Geographic Information Systems (GIS):Geographic Information Systems (GIS):Shaping Global HealthShaping Global Health

May 30, 2008May 30, 2008GIS and Infectious Diseases SymposiumGIS and Infectious Diseases Symposium

RIVMRIVMBilthoven, NetherlandsBilthoven, Netherlands

Chris Kinabrew, MPH, MSWChris Kinabrew, MPH, MSW

Public Health Specialist (ESRI)Public Health Specialist (ESRI)

Chris Kinabrew, MPH, MSWChris Kinabrew, MPH, MSW

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• Public Health Specialist with ESRI since Fall 2005

• Graduate of Tulane School of Public Health / Social Work

• Graduate of CDC’s Public Health Leadership Institute

• Previously Associate Director of a Network of Public Health Nonprofit Research and Practice Institutes in the United States (NNPHI)

• Member of American Public Health Association and many other trade/professional organizations

• Frequent speaker on GIS and Health

AgendaAgenda

• Overview of GIS Overview of GIS – What is it?What is it?

– Who uses it in public health and healthcareWho uses it in public health and healthcare

– Basis for GIS in public healthBasis for GIS in public health

• GIS User Community in HealthGIS User Community in Health

• GIS Applications for Infectious Disease GIS Applications for Infectious Disease Research, Control and PreventionResearch, Control and Prevention

• GIS ResourcesGIS Resources

Before we get started…a videoBefore we get started…a video Using GIS for Assessment and Communication: Using GIS for Assessment and Communication: Estimating the Number of People Displaced Estimating the Number of People Displaced by Hurricane Katrinaby Hurricane Katrina

AnswersAnswers! !

MapsMaps

ChartsCharts

ReportsReports

What is GIS?What is GIS?

A system forA system for capturing, storing, editing, integrating, capturing, storing, editing, integrating,

managing, displaying, querying, analyzing & managing, displaying, querying, analyzing &

distributing distributing geographic data.geographic data.

Health DataHealth Data

Road NetworksRoad Networks

Facilities/BuildingsFacilities/Buildings

Administrative Units Administrative Units

Data layers linked Data layers linked by Geographyby Geography

Understand & visualize spatial relationshipsUnderstand & visualize spatial relationships

GIS is Composed of . . . . .

Data

Software

Hardware

StaffingGISGIS

Applications

Training

Antonie van Leeuwenhoeklaan 93721 MA Bilthoven

A street address… for RIVM (administrative data)A street address… for RIVM (administrative data) address matching to a street fileaddress matching to a street file

Converts to this… (geographical data)Converts to this… (geographical data)

52.117 degrees latitude52.117 degrees latitude 5.192 degrees longitude5.192 degrees longitude

How does it work: Geocoding an addressHow does it work: Geocoding an address

GPS receiver reading from groundGPS receiver reading from ground

The Dam in Amsterdam… (landmark)The Dam in Amsterdam… (landmark)

Converts to this… (geographical data)Converts to this… (geographical data)

52.222 degrees latitude52.222 degrees latitude 4.534 degrees longitude4.534 degrees longitude

(A system of geopositioning satellites.)

Geocoding Land Features… Geocoding Land Features…

remote sensing technology remote sensing technology (instruments and satellite photos)(instruments and satellite photos)

Hurricane… (weather data)Hurricane… (weather data)

Converts to this… a geographical “shape”Converts to this… a geographical “shape”

Geocoding weather patternsGeocoding weather patterns

GIS allows us toGIS allows us to… ask questions about our data… ask questions about our data

Florida Counties Where more Than 25% of the Population liveBelow the Poverty Level

Identifying Specific Features

Identifying Features Based on Conditions

GIS also facilitates…GIS also facilitates… more complex spatial analysismore complex spatial analysis

Visualize patterns over time

Map rates of disease

Run Models Based on Conditions

ESRI User Community in Public Health – Global to LocalESRI User Community in Public Health – Global to Local

• UN Agencies & Affiliates …WHO, FAOUN Agencies & Affiliates …WHO, FAO

• European CDCEuropean CDC

• 86 Ministries of Health86 Ministries of Health• 85% of European Union Member Nations85% of European Union Member Nations

• 50 State Health Departments in US50 State Health Departments in US

• 500+ Local Health Departments in US500+ Local Health Departments in US

• Hundreds of HospitalsHundreds of Hospitals

• Numerous Health NGOsNumerous Health NGOs

• Schools of Public Health & MedicineSchools of Public Health & Medicine

Why do health organizations use GIS?Why do health organizations use GIS?

