• The digital cohort, starting in the autumn and collecting data over ten years, is led by Dipsalut, the Public Health Agency of the Girona Provincial Council, with support from the Government of Catalonia through ICS-IAS, IDIAP Jordi Gol, TIC Salut Social, and IDIBGI.
• For the first time, we will have zero-mile public health data tailored to the reality of our municipalities, allowing us to understand and monitor the evolution of social, environmental, and health determinants and inequalities in the Girona region.

Currently, the Girona region faces territorial inequality in the availability of municipal data, as most are only available for municipalities with more than 20,000 inhabitants. This lack of local-level data makes it difficult to provide useful, high-quality information that would enable local administrations and social agents in the region to tailor their social, environmental, and health policies to the territory's reality.

To address this gap, and with the guidance of a scientific committee of experts in social, health, and environmental research, the Dipsalut Observatory is promoting the creation of the GiroStudi digital cohort.

"As we know, societal development over the past fifty years has not been harmless. It leaves a footprint on our bodies, communities, and natural systems that affects both human and planetary health," says Maria Puig, third vice president of the Girona Provincial Council and president of Dipsalut. She adds, "We live longer, though not always with sufficient quality of life. Until now, however, we lacked local data to help us analyse these effects across the 221 municipalities of Girona. With GiroStudi, we will finally have them."

GiroStudi will make it possible to generate indicators for local agents, municipalities, and more, which will be made available to the public and help shape public policies, reveal existing population inequalities, advance scientific knowledge of social, environmental, and health disparities, and promote sustainable human development without leaving anyone behind.

The GiroStudi digital cohort will consist of around four thousand people who, over ten years, will provide electronic information about their health status, wellbeing, living conditions, and environment. They will also contribute biological samples that will help identify the various factors we are exposed to throughout life and how these may affect our health.

All data collected will be processed to ensure statistical relevance for the municipalities and counties of Girona.

Participants in GiroStudi will be between 16 and 74 years old and randomly selected from the population of nineteen municipalities in the Girona region. These municipalities will also be chosen based on scientific statistical criteria.

This controlled sample will provide a statistically significant representation of the region's population and ensure the cohort’s scientific validity.

Additionally, there will be an open sample consisting of individuals who voluntarily wish to participate. This open cohort will enable citizen science processes that support data collection, foster community involvement, and help generate new research projects.

A unique health innovation project

GiroStudi is a unique health innovation initiative. Its characteristics and data potential can make it a benchmark in public health and population-based research.

• It is an ambitious cohort designed to become a tool for more effective public policy in a small territory such as the counties of Girona.
• It is one of the few digital-format cohorts currently existing on a global scale. For the first time, researchers will interact with participants entirely online — via mobile phone or web — allowing for year-round, 24/7 communication. This is especially valuable in health crises, such as COVID-19.
• A high degree of representativeness in a small territory: developing a large-scale digital cohort with statistically representative results for the counties and municipalities is unprecedented — to our knowledge — in the fields of public health and research.
• The initiative stems from the local administration: GiroStudi was born from the local government not only to gather data for the municipalities but also to lay the foundation for strengthening local research and promoting the Girona Health Hub.
• The cohort will identify social and environmental factors affecting population health and begin to explore the impact of human activity on the territory.
• The collection of biological samples and its potential will allow for:
  – Analysing samples to obtain exposure results specific to the Girona region.
  – Studying the relationship between sample analysis and survey data (e.g., environment, lifestyle, wellbeing, socioeconomic conditions, health status).
  – Expanding biomedical, community, and public health research in the Girona region.

Citizen science: the open sample

GiroStudi will not only work with a controlled sample but will also open participation to all individuals wishing to take part (open sample), engaging the wider public through citizen science and providing stakeholders with access to tools, data, and materials.

Partnerships and collaboration

As Maria Puig, president of Dipsalut, explains: "GiroStudi is an important and complex project that requires strong alliances to succeed. This is why the involvement of the Department of Health of the Government of Catalonia is essential."

The Catalan Institute of Health - Institute of Health Care (ICS-IAS) will facilitate the recruitment process and sample collection.

The Primary Care Research Institute (IDIAP Jordi Gol) will support recruitment and advise on community-based research methodologies.

TIC Salut Social will help design and implement the technological platform that manages the sample, questionnaires and interviews, and the collection and storage of data.

Jaume Heredia, manager of the Girona Health Region, emphasized the importance of the Department of Health’s involvement: "as it could not be otherwise", with the active participation of research professionals and primary care staff in collecting and analysing samples through the territorial clinical laboratory.

Heredia also stressed that "people’s health depends not only on the healthcare system but also on the conditions in which they live. In fact, about 80% of population health is determined by factors outside the healthcare system — what we call social and environmental determinants." He reminded us that, as the Government of Catalonia’s 2021–2025 Health Plan states, biomedical research and the study of these health determinants must be promoted — and that GiroStudi offers a unique opportunity to advance this strategic line and positions us as pioneers across Catalonia.

Finally, the Girona Biomedical Research Institute Dr. Josep Trueta (IDIBGI), which has a framework collaboration agreement with Dipsalut, will be responsible for processing and preserving the biological samples.

According to IDIBGI’s director, Dr. Marga Nadal, "It is important for IDIBGI to be part of the GiroStudi launch, as this initiative represents a unique opportunity for health in the Girona region and a major step forward in aligning public health with biomedical research in our territory."

Regarding the management of biological samples, Dr. Nadal added: "The IDIBGI Biobank is a facility that can provide traceability, quality, and ethical custodianship of human samples. We have proven experience managing cohorts through this scientific platform, which is accredited by the Instituto de Salud Carlos III."

Other partners can also contribute to expanding GiroStudi’s research, such as the Spanish National Research Council (CSIC) and the Catalan Institute for Water Research (ICRA). In fact, the Dipsalut Observatory has submitted joint proposals with ICRA and CSIC to European and Spanish Ministry of Science projects to study, via the digital cohort, the correlation between chemical toxins detected in wastewater (which can cause endocrine, neurological, and other dysfunctions) and the presence of the same toxins in GiroStudi’s biological samples, as well as links to antimicrobial resistance.

In summary, GiroStudi will pave the way for new research projects exploring future correlations between human health, planetary health, and environmental factors.