Potential meets reality: GIS and public health research in Australia

Geographical Information Systems-computerised systems for the capture, storage, retrieval, analysis and display of spatial data - have recently been promoted as important tools for the study of public health. Attention must also be given to the issues involved in this relatively new application, especially in Australian conditions. These include the coarse spatial resolution of most health and social data, the propagation of error through the need to use estimates and concordance tables to handle data in mismatched official spatial boundaries, the inflexible analytical capacity of most GIS for the needs of epidemiology, and difficulties in access to data, which are compounded by the absence of a good metadata register. The conflict between the need for spatial precision in GIS and preserving the confidentiality of health data is a salient issue. Medical geographers and public heath researchers using GIS must recognise these issues in order to work together and toward extending the use of GIS technology beyond broad ecological and accessibility studies.     

Mapping environmental injustices: pitfalls and potential of geographic information systems in assessing environmental health and equity

Geographic Information Systems (GIS) have been used increasingly to map instances of environmental injustice, the disproportionate exposure of certain populations to environmental hazards. Some of the technical and analytic difficulties of mapping environmental injustice are outlined in this article, along with suggestions for using GIS to better assess and predict environmental health and equity. I examine 13 GIS-based environmental equity studies conducted within the past decade and use a study of noxious land use locations in the Bronx, New York, to illustrate and evaluate the differences in two common methods of determining exposure extent and the characteristics of proximate populations. Unresolved issues in mapping environmental equity and health include lack of comprehensive hazards databases; the inadequacy of current exposure indices; the need to develop realistic methodologies for determining the geographic extent of exposure and the characteristics of the affected populations; and the paucity and insufficiency of health assessment data. GIS have great potential to help us understand the spatial relationship between pollution and health. Refinements in exposure indices; the use of dispersion modeling and advanced proximity analysis; the application of neighborhood-scale analysis; and the consideration of other factors such as zoning and planning policies will enable more conclusive findings. The environmental equity studies reviewed in this article found a disproportionate environmental burden based on race and/or income. It is critical now to demonstrate correspondence between environmental burdens and adverse health impacts--to show the disproportionate effects of pollution rather than just the disproportionate distribution of pollution sources.     

Findings from a survey on GIS use in the UK National Health Service: organisational challenges and opportunities

The use of geographical information systems (GIS) in a variety of application areas points to an increasing interest in the spatial aspects of health policies. Despite the fact that most public sector organisations in the United Kingdom (UK) have access to such software tools, there has not been a comprehensive review of take-up within the health sector. In this paper, we report on a recently completed mixed-method research project that has examined the current levels of GIS use in the UK National Health Service, and focus our discussion on health authorities (HAs). Couched within the context of previous studies that have been concerned with outlining the types of factors influencing IT implementation in the health sector, we illuminate the importance of behavioural, cultural and organisational factors on the diffusion of GIS in the UK National Health Service. It is noted that very few organisations had a GIS strategy and we contend that if GIS is to play a wider role in addressing issues surrounding 'joined-up' government, more advice and guidance is needed on policies promoting the exchange of geographical data between agencies concerned with tackling health issues. We conclude by drawing attention to the perceived lack of national guidance on GIS matters, more generally, within the UK health sector.     

Geographic information systems: their use in environmental epidemiologic research.

Advances in geographic information system (GIS) technology, developed by geographers, provide new opportunities for environmental epidemiologists to study associations between environmental exposures and the spatial distribution of disease. A GIS is a powerful computer mapping and analysis technology capable of integrating large quantities of geographic (spatial) data as well as linking geographic with nongeographic data (e.g., demographic information, environmental exposure levels). In this paper we provide an overview of some of the capabilities and limitations of GIS technology; we illustrate, through practical examples, the use of several functions of a GIS including automated address matching, distance functions, buffer analysis, spatial query, and polygon overlay; we discuss methods and limitations of address geocoding, often central to the use of a GIS in environmental epidemiologic research; and we suggest ways to facilitate its use in future studies. Collaborative efforts between epidemiologists, biostatisticians, environmental scientists, GIS specialists, and medical geographers are needed to realize the full potential of GIS technology in environmental health research and may lead to innovative solutions to complex questions.     

