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Geography -- The Missing Vital Sign In Your Physician's Office

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What do Hippocrates and Ethan Berke have in common, besides 2,400 years difference in their ages?Well, for starters they are both physicians -- Hippocrates of course lived in about 400 BC and Ethan Berke lives in the present. They both understand the direct connection between the "places" in your life and their respective impact on your personal health. They both concluded that your health depends on the air you breathe, the water you drink, and the environment in which you live. In fact, Berke believes that place (geographically) matters in your own personal health and so do many of his collogues in family medicine.

Berke suggests that place is another useful "vital sign" to any primary care physician -- someone who is concerned about the whole patient. This belief that our "places" are actually another "vital sign" is not so hard to grasp when he suggests in his correspondence piece in the Journal of the American Board of Family Medicine that "recommendations made in the clinical setting pertaining to healthy lifestyles -- more activity, better diets, avoidance of potential toxins or pollutants -- cannot occur in a vacuum. If our patients are in a home or a work environment that does not give them the opportunity to heed our recommendation, their chance of success will be diminished". Strong words but good advice!

Here is where I am on the same page with Hippocrates and Dr. Berke: where a person lives (and has lived) must be considered as part of the context in which clinical decision-making occurs. I would add that increasing the transparency and utility of the information upon which physicians make recommendations and patients are encouraged to comply, could change the way we all go about "partnering" with our personal physicians. So the next time you say "there is no place like home," think about its environmental context. The relationship we all have with our home, regardless of its amenities, is unique and potentially harmful to our health because of where that home is located geographically (and perhaps what products were used in its manufacture).

You don't have to look very far to find the evidence on this subject -- just keep reading! While we typically get introduced to our first "home" shortly after at birth without a choice, our personal and local environment either allows us to get a good start on life, or diminishes it from the start in many different ways. So our chances of success in achieving life-long health and wellness are very connected to the places we spend those early years. Of course, adults can control many aspects of their "local" environments. We can chose not to smoke or cook over open indoor flames and use indoor sanitation, etc. But children never get that choice.

A child has to trust someone else (like our parents and our governments) to protect our air, water, soil, and in some cases, our exposures to things that can harm us. This is a very big adult responsibility! You probably have your own story about geomedicine -- unusual health symptoms that can't be explained, cancers that run in certain families, neighborhoods, or communities, or the onset of chronic conditions that don't appear to have a genetic or lifestyle link. Suddenly people start to pay attention to what's around them searching for anything that might make discover a cause or offer relief or a cure.

Much like the mountain stream has a headwater, so does our personal health. Many will say that genetics is our health headwaters; but as the stream meanders across many different geographical landscapes, so does our health, accumulating unseen exposures and facing uncertain and not very apparent risks. The application of geomedicine, then, is about translating what we know about illness and disease and what we understand about the role that our various environments play in making us sick (or well), into practical information that allows each of us -- physician or consumer -- to make better choices about where we live and how we engage with our environments. There is much more to share about geomedicine. In my next blog I will discuss some of the interesting comments from readers about their own real life experiences with geomedicine.

If you're new to this discussion perhaps watching my TedMed 2009 talk and reading Alana Kornfield's blog on that event will help. Until then I always appreciate your second opinion.

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