the links between health and the environment. With the burgeoning volume and increasing heterogeneity of data (Big Data), this chapter discusses the pertinence of indicators and the problem of data structure alignment, as well as also ethics in what is inevitably a sensitive context.

The third chapter examines the representation of information, for consultation by the general public, by academics or by the political decision-makers. Of the various information representation techniques, one is set apart from the rest by its communication properties: this method is cartography (the second element in our triptych). Nevertheless, even cartography is not without its limitations. The pros and cons of this type of spatial representation will be discussed, notably in terms of the interleaving of scales and of MAUPs (Modifiable Area Unit Problems), but also in terms of the aggregation and disaggregation of data. In view of the constraints of data availability and clinical ethics, we discuss an optimal scale by which to measure environment–health links.

Chapter 4 discusses digital technology (the third element in our triptych) for the understanding of health questions within a territory. This chapter deals with the question of real-time health data, the concept of Consumer Health Informatics and the vast domain of e-health, by means of a number of examples such as health itineraries, serious games or the connected medical cabinet.

The fifth and final chapter looks to the future and discusses the development of the SMART concept in various fields that have an impact on health – a notable example is the concept of a Smart city. It deals with the question of territorial optimization (health-related and environmental) by introducing a theory drawn from engineering sciences: constructal theory.

1

From the Territory to Health Territories

Abstract

The concept of a territory is polysemic, and has evolved over time. In 1875, Pierre Larousse defined a territory as an area of a country subject to any specific authority or jurisdiction. A territory is defined by three characteristics: it is appropriable, has boundaries and has a name (be it toponymical or anthroponymical). In Gilles Deleuze’s view, a territory is formed when components of environments cease to be directional and become dimensional; when they turn from being functional to being expressive – that is, the territory denotes a space with an expression marked by the way of living there. Geographer Roger Brunet defines a territory as a constituent part of the urban environment, which, in principle, is lower in status than normal delimitations, because the appropriation is not complete in a territory, in contrast to the total appropriation in districts. It is also a portion of space with a feeling of appropriation (a space which is inhabited, perceived, practiced, etc.). Hence, the notion of a territory is at once judicial, social, cultural and even emotional. It always involves an appropriation of a space.

Keywords

Aggregation; Cartography; Cohorts; Fine particles; Health impact assessments; Health territories; Morbidity; Mortality; Peak flow; Ultrafine particle

1.1 Territory: originally a geographic and administrative concept

The concept of a territory is polysemic, and has evolved over time. In 1875, Pierre Larousse defined a territory as an area of a country subject to any specific authority or jurisdiction. A territory is defined by three characteristics: it is appropriable, has boundaries and has a name (be it toponymical or anthroponymical). In Gilles Deleuze’s view, a territory is formed when components of environments cease to be directional and become dimensional; when they turn from being functional to being expressive – that is, the territory denotes a space with an expression marked by the way of living there [FER 98]. Geographer Roger Brunet defines a territory as a constituent part of the urban environment, which, in principle, is lower in status than normal delimitations, because the appropriation is not complete in a territory, in contrast to the total appropriation in districts [BRU 09]. It is also a portion of space with a feeling of appropriation (a space which is inhabited, perceived, practiced, etc.). Hence, the notion of a territory is at once judicial, social, cultural and even emotional. It always involves an appropriation of a space [BRU 09].

A territory is also defined by its administrative boundaries, which determine the range of decisional influence. The online French dictionary Trésor de la langue Française informatisé, accessible at http://www.atilf.fr/tlfi, gives the following definition of a territoire (territory): a space delimited by boundaries, subject to its own political authority, legally considered to be a constitutive element of the State, and representing the boundaries of governors’ range of influence.

In practice, territories are subdivided on the basis of administrative logic. Small communes may only have one postal code, whereas for large communes, several different postal codes may belong to the same commune regardless of whether or not there are districts within the commune. Similarly, a postal code may encapsulate several communes, or even overlap two communes. Bourrelly [BOU 14] points out that French postal codes represent spatial imprecision, which needs to be taken into account. In 2003, there were 6,285 postal codes in France, covering 38,954 communes. We shall see later on that this means choices must be made in referencing the health data collected as part of the PMSI (Programme de Médicalisation des Systèmes d’Information – Information Systems Medicalization Program), begun in June 1982 by the Ministry of Health with the aim of introducing a medical dimension into the information collected about hospital activity.

In terms of data on the populace (census), the smallest available scale is that of IRIS, which corresponds to the smallest scale that can ensure anonymity (CNIL). The idea of the IRIS was devised by INSEE when preparing to publish the census data for the French populace in 1999. INSEE had developed a way of dividing the territory into uniformly-sized grid squares, called IRIS2000. The acronym stands for Ilots Regroupés pour l’Information Statistique – Clusters for Statistical Information – and used as a reference the approximation of 2,000 residents per elementary grid square. Thus, communes having at least 10,000 residents, and a