Review of: Gapminder, www.gapminder.org; HealthMap, www.healthmap.org; Worldmapper, www.worldmapper.org; and Food Environment Atlas, http://www.ers.usda.gov/foodatlas/.
“Medicare Claims Show Overuse for CT Scanning” reported the New York Times (NYT), June 17, 2011. Although radiologists consider one CT scan to be adequate, many hospitals perform two. An interactive map on the NYT website provided information on rates of double CTs for all hospitals in the US. These findings came to light because new technologies provided ways to analyze these data.
This story is just one example of the creative use of routinely gathered data. The combination of GIS mapping, public access to governmental and international databases, and online graphing and mapping tools make for exciting and authentic investigations at the intersection of biology and the social determinants of health.
Some of the tools that complement courses in biology, public health, and global health are: Gapminder, HealthMap, Worldmapper, and Food Environment Atlas. The Centers for Disease Control (CDC), US Agency for International Development, and World Health Organization (WHO) also provide extensive databases, and some maps and graphs. Professor Julie Seiter of Oakland Community College and I have collaborated in developing data-rich, problem-solving experiences to engage students in defining research questions, and assembling and interpreting graphs and maps to support their arguments. These activities are available as an issue of Biology International (http://biologyinternational.org) titled “Global Health has No Borders.”
The most exciting tool, in our opinion, is Gapminder. Developer Hans Rosling, professor of international health at Karolinska Institute in Stockholm, Sweden, and his team have built a powerful website that provides access to graphing tools and constantly updated information on over 200 variables, with some dating back to 1800. UNICEF, the World Bank, Food and Agriculture organization of the United Nations, and other global agencies have provided access to their data. The website enables students to easily pose questions about a range of measures including life expectancy, adult literacy, exports and imports, crime, and rates of disease. Gapminder is designed to illustrate as many as five variables concurrently including the variables on the x- and y-axis, a variable illustrated by the size of the points on the graph, and another variable illustrated by the color of the points. Finally, students can also look at changes over time.
Actually, Gapminder needs to be experienced to be appreciated. Before you read any further, please go to your computer and open www.gapminder.org/world. After the “Wealth and Health of Nations” has downloaded, move the cursor to the right of “play” back to 1850 and hit “play” to see the changes in life expectancy and income around the world. Colors denote countries on different continents, and the sizes of bubbles indicate population. Now choose several countries to look at closely; on the right menu select five countries, including the US, Botswana, China, and two others of your choice. Go back to 1850 and hit “play” again. What you see are the different patterns of health and development.
I’ve used this tool with students in several different classes at Beloit College. It’s challenging to design activities that lead students through the maze of data to construct and test their own hypotheses. Students need an hour of supervised classroom time to explore the website and respond to a defined question before they go off in pairs to work on an assignment. Questions that work well for student investigation specify the dependent variable and a set of reasonable independent variables to test, and direct students to resources to support their reasoning with outside research. I’ve asked students to identify factors that correlate with improvements in life expectancy or child mortality, and, like you, to select a set of five countries to explore in depth. They have considered access to clean water, sanitation, fertility, literacy, urbanization, income, and more.
The Gapminder website also has many informative short videos, including Rosling’s TED talks and a tutorial. Make sure to watch “The seemingly impossible is possible.” These 10–20 minute videos engage students with the excitement of graphical representation of data.
Tufte, in The Visual Display of Graphic Information (2001) writes that excellent statistical graphics clarify the meaning of large datasets, work at many levels of complexity, and tell great stories. I think that Tufte would find Gapminder to be a breakthrough technology with high potential for both success and confusion. It is difficult to narrow down the wealth of data to develop testable hypotheses based on the available information. Students need to ask questions about how much information is enough, and when too much information clouds their ability to analyze. There’s just so much data, and the temptation to develop unsubstantiated correlations is great.
The analyses with Gapminder, like all statistical analyses, are only as good as the quality of the data, and these data reflect the biases of the data gatherers. Most are collected at the national level, and thus miss many of the important regional differences that enable effective public health programs to target specific regions and communities. Krieger, in Epidemiology and The People’s Health (2011) critiques Gapminder’s databases because they obscure the biases in the collection, and construct an easy and beautiful, but not very nuanced, truth. As educators, we need to help students to identify the limitations and biases of the data as they construct arguments.
There are many other exciting web tools to enhance students’ critical thinking skills. Worldmapper is great for a “wow” effect, and for helping students overcome fear of maps and learn how to talk about what they see. Worldmapper provides global maps with countries reshaped according to the prevalence of a variety of conditions such as malaria, infant deaths, or even Internet users. The map of HIV prevalence, for example, shows the countries of Africa as much larger than their landmass, and the countries of Europe as much smaller. South Africa, the country with the largest number of HIV cases, looks positively swollen. The strength of Worldmapper maps is that they shocks students into thinking about maps, but students aren’t able to really test hypotheses as they can with Gapminder. The real drawback of this tool is that it assumes that viewers are familiar with the size of countries in the standard Mercator map of the world; without this knowledge, these maps are simply confusing.
HealthMap introduces the challenge of tracking disease outbreaks in real time. This tool provides an updated and interactive map of information on infectious disease outbreaks, synthesized from professional sources, Internet reports, and social media. Students can ask questions such as, “How do we know what we know, how fast do we know it, and what can we do when we know?” HealthMap contains the basics for modeling disease spread. Documentation of outbreaks lead students to Centers for Disease Control (CDC), Program for Monitoring Emerging Diseases (ProMed), the World Health Organization, and more. With this tool, students can do background research on pathogens, disease vectors, specific outbreaks, and conditions of disease spread.
For investigations of health and social factors in the United States, the CDC provides numerous graphs and maps, all easily found with a “Google image” search. An intriguing set of visuals on obesity trends from 1985 is found at http://www.cdc.gov/obesity/data/trends.html. A more integrated website, The Food Environment Atlas, produced by the Economic Research Service of the US Department of Agriculture, has interactive maps of county-level data about the social determinants of health, food availability and pricing, physical activity, and selected health measures. These data can be supported with more extensive health data from the CDC.
These sites bring authentic, data-rich learning environments to our students, and serve to enhance the relevance of our teaching to the “real world.” Students engaged in real research on current and capacious problems are developing the 21st century skills they will need in our changing world.
Resources mentioned
Centers for Disease Control, www.cdc.gov
Centers for Disease Control (CDC) Obesity Trends http://www.cdc.gov/obesity/data/trends.html
Fass, M. F., J. Seiter. Global health has no borders. Biology International. 2011;49:5–12. http://biologyinternational.org/volume-49/
Gapminder, www.gapminder.org
HealthMap, www.healthmap.org
International Society for Infectious Diseases, Program for Monitoring Emerging Diseases, http://www.promedmail.org/
Krieger, Nancy. 2011. Epidemiology and the people’s health. Oxford University Press, Oxford, UK.
Tufte, Edward. 2001. The visual display of quantitative information, 2nd edition. Graphic Press, Cheshire, CT.
US Agency for International Development, Demographic and Health Surveys, http://www.measuredhs.com
US Department of Agriculture, Economic Research Service, Food Environment Atlas http://www.ers.usda.gov/foodatlas/
Worldmapper, www.worldmapper.org
World Health Organization (WHO), www.who.int