Identifying environmental risk factors for endemic cholera: a raster GIS approach

The bacteria that cause cholera are known to be normal inhabitants of surface water, however, the environmental risk factors for different biotypes of cholera are not well understood. This study identifies environmental risk factors for cholera in an endemic area of Bangladesh using a geographic information systems (GIS) approach. The study data were collected from a longitudinal health and demographic surveillance system and the data were integrated within a geographic information system database of the research area. Two study periods were chosen because they had different dominant biotypes of the disease. From 1992 to 1996 El Tor cholera was dominant and from 1983 to 1987 classical cholera was dominant. The study found the same three risk factors for the two biotypes of cholera including proximity to surface water, high population density, and poor educational level. The GIS database was used to measure the risk factors and spatial filtering techniques were employed. These robust spatial methods are offered as an example for future epidemiological research efforts that define environmental risk factors for infectious diseases.     

The benefits of the application of geographical information systems in public and environmental health

One of the most important issues in public and environmental health today concerns the type of instruments that can be used to devise quick, reliable and scientifically valid methods of rapid assessment which, in turn, can be utilized in health research and in the planning, monitoring and evaluation of health programmes. As the applications of geographical information systems (GIS) relate to the collection, storage, integration, management, retrieval, analysis and display of spatial data, it is not surprising that the potential usefulness of this new technology in the fields of health research and policy is beginning to be realized. This article seeks to demonstrate the opportunities which the use of geographical information systems can offer to research and policy on health issues. The article first describes the principles and objectives of GIS before going on to discuss hardware and software developments as well as the variety of application fields, organizations and users. Some examples of current applications are provided to illustrate the type of work being undertaken. The final sections address issues specifically related to the application of GIS in health research and policies in the European context.     

Considerations for using a geographic information system to assess environmental supports for physical activity

The use of a geographic information system (GIS) to study environmental supports for physical activity raises several issues, including acquisition and development, quality, and analysis.

We recommend to public health professionals interested in using GIS that they investigate available data, plan for data development where none exists, ensure the availability of trained personnel and sufficient time, and consider issues such as data quality, analyses, and confidentiality.

This article shares information about data-related issues that we encountered when using GIS to validate responses to a questionnaire about environmental supports for physical activity.

     

New perspectives on the use of Geographical Information Systems (GIS) in environmental health sciences

At first glance, the domain of health is no typical area to applicate Geographical Information Systems (GIS). Nevertheless, the recent development clearly shows that also within the domains of environmental health, disease ecology and public health GIS have become an indispensable tool for processing, analysing and visualising spatial data. In the field of geographical epidemiology, GIS are used for drawing up disease maps and for ecological analysis. The striking advantages of GIS for the disease mapping process are the considerably simplified generation and variation of maps as well as a broader variety in terms of determining a real units. In the frame of ecological analysis, GIS can significantly assist with the assessment of the distribution of health-relevant environmental factors via interpolation and modelling. On the other hand, the GIS-supported methods for the detection of striking spatial patterns of disease distribution need to be much improved. An important topic in this respect is the integration of the time dimension. The increasing use of remote sensing as well as the integration into internet functionalities will stimulate the application of GIS in the field of Environmental Health Sciences (EHS). In future, the integration and analysis of health-relevant data in one single data system will open up many new research opportunities.     

Mapping health on the internet: a new tool for environmental justice and public health research

This paper examines the prospects for integrating Internet platform GIS or 'web-GIS' into environmental justice and related public health research. Specifically, we document the development of a web-GIS created for investigating relationships between health, air quality and socioeconomic factors in Hamilton, Canada. After development of the web-GIS site, we assembled a focus group of public health professionals to test functionality and render opinions about the potential of the site and geographic information in their program implementation. Results show overwhelming support for the further integration of GIS into public health practice. The results also underscore the potential of web-GIS to alleviate concerns of cost and data availability that often limit the use of GIS in community debates centred on environmental justice issues.     

