Envisioning better health outcomes for all
The current covid-19 pandemic has shined the spotlight on longstanding health inequities for people of color. According to the Centers for Disease Control and Prevention, compared to the general United States population, African Americans are 1.4 times more likely to contract the coronavirus, and 2.8 times more likely to die from covid-19. Similarly, Native Americans and Hispanics/Latinos are nearly twice as likely to be infected by coronavirus, and 2.5 to 2.8 times more likely to die from it.
Underlying these statistics are significant structural, social, and spatial issues. But why is this? And how do we begin to quantify and address the nested problems of public health inequality?
Understanding the geography of health inequity
One tool that can help us understand the higher coronavirus infection and death rate among people of color is mapping produced by a geographic information system (GIS). GIS correlates geography to key issues by layering relevant, sometimes seemingly disparate data to achieve clarity on complex situations.
For instance, one of the first things GIS users and epidemiologists mapped in the pandemic was the locations of vulnerable populations. Each layer of data took into account various contributing factors to such vulnerability. These include potential exposure through essential jobs; disease susceptibility for seniors and people with certain health conditions; the risk of transmission for public transit commuters and those in group living situations; and socioeconomic disadvantages through poverty, inadequate education, and lack of health insurance. The dynamic analyses that GIS enabled immediately guided actions by first responders and gave epidemiologists an evidenced-based way to assess vulnerability against hospital accessibility and capacity.
As awareness of the disproportionate number of deaths in communities of color grew, the same tool was applied to understand the causes behind this inequity, which, in turn, can aid in defining and developing potential solutions.
It’s been long understood that people living in inner cities face conditions that have clear correlations to overall health. These include income and education disparity, a low percentage of home ownership, increased exposure to neighborhood pollution, and reduced access to wellness care and reasonably priced fresh food. Another important dataset relevant to the covid crisis is the disproportionate percentage of people of color in service jobs that put them into daily close contact with the virus.
“GIS can help identify where outcome disparities exist, perform analysis to understand root causes, and focus mitigation efforts on places where systemic racism concentrates causal factors,” says Este Geraghty, chief medical officer and health solutions director at GIS vendor Esri. By analyzing all relevant data on a GIS-based smart map, Geraghty says leaders are poised to uncover localized insights that drive potential solutions. This means, “we can provide stopgaps until we have fully equitable systems, ensuring that one day everyone will have the same opportunity to reach their full health potential.”
Geraghty adds, “If you can’t understand all of the contributing factors in context, you might not anticipate potential problems or solutions.”
GIS for effective covid-19 vaccine distribution
Another pandemic-related problem tied closely to geography is how to get covid vaccines to the public in an equitable, safe, and effective manner. GIS provides the tools to analyze prioritized needs, plan distribution networks, guide deliveries, see the real-time status of inoculation missions, and monitor overall progress.
Geraghty developed a covid vaccine distribution approach using GIS. She explains that the first step is to map those facilities currently suitable for distributing the vaccine to the public. Since some vaccines need ultra-cold storage, facilities will have to be differentiated according to that and other storage capabilities. As part of the facility dataset, Geraghty says, GIS can also be used to calculate how many vaccines each facility’s staff can potentially administer in a day. In addition to hospitals, other facility types will need to be considered based on their ability to deliver the vaccine to underserved and remote populations. Facilities might include university health clinics, independent and retail pharmacies, and potentially even work sites willing and able to inoculate employees, among others.
The next step involves mapping the population—not only their locations and numbers, but also according to the categories recommended by the CDC guidance and state-based plans for the phased rollout of the vaccine.
By correlating these two layers of data on the map (facilities and population), it becomes clear which communities aren’t within a reasonable travel time to a vaccination location, based on multiple modes of travel (for example, driving, walking, public transit).
Geraghty explains, “That geographic perspective will help find any gaps. Who is left out? Where are the populations that aren’t within the range of identified facilities?” This is where GIS can improve decision-making by finding options to fill gaps and make sure that everyone has access to the vaccine.
In areas where GIS analysis identifies “gaps” on the map, such as communities or rural areas that aren’t being reached, Geraghty envisions pop-up clinics in places like school gyms, or drive-throughs in large parking lots, or, in some circumstances, personal outreach. For example, Geraghty explains, “People experiencing homelessness may be less likely to show up at a clinic to get a vaccine, so you may have to reach out to them.”
