Presentation at ENRGHI 2014 Portsmouth, UK about the role of spatial visualization as exploratory science in coping with disease conditions for which we have limited data.

1. Visualisation as Exploratory Science:
The Role of Spatial Methods in
Health and Disability Research
Presenter
Hamish Robertson
PhD Candidate
Australian Institute of Health Innovation
Faculty of Medicine
University of NSW
ENRGHI14

2. Contents
• Introduction
• Population ageing overview
• Research focus and extension
• Knowledge gaps: ageing and disability
• Visualisation as exploratory science
• Health and disability catch up
• Conclusion

3. Introduction
• Background in multicultural health and ageing research
including Aboriginal ageing
• Converted from Masters to a PhD programme in 2012
• Focus on aspects of population ageing including
politics, policy, demography etc
• Interest in GIS and systems that accommodate real-
world complexities including temporal and dynamic
• Critical emphasis, not just reproduction of the field
• Active presentation agenda – national, regional and
international
• This is an overview with some commentary – hopefully
useful and possibly interesting

4. Research Focus
What will be the localised effects of age-related
diseases (specifically AD) across New South Wales
on communities and (current) health and social
support systems?
Doing this through:
- simulation (system dynamics);
- spatialisation (GIS);
- visualisation (Google Earth).

5. PhD Research Structure
• Major components:
– Demographic modelling
– Epidemiological modelling – condition + severity
– Cost of care sub-model (possible)
e.g. annualised cost of RACF and community-based care options
– Spatial modelling – distribution and scale issues
– Spatial analysis (against existing infrastructure)
– Visualisation and exploration
– What-if analyses e.g. if x and we do y, what result
might we expect to see?

6. Global Population and Health Trends
• Falling population growth and fertility rates
(mostly) – some exceptions, others speeding up
• Rising older populations – totals and proportion
• More elderly people living alone in the community
• Rising numbers with chronic diseases
• Rising numbers with disability
• Rising numbers with neuroepidemiological (brain)
conditions (dementias, motor and gait problems)
• Complexity of the theory and epidemiology of age
and ageing (genetic, physiological, biological,
psycho-social, cultural, definitional etc)

7. Population Ageing is a Global Phenomenon

8. Significant Data Limitations
Ferri et al, (2005) “Global prevalence of dementia: a Delphi consensus study”, The Lancet

9. ADI Global Consensus Rates
Source: Alzheimer’s Disease International Fact Sheet 2008

10. Issues with Modelling Prevalence
• The dementias in general and AD in particular
• Differential rates including sub-types vary by
location – non-uniform distributions
• Quality and currency of population data
• Coverage in low resource and/or conflict settings
• Global population and prevalence estimations
• Dynamic variables such as rates by sub-type,
diagnosis, educational levels, economic capacity,
training, workforce, safety in the field etc
• Population-level knowledge versus clinical
studies versus informed estimates

11. Cohort-Specific Ageing in Australia
2006-2021 and 2006-2031
Source: Australian Innovation System Report 2012

12. Knowledge Gaps: Ageing and Disability
• Many studies are sample-based only – no
universal data on prevalence or incidence of
specific conditions e.g. Alzheimer’s disease
• Some global estimates are Delphi-based i.e.
informed ‘guesstimates’ by a panel of experts
• Many conditions have mixed aetiologies –
correlate data good but causal chain poor
• Non-linearity an issue with population-level
projections e.g. recent research on dementia
rates suggests rising and falling possible

13. Visualisation as Exploratory Science
• Started presenting internationally and found a complete lack of familiarity
with spatial analysis and representation – similar in social policy etc
• Adding a spatial dimension to modelling activities is useful and interesting
for mixed audiences who may not share professional backgrounds,
methods etc
• Started trialling basic models of AD for Australia, New Zealand etc
• Then applied basic concepts to Africa using LandScan data set – example
in KML format
• Now moving into the disability sector where GIS etc also (mostly) poorly
understood and applied
• As mentioned, disability and ageing correlate well but politics of disability
may be an issue (identity versus functional impairment or adjustment)
• Spatial modelling and visualisation extend basic demographic-
epidemiological estimates and can add scale and distribution patterns to
our understanding of poorly understood diseases and their impact

14. Health and Disability (Need to) Catch Up
• Spatial literacy low in much of the health and disability
sciences + planning + policy + business practices
• Significant information gaps in both health and disability
sectors e.g. gender, diversity etc
• Emphasis on technology often exceeds scientific understanding
i.e. they like new things
• New technology has its own consequences (Tenner etc), often
unplanned for entirely – positive emphasis dominates
• Complexity of health and disability makes spatial perspective
central but it remains marginal
• Claims to ‘evidence-based’ planning and implementation need
to be checked against actual and potential effects
• Ageing will affect both health and disability domains in
significant ways but many policy responses avoid close
examination of localised impacts.

15. Conclusion
• Many aspects of health and disability are patterned spatially
because of social structures, policies and processes
• Population ageing will have a huge global impact until at least
2050 – hyper-ageing of societies
• Many age-related conditions lack good data at the global level
and below – emphasis on MDG diseases
• Spatial science and technology plus geographic theory have a
potential contribution to make (I think a significant one but…)
• Health and medical geography (HMG) should be central to
policy-level responses and below – science often quite selective
• Critical HMG has a role to play in critiquing public and private
sector responses to these issues and adding to the potential of
advocacy and related organisations and their work