Real-Time Data Reveals Impact of Environment on Physical Health

Real-time data and location information showed that social environments can have long-term effects on physical health and well-being, according to a study published in the Journal of Health and Social Behavior.

Environment is a key social determinant of health. Many people in the US live in neighborhoods with high rates of violence, unsafe air or water, and other safety risks, which often result in poorer health outcomes.

A team from Cornell University set out to use smartphone-based data collection methods to examine the environment’s impact on health in real time. Participants used smartphones for a week, reporting where they were, what they were doing, and how they felt several times a day. Researchers were also able to track their movements.

The study included 61 participants age 55 and older from four diverse neighborhoods: East Harlem, Gramercy, and the north and south sections of Bedford-Stuyvesant. The subjects would note when they saw litter, vacant buildings, damaged sidewalks, and other scenes they considered problematic, such as evidence of drug or alcohol use.

Participants received a ping on their smartphones to complete a survey about what they saw and how it made them feel. The participants completed most of the surveys within ten to 15 minutes of being pinged, with an overall response rate of 99 percent.

The results showed that on average, about one-third of the study participants reported feeling some pain and about one-third reported feeling fatigue in any given survey, with those feelings being less prevalent in more orderly spaces. The risk increased with each additional condition of disorder observed.

In places perceived as threatening or stressful, subjects were significantly more likely to report spikes in pain or fatigue. When observing at least two of those disorderly conditions – including litter, vacant buildings, evidence of drug or alcohol use – participants were twice as likely to report feeling tired and about two-thirds more likely to report feeling pain.

“These fluctuations may have longer-term impacts on health and well-being for older adults who have to navigate demanding or distressing social environments on a regular basis,” said Erin York Cornwell, lead author of the study.

In the past, researchers have typically relied on survey respondents to keep paper logs of their experiences, often recorded long after events occurred. While smartphone-based data collection is still an emerging method, researchers believe that it could allow more immediate responses, leading to improved survey accuracy and reduced bias.

“It’s an incredible tool for understanding how people experience and perceive their environments in real time, and then looking at how those environments may affect their health,” said York Cornwell. “We haven’t been able to get that insight in such a clean way in the past, so this approach has really exciting implications.”

Real-time data is also helping leaders in North Carolina better understand and address individuals’ social determinants of health. In September 2019, the North Carolina Department of Health and Human Services (NC DHHS) announced a partnership with Phreesia to use a platform to identify patients with unmet social needs.

The platform can send real-time alerts to providers and care coordinators about patients’ individual needs, offering a more holistic view of patient health.

The partnership marked a critical opportunity to connect individuals with social services. At the time, NC DHHS noted that more than 1.2 million North Carolinians cannot find affordable housing, and one in 28 of the state’s children under the age of six is homeless.

“To advance the health and well-being of North Carolinians, we need to build a coordinated, whole person-centered system that addresses both medical and non-medical drivers of health,” said DHHS Secretary Mandy K. Cohen, MD.

“Our partnership with Phreesia will make it easier for doctors and other healthcare providers to ask patients about their non-medical health needs, which are a critical component of their overall health.”