Nadine Schuurman

I am a GIScience researcher with a broad range of interests including health informatics, critical GIScience and epistemology and ontology.

I began my career in critical GIScience and morphed into a health geographer over past decade. Despite falling into a neat box at the present time, I still write occasional papers that fall into the broad category of human geography. I am running multiple projects in areas as diverse as global health and health and the built urban environment. There are three themes that animate all of my research: spatial access to health services; health surveillance; volunteered geographic information; and the influence of the environment on health events. I have an active lab that hosts seven graduate students. We work together as a team; this approach has led to a very productive environment.

Video Introduction

Selected on-going projects in my GIS and Health laboratory

Global Health

My interest in global health began in Cape Town, South Africa. Working with Dr. Morad Hameed from the University of British Columbia (UBC) and graduate students, we developed an injury surveillance system to document severe injuries as patients are admitted to hospital. The surveillance system is designed to improve patient care as well as to target prevention efforts. Human resources are scarce in low and middle income countries (LMIC). To that end, our injury surveillance is focused on parsimonious data collection that can be deployed in very low resource settings.

Photo of the injury record keeping at Groote Schuur Hospital when we started the project in 2008.

Some of the 10,000 records that we had collected by 2011.

Maternal health

Maternal health is a pressing issue worldwide. I have joined a UBC team focused on reducing pre-eclampsia in low and middle income countries. I introduced the concept of maternal resilience to highlight areas where maternal outcomes are positive - despite poor environmental conditions. My grad student and I are working on a project to develop an index of maternal resilience in LMIC - as well as in Canada where aboriginal infant mortality is ten times higher than in the general population. We are uniquely focused on environmental correlates with maternal health including overcrowding, access to running water and latrines, and access to health services.

Image from the New Internationalist.

Multiple sclerosis

Multiple sclerosis (MS) is a chronic, degenerative disease of the central nervous system. The exact cause of MS is not yet understood. Multiple risk factors may be involved including interactions between susceptibility genes and environmental factors. Several clinical and epidemiological studies support the hypothesis that vitamin D levels – perhaps mediated by ultraviolet B (UVB) exposure – are able to modulate disease processes in MS. Over the past 50 years, empirical data has indicated that increased latitude is linked to greater prevalence of MS. However, direct causation has not been proven, especially in the light of confounding factors – such as multiple moves over a lifetime. Working with Dr. Helen Tremlett at UBC and a Phd student ( link to Ofer’s site), we developed a protocol to calculate total UVB exposure over the lifetime of patients. We were able to use detailed life histories of 4000 patients combined with TOMS data from NOAA to develop this methodology. This protocol applies geographical concepts to better understand the etiology of a prevalent disease.

Cumulative UVB exposure with increased exposure shown as a gradient from yellow to red – with increase in age depicted by the height of the lines. The white lines represent trajectories from place of origin. The figure demonstrates visually the variation in relative UVB exposure – even amongst the majority of Canadian born patients.

Injury and the built environment

The relationship between injury and the built environment has historically been poorly understood. I have conducted several studies that articulate clear links between pedestrian injury and the environment. I developed a methodology that allows us to conduct environmental scans of urban injury hotspots. Our team then conducted environmental scans at each hotspot to determine environmental correlates with injuries. We are now working on a GEOIDE funded project to extend this methodology to violent injuries - including gunshot wounds.

Pedestrian injury hotspots in Vancouver.

Geographic injury surveillance: location of both pedestrian and motor vehicle motorist infractions at injury hotspots at rush hour in Vancovuer.

Access to health services

A final cornerstone of my research has focused on access to health services. It is an axiom of health research that access increases positive health outcomes. However, access (both spatial and socially enabled) is geographically disparate. In my lab, we have developed methods to measure potential spatial access to a range of health services. We link travel time access to population catchments to determine areas where services need to be intensified and use the results to contribute to evidence-based decision-making.

Access to obstetrical services. Less than 25% of the province is outside one hour of access to maternal services.

Access to primary health in Nova Scotia, Canada. Note that access is generally adequate with optimal access in urban areas. This is in contrast to provinces with larger geographic area and more remote populations.