Research protocol: EB-GIS4HEALTH UK – foundation evidence base and ontology-based framework of modular, reusable models for UK/NHS health and healthcare GIS applications

EB-GIS4HEALTH UK aims at building a UK-oriented foundation evidence base and modular conceptual models for GIS applications and programmes in health and healthcare to improve the currently poor GIS state of affairs within the NHS; help the NHS understand and harness the importance of spatial information in the health sector in order to better respond to national health plans, priorities, and requirements; and also foster the much-needed NHS-academia GIS collaboration. The project will focus on diabetes and dental care, which together account for about 11% of the annual NHS budget, and are thus important topics where GIS can help optimising resource utilisation and outcomes. Virtual e-focus groups will ensure all UK/NHS health GIS stakeholders are represented. The models will be built using Protégé ontology editor based on the best evidence pooled in the project's evidence base (from critical literature reviews and e-focus groups). We will disseminate our evidence base, GIS models, and documentation through the project's Web server. The models will be human-readable in different ways to inform NHS GIS implementers, and it will be possible to also use them to generate the necessary template databases (and even to develop "intelligent" health GIS solutions using software agents) for running the modelled applications. Our products and experience in this project will be transferable to address other national health topics based on the same principles. Our ultimate goal is to provide the NHS with practical, vendor-neutral, modular workflow models, and ready-to-use, evidence-based frameworks for developing successful GIS business plans and implementing GIS to address various health issues. NHS organisations adopting such frameworks will achieve a common understanding of spatial data and processes, which will enable them to efficiently and effectively share, compare, and integrate their data silos and results for more informed planning and better outcomes.     

地理信息系统在卫生领域中的应用进展

随着科技的发展,地理信息系统已逐渐应用于交通、农业、环境和自然资源的管理等社会领域,最近它也被应用于卫生领域中的环境与疾病关系的研究。地理信息系统是一个计算机辅助的空间数据信息管理系统,一般来说,应用地理信息系统可以实现空间数据的管理(采集、储存和维护),分析(统计、空间建模)和显示(图形、地图制作)。由于健康在很大程度上由环境因素决定,地理信息系统的空间建模技术可以帮助我们很好的理解疾病的发生和环境因素,以及医疗卫生系统之间的关系。地理信息系统在疾病研究、健康教育以及卫生项目的规划、监测和评估中,必定会成为一个很重要的工具。     

Research protocol: EB-GIS4HEALTH UK - foundation evidence base and ontology-based framework of modular, reusable models for UK/NHS health and healthcare GIS applications

EB-GIS4HEALTH UK aims at building a UK-oriented foundation evidence base and modular conceptual models for GIS applications and programmes in health and healthcare to improve the currently poor GIS state of affairs within the NHS; help the NHS understand and harness the importance of spatial information in the health sector in order to better respond to national health plans, priorities, and requirements; and also foster the much-needed NHS-academia GIS collaboration. The project will focus on diabetes and dental care, which together account for about 11% of the annual NHS budget, and are thus important topics where GIS can help optimising resource utilisation and outcomes. Virtual e-focus groups will ensure all UK/NHS health GIS stakeholders are represented. The models will be built using Protege ontology editor http://protege.stanford.edu/ based on the best evidence pooled in the project's evidence base (from critical literature reviews and e-focus groups). We will disseminate our evidence base, GIS models, and documentation through the project's Web server. The models will be human-readable in different ways to inform NHS GIS implementers, and it will be possible to also use them to generate the necessary template databases (and even to develop "intelligent" health GIS solutions using software agents) for running the modelled applications. Our products and experience in this project will be transferable to address other national health topics based on the same principles. Our ultimate goal is to provide the NHS with practical, vendor-neutral, modular workflow models, and ready-to-use, evidence-based frameworks for developing successful GIS business plans and implementing GIS to address various health issues. NHS organisations adopting such frameworks will achieve a common understanding of spatial data and processes, which will enable them to efficiently and effectively share, compare, and integrate their data silos and results for more informed planning and better outcomes.     

Visualization and exploratory analysis of epidemiologic data using a novel space time information system

Background  

Recent years have seen an expansion in the use of Geographic Information Systems (GIS) in environmental health research. In this field GIS can be used to detect disease clustering, to analyze access to hospital emergency care, to predict environmental outbreaks, and to estimate exposure to toxic compounds. Despite these advances the inability of GIS to properly handle temporal information is increasingly recognised as a significant constraint. The effective representation and visualization of both spatial and temporal dimensions therefore is expected to significantly enhance our ability to undertake environmental health research using time-referenced geospatial data. Especially for diseases with long latency periods (such as cancer) the ability to represent, quantify and model individual exposure through time is a critical component of risk estimation. In response to this need a STIS – a Space Time Information System has been developed to visualize and analyze objects simultaneously through space and time.     

