Maignant Gilles - Statistical, Mapping and Digital Approaches in Healthcare

Gilles Maignant

Pascal Staccini

Territory Management and Digital Healthcare Set

coordinated by

Gilles Maignant

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

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ISBN 978-1-78548-211-3

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La pense du moyen pour construire devient le moyen de penser

Paul Valry

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 dpartement dingnierie du risque et informatique de sant ) in the Faculty of Medicine, at the University of Cte dAzur (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 .

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 environmenthealth 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.

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 environmenthealth links.