Health in the rural West: Workshop explores how digital tools can help

Imagine living in a house surrounded by grassy plains extending as far as the eye can see. Your nearest neighbor is a bike ride away. The nearest town is a three-hour drive away. If you needed to get to visit an emergency room or medical clinic one of your biggest health care obstacles would be simply getting there. 

As Dean Lloyd Minor, MD, welcomed attendees to the Digital Health in the Rural American West workshop, he invited them to imagine what it's like to live in a rural area of the Western United States. 

"From staggering distances to care facilities to a scarcity of medical professionals," Minor said, "this family faces health care challenges that are unfamiliar to the vast majority of the U.S. population that lives in urban and suburban areas."

Familiarizing leaders in medicine, technology and other fields with the health challenges of people living in rural areas was one of the goals of the day-long workshop co-hosted by Stanford Medicine and Stanford University's Bill Lane Center for the American West. 

In the morning, presenters discussed health concerns such as obesity, diabetes and limited access to mental health care that tend to be more common in rural regions. Then, the group worked together to helped brainstorm solutions involving digital tools.

"It isn't every day you see such an interdisciplinary group taking time to come together to think about how we can develop and deploy technology for the public good. How can we reduce health disparities and improve well being for all people with the new tools we have at our disposal?" said Lisa Chamberlain, MD, as she introduced a session she moderated -- "Optimizing Digital Health to Improve Population Health" -- and its panelists Mark Cullen, MD, and Abby King, PhD.

King, a professor of health research and policy, discussed Our Voice, a smartphone app used by people "age nine to 90" (so far) that allows participants to take geotagged photos and videos of features in their community that hurt or help health. Their images and videos are shared with researchers who study it and look for patterns, but ultimately the tool belongs to the people, King explained. For example, she said, a group of seniors used their app data to persuade lawmakers to add speed bumps to their neighborhood.

"In this way, people's voices are heard, even those who haven't typically had a voice in their communities," King said. "Capturing and sharing their local experiences in compelling ways can set in motion a positive chain reaction in which neighborhoods can be improved, leading to healthy living and feelings of empowerment and engagement."

The app is new to rural communities, but it's already revealing barriers and enablers of health that are "a whole different animal" from that of urban environments. For example, in urban areas the app has been used to identify well-lit, safe sidewalks for kids to walk to and from school. Yet, when the app was used in rural areas, King explained, it showed that in many cases "there are no street lights and there are no sidewalks" making it tough for families to identify safe routes to school. The app also revealed that access to healthy food is often limited in rural areas, which can make it difficult to eat nutritious meals.

While King's work yielded some unexpected avenues for research, Cullen's work and why he's studying it, as he put it, "will surprise no one here -- the threat of wildfires in the West." Cullen, the director of the Stanford Center for Population Health Sciences, and his collaborators are using over 20 years of data to answer the question: Which is worse for the respiratory health of communities, small, controlled burns to clear dead vegetation, or larger, uncontrolled fires? 

"The impact of fires on our region is profound and is hardly limited to the people near the fires. Virtually all of us in the area of the plumes were exposed to the fires," Cullen said, referring to last fall's Camp Fire.

As the day unfolded, a pattern emerged from the discussions -- addressing the needs of individuals living in rural areas has the potential to benefit more than just a few people.

"One of our goals here at Stanford is to see the synergies between individual and population health," said Minor. "There are more areas of synergy between individual health and population than we might have thought."