Public communication about vaccination progress offers another opportunity for mapping and spatial thinking. For example, an updated map could give a clear picture of how many people have been vaccinated in different parts of a state or county. The same map could help people figure out when it’s their turn to be vaccinated and where they can go to receive their vaccine. Maps could even help community residents compare wait times among different facilities to guide their choices and offer the best possible experiences.
Geraghty says that organizing covid vaccine distribution in this way can represent hope for people. “If we take this logical and strategic perspective, we can be more efficient in vaccine delivery and enjoy our normal activities much sooner.”
Vulnerable populations, geographic insights
Long before the world was forced to struggle with covid, the connection between geography and solving public health and social issues was very clear. Using GIS to address homelessness is one example.
In Los Angeles County, GIS has been used to map the homeless population by location, and also document and analyze the risk factors that create homelessness in each community. GIS analysis revealed that a predominant risk factor for homelessness in the northern, and especially northwestern part of the county, was veterans with post-traumatic stress disorder (PTSD). Conversely, in the northeast area, the predominant risk factor creating new homelessness was women and children escaping domestic violence.
In Snohomish County, Washington, health-care workers hit the streets to gather the data needed to facilitate such risk-factor mapping. They used GIS to perform the biannual survey and census of homeless people, gathering details on the conditions and needs of 400 people in short order. They collected standard information like the age of people in camps and whether any were veterans and reported whether they saw needles used for drugs.
Once location-specific differences like these are identified, appropriate resources can be deployed on a community-by-community basis, such as targeted social and health services to help specifically with domestic violence, PTSD, addiction, joblessness, or other identified root causes. “Using a geographic perspective, you can allocate resources, which are always limited, in ways that do the most good,” Geraghty says.
Lessons from the pandemic
Addressing disparities related to living conditions, locations, and genetics has always been a factor of disease spread and mortality, but it has never been tracked, measured, and analyzed on such a scale. However, confronting the covid crisis has been an ongoing case of catch-up, trying to find and correlate critical data to save lives, and Geraghty doesn’t want to see that level of frenetic activity repeated.
“Building strong public health preparedness systems means having foundational data ready,” she explains. “For instance, where, relative to the population, are the hospitals, the shelters, blood banks, and key infrastructure? Who are the community players and partners, and what services can they provide, and where?” In March, at the start of the pandemic, there was no comprehensive map of how many beds each hospital had, what percentage were intensive care beds, the number of ventilators available, and how much personal protection equipment was easily obtainable, and from where. “For anything that is health-related infrastructure,” explains Geraghty, “you should have a baseline map and data that you keep updated, as well as population demographic data.”
The crisis has also brought to light other issues; for example, better and more data sharing is needed, as well as clearer governance for which data are acceptable to share, so nothing will delay essential communications among institutions in the next crisis. And improved system interoperability ensuring key systems can work together to keep data fresh and reaction times quick should be a priority. The covid-19 pandemic has been a tragedy in terms of the human toll. But if we can learn from it, perhaps we can make corrections so that all communities and future generations can look forward to better, longer, and healthier lives.
This content was produced by Insights, the custom content arm of MIT Technology Review. It was not written by MIT Technology Review’s editorial staff.
The Download: AI films, and the threat of microplastics
The Frost nails its uncanny, disconcerting vibe in its first few shots. Vast icy mountains, a makeshift camp of military-style tents, a group of people huddled around a fire, barking dogs. It’s familiar stuff, yet weird enough to plant a growing seed of dread. There’s something wrong here.
Welcome to the unsettling world of AI moviemaking. The Frost is a 12-minute movie from Detroit-based video creation company Waymark in which every shot is generated by an image-making AI. It’s one of the most impressive—and bizarre—examples yet of this strange new genre. Read the full story, and take an exclusive look at the movie.
—Will Douglas Heaven
Microplastics are everywhere. What does that mean for our immune systems?
Microplastics are pretty much everywhere you look. These tiny pieces of plastic pollution, less than five millimeters across, have been found in human blood, breast milk, and placentas. They’re even in our drinking water and the air we breathe.