GIS在公共卫生领域的应用现状与发展趋势

从公共卫生的疾病监测与预防、环境健康研究、卫生服务与利用、公共卫生突发事件等4个方面,概述了近年来国内外应用GIS的现状,分析了当前GIS技术的不足,对GIS在该领域的发展趋势进行了展望。指出随着GIS进一步提高其空间数据分析能力,广泛地集成其他技术,GIS在公共卫生领域有着巨大的应用潜力。     

Geography and geographic information systems in family medicine research

Understanding spatial relationships between determinants and outcomes of health care is important as the concept of population-based health care gains acceptance. A wide range of tools for understanding these spatial relationships is available to the family medicine researcher through the use of Geographic Information Systems (GIS). The power of GIS lies in its ability to display the spatial distribution of a health-related predictor or outcome. These maps can then be used to either generate or test hypotheses that would not have otherwise occurred to the investigator without visualizing the spatial relationships. The type of GIS application used is dependent on the type of data the researcher has and the research question. The three most common types of data are point or event data, lattice data, and geostatistical data. Point or event data can be displayed using a technique known as geocoding. Lattice data is most commonly displayed as shaded or colored areas where the shading represents rates or counts. Geostatistical data provides counts or numbers at a given location. The analytic techniques used for analyzing spatial data depend on the type of data. Maps tell powerful stories and display relationships that may not be obvious using other techniques.     

Built environment and behavior: spatial sampling using parcel data

PURPOSE: The quality and economy of inferential research rely heavily on the sampling method. This paper addresses a methodological challenge in environment-behavior research: sampling respondents in relation to their built environmental characteristics. METHODS: A discussion of issues related to traditional neighborhood-based sampling serves to introduce a new spatial sampling strategy. Spatial sampling consists of defining conceptual population of interest, constructing spatial sample frame using parcel-level environmental data in GIS, examining the sample frame, determining the sampling design and size, and drawing the samples. An application of this method is illustrated using a recent study examining environmental correlates of walking and biking. RESULTS: Spatial sampling with parcel-level data ensures sufficient variations in and proper distributions of the environmental variables of interest, while controlling for the conditions of no interest. The use of the individual as unit of analysis offers an economic, generalizable, and easily interpretable approach to environment-behavior research, and discourages the potentially erroneous a priori definition of neighborhoods and aggregation problems. CONCLUSIONS: With its capacity to consider a broad range of detailed environmental variables, spatial sampling contributes to finding new or stronger environment-behavior associations and to the growing number of studies using the social ecologic model.     

Users' perspectives on epidemiological, GIS and point pattern approaches to analysing environment and health data

Despite examples showing the usefulness of geographical information systems (GIS) and spatial point pattern analysis in health research, there remain barriers to their widespread use within health service settings. This paper explores potential users' views on the relative usefulness of such approaches for analysing spatially referenced environmental health data. Our findings indicate that researchers and practitioners do not always prefer the approach with which they are most familiar. In addition, there is a need for higher levels of understanding of, and confidence in, GIS and point pattern analysis techniques amongst health service professionals. The greatest need is for multi-disciplinary research which uses the most appropriate approach for each investigation, rather than that with which researchers are most familiar.     

Surveillance of drinking water supply with a geographic information system: a pilot project of the of the Iogd NRM and the Hoxter district

Drinking water surveillance includes the use of spatial data. A geographic information system (GIS) is a practicable tool for work with spatial data in the health sector as well. Co-operation between the Institute of Public Health for North Rhine Westphalia, the local health authority of the Hoexter district and the Institute for Geoinformatics of the University of Muenster started a project testing the use of GIS for drinking water surveillance. A special application was programmed. It includes functions of retrieval and classification of the measured values of drinking water wells, in order to show time trends in a diagram and to visualise the location of the wells and the analysis data in a map. The members of the Public Health Office accepted the method and started using it regularly. In addition, the collaboration between the health authority and other local authorities was strengthened. Several data sets were included in the GIS, such as wells and results of water analysis, water protection areas, land use data, and topographical maps. Basing on to the experiences with this project, the development of a standard application is planned that is supposed to be communicated to all local health authorities in North Rhine Westphalia.