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Removal of the pump handle led to a rapid decline in the incidence of cholera, helping the medical community to eventually conclude that cholera was a water-borne disease. Snow's work provides an indication of how a GIS could benefit public health investigations and other research. He continued to analyze his data, eventually showing that the incidence rate of cholera was also related to local elevation as well as soil type and alkalinity.

Low-lying areas, particularly those with poorly draining soil, were found to have higher incidence rates for cholera, which Dr. Snow attributed to the pools of water that tended to collect there, again showing evidence that cholera was in fact a water-borne disease rather than one borne by 'miasma' as was commonly believed at the time. This is an early example of what has come to be known as disease diffusion mapping , an area of study based on the idea that a disease starts from some source or central point and then spreads throughout the local area according to patterns and conditions there.

This is another area of research where the capabilities of a GIS have been shown to be of help to practitioners. Snow faced, and researchers today depend on modern GIS and other computer mapping applications to assist in their analyses.

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For example, see the map to the right depicting death rates from heart disease among white males above age 35 in the US between and Public health informatics PHI is an emerging specialty which focuses on the application of information science and technology to public health practice and research. For example, GIS displays have been used to show a clear relationship between clusters of emergent Hepatitis C cases and those of known intravenous drug users in Connecticut.

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Conversely, showing the coincidence of potential causal factors with the ultimate effect can help suggest a potential causal relationship, thereby driving further investigation and analysis source needed? Alternately, GIS techniques have been used to show a lack of correlation between causes and effects or between different effects. For example, the distributions of both birth defects and infant mortality in Iowa were studied, and the researchers found no relationship in those data.

GIS in Public Health Practice

GIS can support public health in different ways as well. First and foremost, GIS displays can help inform proper understanding and drive better decisions. For example, elimination of health disparities is one of two primary goals of Healthy People , one of the preeminent public health programs in existence today in the US. GIS can play a significant role in that effort, helping public health practitioners identify areas of disparities or inequities, and ideally helping them identify and develop solutions to address those shortcomings.

GIS can also help researchers integrate disparate data from a wide variety of sources, and can even be used to enforce quality control measures on those data. Much public health data is still manually generated, and is therefore subject to human-generated mistakes and miscoding.

There are also concerns or issues with use of GIS tools for public health efforts. Chief among those is a concern for privacy and confidentiality of individuals. Use of GIS displays and related databases raises the potential of compromising those privacy standards, so some precautions are necessary to avoid pinpointing individuals based on spatial data.

For example, data may need to be aggregated to cover larger areas such as a zip code or county, helping to mask individual identities. Maps can also be constructed at smaller scales so that less detail is revealed. Alternately, key identifying features such as the road and street network can be left off the maps to mask exact location, or it may even be advisable to intentionally offset the location markers by some random amount if deemed necessary.

It is well established in the literature that statistical inference based on aggregated data can lead researchers to erroneous conclusions, suggesting relationships that in fact do not exist or obscuring relationships that do in fact exist. This issue is known as the modifiable areal unit problem. For example, New York public health officials worried that cancer clusters and causes would be misidentified after they were forced to post maps showing cancer cases by ZIP code on the internet.

Their assertion was that ZIP codes were designed for a purpose unrelated to public health issues, and so use of these arbitrary boundaries might lead to inappropriate groupings and then to incorrect conclusions.

GIS and public health

Use of GIS in public health is an application area still in its infancy. Like most new applications, there is a lot of promise, but also a lot of pitfalls that must be avoided along the way. Geographic information systems. Public health--Geographic information systems. Public health--Information services.

Medical geography--Methodology. Maheswaran, Ravi. Topography, Medical--methods.

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    GIS in Public Health Practice Summary

    Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation, without intent to infringe. Bluetooth is a registered trademark of Bluetooth SIG. LandView is a registered trademark of the U. Census Bureau. Populations and communities are geographically distributed and communities tend to have their own defining characteristics. Factors influencing health are commonly classified under four groups: 1. Inherited conditions 2. Environment, which includes both physical i.

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    Lifestyle 4. Healthcare Each of these factors may have marked geographical variation. The practice of key elements of public health, including communicable disease control, environmental health protection, health needs assessment, planning and policy, surveillance, monitoring and evaluation, and operational public health management, is often explicitly geographical in nature. In addition, resource allocation at the macro and micro levels has a strong geographical component based on demography, health needs, existing provisions, and other factors.

    GIS, the definition of which has evolved from geographic information systems to geographic information science, involves a scientific problem-solving approach, encompassing the development and application of scientific methods to solve societal problems. It, therefore, has become an integral and essential part of public health research and practice. Significant advances in scientific approaches to evaluating and using geographic information are taking place.

