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  • How creative science is helping make neighborhoods healthier

    By Deirdre MacBean, 3M Storyteller

    Two women examine a health care app on a tablet
    Photo courtesy of Our Voice, Australia

    • Dr. Abby King is frustrated by our habit of blaming poor health choices on individuals.

      She believes instead that much of the blame often lies in our environment.

      Dr. King is a behavioral health scientist and professor of Health Research and Policy (Epidemiology) and Medicine at the Stanford Prevention Research Center. She and her team use data and technology to gather insights that drive healthier neighborhoods.

      Dr. King sees technology as a double-edged sword: On the one hand, it’s a huge, economy-driving enabler of convenience, but on the other, “We don't even have to go to the store anymore! We've engineered physical activity out of our daily routines.”


    • Dr. Abby King
      Dr. Abby King

      Why does mindless physical activity matter most?

      “I’m one of the 90 percent of the population who are not intrinsically driven to be active. I’m a great fan of ‘mindless’ activity, where we get our physical activity as a natural part of the day – the way our forefathers lived,” she laughs.

      Dr. King and her colleagues at Stanford are attacking the problem with big data culled from health apps, as well as with local data collected by residents themselves. Their aim is to unmask the true story about our activity – or lack of it – and support practical neighborhood improvements to get us back on track.

      “Many of us are pretty tired at the end of the day. If you ask people if they were active, they'll say yes. It feels that way, but we can see from the data they really weren't.”

      By analyzing data from 68 million days of physical activity for nearly 720,000 users of health and fitness apps, made by Palo Alto-based Azumio, an interdisciplinary team at Stanford now has a bird’s-eye view of the average daily steps of people across 111 countries.

      In an article in Nature, The researchers, led by Drs. Jure Leskovec and Tim Althoff and including Dr. King, found a lot of variation – between countries and within them. The researchers looked in depth at the size of this “activity inequality” – or gap between the active and the inactive populations within a country – concluding that it was more strongly correlated with obesity levels than the average volume of activity overall. Walkability of a neighborhood, not surprisingly, significantly influenced general levels of activity, particularly in women.

      You can see the variability in the levels of physical activity across the world in the map below, showing smartphone data from more than 68 million days of activity by 717,527 individuals.

    World map highlighting physical activity in different countries, China has the highest number of steps, Pakistan and Indonesia on the lowest end, and North America in the middle.

    Still image from video

    Check out this video created by Stanford’s Our Voice Initiative.

    • Using health apps to study people in the wild

      It’s an experiment the scale of which no one had dreamed a few years back. Fitness apps and data science allow us to observe the behavior of what Dr. King calls people “in the wild" all over the globe.

      She finds the science powering the analysis awe-inspiring. “I'm just overwhelmed by the complexity of it. The data experience and innovation that the Stanford computer scientists I work with bring to their field are extraordinary.”

      It’s a quantum leap forward – reducing the time taken for complex studies of neighborhood walkability and physical activity from around seven years to a matter of months.

      “We can look across thousands of cities and correlate any physical activity change in people who have moved to a new neighborhood with the difference in walkability of their new and former environments. Then, where we see increases in activity, we can investigate the features driving them, like safe parks, public transport or accessible sidewalks.”

      These insights can then be used to influence positive changes in urban planning, she explains.

      Dr. King hopes that work like this will eventually “get us back to our active roots, make walking more natural, and encourage the creation of green spaces that make us feel more serene.”

    • Two people using an app on a tablet
      Photo courtesy of Our Voice, Australia

      Citizen-scientists take health into their own hands

      But it can take a long time to influence urban planning, no matter how good your data. In the meantime, Dr. King is the proud leader of a very practical, grass-roots “citizen-science” project called “Our Voice.” It uses a simple app to enable people to take geo-coded photos and recordings to highlight for policy makers and community leaders which areas are in greatest need of improvement.

      “This is my huge passion right now,” says Dr. King. “We have a global network of 17 countries, representing every continent. Our goal is to harness and leverage the power of residents themselves to understand their local environments and how they may be keeping people from living healthy lives along with other goals.”

      Why is Our Voice so important to her?

      “I work with a lot of underserved, marginalized communities. Choices are so reduced with the pressures of multiple jobs, losing jobs, putting food on the table, that ‘healthy living’ may become a lower priority. This is a way to give everyone a voice, whatever their socio-economic status.”

      Examples of Our Voice projects range from promoting healthy aging among LGBT elders in Anchorage, Alaska, to improving visibility and safe walking for senior citizens in Israel. All go through a four-stage process. It starts with Discover (with the tool), then moves to Discuss (agreeing on priorities as a community). Then comes Advocate (learn to tell a compelling data-driven story), and finally Change, with communities becoming more engaged and developing more understanding for different views throughout the process.

      Dr. King has enjoyed seeing new intergenerational or cultural understanding develop. In Mexico, for instance, young teens and older adults worked together to identify solutions to graffiti that would work for both sides, recognizing the desire for youthful creativity and self-expression, while respecting traditional values. In Israel, Israeli Arabs and Jews came together, sometimes for the first time, in some mixed neighborhoods to talk about how to make their environment healthier.

      Dr. King sees data as the key for change.

      “For decades, people have said if you're heavy or you don’t exercise, it's your fault – you don't have enough ‘will power.’ But our data make clear that it’s the individual nested within their environmental context that is so important,” she explains.

      “Data provide the basis for positive community partnerships. Policy makers can begin to see things more clearly and better understand residents’ perspectives, with the residents themselves becoming collaborators, not adversaries.”

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