Given their ubiquity, it’s worth considering what we know about microplastics. What are they doing to us?
The short answer is: we don’t really know. But scientists have begun to build a picture of their potential effects from early studies in animals and clumps of cells, and new research suggests that they could affect not only the health of our body tissues, but our immune systems more generally. Read the full story.
Microplastics are everywhere. What does that mean for our immune systems?
Here, bits of plastic can end up collecting various types of bacteria, which cling to their surfaces. Seabirds that ingest them not only end up with a stomach full of plastic—which can end up starving them—but also get introduced to types of bacteria that they wouldn’t encounter otherwise. It seems to disturb their gut microbiomes.
There are similar concerns for humans. These tiny bits of plastic, floating and flying all over the world, could act as a “Trojan horse,” introducing harmful drug-resistant bacteria and their genes, as some researchers put it.
It’s a deeply unsettling thought. As research plows on, hopefully we’ll learn not only what microplastics are doing to us, but how we might tackle the problem.
Read more from Tech Review’s archive
It is too simplistic to say we should ban all plastic. But we could do with revolutionizing the way we recycle it, as my colleague Casey Crownhart pointed out in an article published last year.
We can use sewage to track the rise of antimicrobial-resistant bacteria, as I wrote in a previous edition of the Checkup. At this point, we need all the help we can get …
… which is partly why scientists are also exploring the possibility of using tiny viruses to treat drug-resistant bacterial infections. Phages were discovered around 100 years ago and are due a comeback!
Our immune systems are incredibly complicated. And sex matters: there are important differences between the immune systems of men and women, as Sandeep Ravindran wrote in this feature, which ran in our magazine issue on gender.
Welcome to the new surreal. How AI-generated video is changing film.
Fast and cheap
Artists are often the first to experiment with new technology. But the immediate future of generative video is being shaped by the advertising industry. Waymark made The Frost to explore how generative AI could be built into its products. The company makes video creation tools for businesses looking for a fast and cheap way to make commercials. Waymark is one of several startups, alongside firms such as Softcube and Vedia AI, that offer bespoke video ads for clients with just a few clicks.
Waymark’s current tech, launched at the start of the year, pulls together several different AI techniques, including large language models, image recognition, and speech synthesis, to generate a video ad on the fly. Waymark also drew on its large data set of non-AI-generated commercials created for previous customers. “We have hundreds of thousands of videos,” says CEO Alex Persky-Stern. “We’ve pulled the best of those and trained it on what a good video looks like.”
To use Waymark’s tool, which it offers as part of a tiered subscription service starting at $25 a month, users supply the web address or social media accounts for their business, and it goes off and gathers all the text and images it can find. It then uses that data to generate a commercial, using OpenAI’s GPT-3 to write a script that is read aloud by a synthesized voice over selected images that highlight the business. A slick minute-long commercial can be generated in seconds. Users can edit the result if they wish, tweaking the script, editing images, choosing a different voice, and so on. Waymark says that more than 100,000 people have used its tool so far.
The trouble is that not every business has a website or images to draw from, says Parker. “An accountant or a therapist might have no assets at all,” he says.
Waymark’s next idea is to use generative AI to create images and video for businesses that don’t yet have any—or don’t want to use the ones they have. “That’s the thrust behind making The Frost,” says Parker. “Create a world, a vibe.”
The Frost has a vibe, for sure. But it is also janky. “It’s not a perfect medium yet by any means,” says Rubin. “It was a bit of a struggle to get certain things from DALL-E, like emotional responses in faces. But at other times, it delighted us. We’d be like, ‘Oh my God, this is magic happening before our eyes.’”
This hit-and-miss process will improve as the technology gets better. DALL-E 2, which Waymark used to make The Frost, was released just a year ago. Video generation tools that generate short clips have only been around for a few months.
The most revolutionary aspect of the technology is being able to generate new shots whenever you want them, says Rubin: “With 15 minutes of trial and error, you get that shot you wanted that fits perfectly into a sequence.” He remembers cutting the film together and needing particular shots, like a close-up of a boot on a mountainside. With DALL-E, he could just call it up. “It’s mind-blowing,” he says. “That’s when it started to be a real eye-opening experience as a filmmaker.”