    Health information at a fine spatial resolution has become widely available; the same can be said for mapping technology. These developments enable public health practitioners to link and analyze data in new ways at the international, regional, and even street levels. The scientific program drew upon many of the leading public health researchers and practitioners in this area. The breadth of knowledge and expertise at the conference and the clear interest in the field from practitioners from a wide variety of specialisms led us to believe that a book that recognized the breadth of the field would be useful.

    For this book, specifically selected expanded contributions were invited from participants to illustrate particular areas of application or address issues pertinent to the field. Many of the chapters have a United Kingdom or European focus, but the principles, issues, and methods discussed should be equally relevant beyond Europe. Although this is not the first book on GIS and public health, we believe it is the first to treat GIS as more than a technology in relation to public health practice. We hope it will be of benefit to practitioners, researchers, and students with an interest in public health.

    We would also like to thank all the contributors for their efforts and support. Acknowledgments of permission to reproduce published material are provided in the corresponding chapters. Lawson Chapter 4 Clustering of Disease Sabel Chapter 18 Conclusions and Future Prospects Since then, a number of health scares have highlighted the need for continuing improvements in public health protection systems.

    Recent high profile examples include the outbreak of severe acute respiratory syndrome SARS and variant Creutzfeldt-Jakob disease, the human form of bovine spongiform encephalopathy commonly known as mad cow disease. The description of disease epidemiology typically has three elements: time, place, and person. Describing the outbreak and spread of a communicable disease therefore explicitly includes a spatial component.

    Although this has long been recognized e. Environmental health issues have been gaining importance both scientifically and in terms of public concern. The interaction between environment and health outcomes is being increasingly recognized at the international level by major organizations including the World Health Organization WHO and the European Commission. For example, a recent report for the European Commission estimated that up to 20 percent of ill health might be due to environmental factors, with air pollution being the worst culprit Commission of the European Communities, It was estimated that 10 percent of children in Europe have asthma, with a higher incidence in Western Europe than in accession countries, indicating a complex mix of environmental, social, and lifestyle factors.

    This is not just an environmental and social problem, but also an economic one.

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    Understanding the complex relationships between combined exposure over time to a cocktail of chemicals and emissions and health outcomes is becoming a top priority in Europe, requiring integrated research programs with greater availability of shared information and geographically referenced information systems. In addition, there are increased concerns to the public, organizations, and governments of the risks to health posed by the potential of bioterrorism following the events of September 11, Health protection establishments have been strengthened in numerous countries throughout the world and part of the requirement for active surveillance is the temporal-spatial component for early warning systems.

    Although the potential benefits of spatial information and analysis are immediately apparent in the communicable disease and environmental health fields, there are major and not fully recognized benefits to be gained in relation to policy and planning in the health and healthcare fields. The basic elements of work in this branch of public health work include health needs assessment, planning and implementation, and monitoring and evaluation.

    Related and overlapping aspects include resource allocation, surveillance, and health impact assessment. There are a number of approaches to health needs assessment Stevens and Raftery, Epidemiologically based needs assessment combines epidemiological approaches, including health status assessments, with assessment of the effectiveness and cost effectiveness of interventions. Comparative needs assessment involves comparing levels of service utilization between different populations while corporate needs assessment incorporates obtaining the views of professionals, patients, and other interested and relevant parties.

    There is a clear spatial element to population-based health needs assessment and the use of Geograhic Information Systems GIS in this field will bring many potential benefits. These include resource allocation based on need, and current practice in resource allocation in most countries already includes a geographical element based on regions or smaller areas.

    Spatial Data: make the most of your opportunities - Chris Grundy - TEDxLSHTM

    Following a population-based needs assessment, the next step in public healthcare management is to plan and implement strategies and interventions to meet these needs to improve health and well-being. If the health needs assessment has a detailed spatial element, then appropriate geographical targeting of interventions or tailoring interventions to meet varying geographical factors could substantially improve the effectiveness of interventions and efficiency in the use of scarce resources.

    Interventions to increase geographical access may include the provision of community transport services. Geographical techniques, such as spatial decision support systems, are currently already widely deployed in the commercial and retail sectors. Tailoring interventions may be improved by detailed spatial analysis of existing referral patterns and care pathways, though the latter may pose challenges in the representation of relevant spatial and temporal information within a Geographic Information System GIS.

    The need for targeted assessment and policy action is also particularly important given the widely acknowledged relationship between poor health and socioeconomic conditions see, for example, Acheson, The logical step that follows intervention is monitoring and evaluation to ensure that the intervention is achieving the desired goal.