Q&A with Enbal Shacham

How did you become interested in the intersection of public health and geospatial research?

Shacham: I began thinking about location and geospatial research when I realized that in the clinic-based work I was doing, in combination with community-based research around HIV infection, ultimately, we were talking about the neighborhoods where people lived. Even when people have access to healthcare, poorer outcomes occur when people live in poor neighborhoods. And that’s when I said, wait a minute, we’re studying the wrong thing. This part is important for clinic-based work, but for people living with HIV at the time, about 15 years ago, they were coming to the clinic four times a year. Now we’ve shifted to two times a year, but four times a year felt like a pretty good engagement with patients. Clinicians were thinking, ‘I have a good relationship with my patient—why aren’t they taking their medications regularly?’ Ultimately, I said, it’s not because of you. In general, if healthcare providers have a good relationship with their patients, patients are more likely to follow their recommendations. Except when you can’t. That’s when I realized that we needed to look at real-time data to identify where and what was influencing individual behaviors at the time. So that’s how I got into geospatial work. With it, you can do so much more and understand so much more about the communities in which we live, work, and play.

Can you share some examples of when and how they intersect and why this research is so important?

I used to have to explain in-depth what geospatial health is—there are some structures within a community that make it harder or easier to be healthy. But I think after COVID-19, we were able to identify that some neighborhoods make it more difficult. We were able to identify that not only do disparities exist, but these inequities are structural. We looked at how housing rules, for example, influence the likelihood of infection or respiratory infectious disease. And housing is, of course, based on location. We have regions in communities where you can have multi-house units and regions where you can’t. You can have apartments here, but what is the zoning around apartments, and how many people can live in those apartments? These types of rules were established a long time ago and often go back to redline districts. That’s one example, but there are other examples, such as air and soil pollutants where people live. In St. Louis, we have a lot of examples of this continued exposure based on where a superfund site might be or where there’s a fire in a landfill. [Authorities] tested the air and they said, ‘Oh, it’s fine.’ But the community members know it’s not, and they’re experiencing life very differently. We don’t know what the long-term outcomes of that example are, but we know they can’t be equitable.

What are you currently researching?

Now, unfortunately, we have to think about the next pandemic or the next outbreak of an infectious disease. While I was saying we’re going to focus on chronic conditions next, we still are focusing on mpox. No, not everyone is at risk, but everyone may be at risk at some point in the next couple of years. So what should we be thinking about? How can we aid in vaccinating those most at risk and closest to infections? We have to think about where and when another outbreak will occur. We’re also looking at how climate change patterns expose our communities to risks of infectious diseases.

You’ve created an app to understand better real-time behaviors and symptoms, including COVID-19 and alcohol use and mood. Can you tell us more about that?

Humans are pretty bad at reporting our behaviors. When we ask people about their alcohol use, they can’t remember or don’t want to tell the truth and be judged. But that’s a real barrier to understanding what we do in our daily lives. I think that daily life patterns drive so much of our health and health outcomes, and we’re not set up to do anything or know how to change. My goal is to change environments so that people can make more healthy, equitable choices in their community. Here’s where the app comes in. We first developed an app about alcohol use and mood among people living with HIV because we didn’t know how detrimental drinking was. Every time someone had a drink, they reported that they were drinking and their mood. And then every 30 minutes after that, they would receive push notifications asking, did you have another drink? We were able to see the patterns in real time. When COVID-19 started, we thought we needed to develop an app quickly to monitor and track symptoms for workforce settings. What we learned, ultimately, is that for non-essential employees, it made getting sick and sick leave easier, in some ways, though you might still be sick while working from home. But for those essential employees, like all our food support staff and hospital staff, we found that they were leaving home for work when they should have been able to stay home.

What is the most important advice you share with students?

I tell them to be curious and to be creative problem solvers. Coding is a very important skill set, but you have to put these pieces together and then question how and why, and what can we do about it? Our curious students do the most innovative research. They grow their skill sets to answer some really challenging and important questions. I can tell them they need to learn these skills and those skills, but ultimately, if they’re not driven by a question they want to help answer, their skills aren’t going to be applied in a meaningful way.

How do organizations like USGIF support your work?

Some of the support has included mentoring programs. The young professional groups that connect students to specific people or experts in the field have been really helpful in exposing them to potential careers. The GEOINT Symposium and USGIF’s support for participating students have also been beneficial. It’s been fun to see our students coming in and walking around these conference halls and saying, ‘Oh, this is really neat. I didn’t know all of this.’ You can’t truly understand the size of this business until you’re in a huge space like that.

What do you predict for the future of GEOINT education?

Our education delivery system has shifted dramatically. COVID-19 allowed us to do certain things like deliver education differently, which is great. Academic institutions, in general, are hesitant about change. But being forced to change and then saying, OK, we can do this better. We’ve had some great models in the field that we should leverage and grow. Another aspect that will contribute the future of GEOINT education is synthesizing non-traditional and traditional data to answer questions. Data synthesis will be the key education piece of geospatial intelligence moving forward.