• Enhances knowledge of community health needs Enhances knowledge of community health needs and health statusand health status– ““What is the demographic composition of this community or What is the demographic composition of this community or

neighborhood?”neighborhood?”

– Is this a health professional shortage area?Is this a health professional shortage area?

– Are there healthy food stores within walking distance?Are there healthy food stores within walking distance?

– Are there health disparities – outcomes, access, etc?Are there health disparities – outcomes, access, etc?

• Enhances evidence-based decision makingEnhances evidence-based decision making– Where should we prioritize this intervention given limited resources?Where should we prioritize this intervention given limited resources?

– Does the population meet the criteria for this program?Does the population meet the criteria for this program?

• Improves quality of data collection and analysisImproves quality of data collection and analysis– Is this a representative sample?Is this a representative sample?

– Where is our shipment of supplies?Where is our shipment of supplies?

Why do health organizations use GIS?Why do health organizations use GIS?

• Improves ability to alert, analyze and respond to public Improves ability to alert, analyze and respond to public health emergencies when geography is relevanthealth emergencies when geography is relevant– How many vulnerable people live in area X?How many vulnerable people live in area X?

– How many and what types of assets are available in neighborhood XHow many and what types of assets are available in neighborhood X

• Improves workflows and processes that are geo-centricImproves workflows and processes that are geo-centric– Where should we pre-position stockpiles?Where should we pre-position stockpiles?

– How can we optimize home health routingHow can we optimize home health routing

• Brings a relevancy to data analysis and information presentation– empowers people to take action

– allows rapid evaluations of alternatives

How are organizations using GIS in health?How are organizations using GIS in health?

Essential UsesEssential Uses

• Disease Surveillance & TrackingDisease Surveillance & Tracking

• Web-based Resource Locators and AtlasesWeb-based Resource Locators and Atlases

• Field Data CollectionField Data Collection

• Policy Analysis & Planning (e.g., gap Policy Analysis & Planning (e.g., gap analysis, disparity analysis)analysis, disparity analysis)

• Environmental Health MonitoringEnvironmental Health Monitoring

• Vital, Immunization and Disease Registries Vital, Immunization and Disease Registries

• Population Health ResearchPopulation Health Research

• Travel DirectionsTravel Directions

Emerging UsesEmerging Uses

• Situational AwarenessSituational Awareness

• Disaster ResponseDisaster Response

• Managing Workforce LogisticsManaging Workforce Logistics

• Consumer Empowerment Consumer Empowerment

• Disease ManagementDisease Management

• Back Office Geo-enablingBack Office Geo-enabling

• Health “business” AnalysisHealth “business” Analysis

• I & R ServicesI & R Services

• Biomedical ApplicationsBiomedical Applications

US National Public Health Performance Standards US National Public Health Performance Standards

Specific references and measures for Specific references and measures for GIS in Essential Service #1 and #2GIS in Essential Service #1 and #2

““Utilization of appropriate methods and technology, Utilization of appropriate methods and technology, such as geographic such as geographic information systems (GIS), information systems (GIS), to interpret and communicate data to diverse to interpret and communicate data to diverse audiences.”audiences.”

““Tools such as Tools such as geographic information systems (GIS) geographic information systems (GIS) are used to combine are used to combine geography, data, and computer mapping to support the exploration of geography, data, and computer mapping to support the exploration of spatial relationships, patterns, and trends in health data. Use of spatial relationships, patterns, and trends in health data. Use of geocoded data geocoded data (matching of street address to a corresponding latitude (matching of street address to a corresponding latitude and longitude) is promoted, while maintaining appropriate safeguards for and longitude) is promoted, while maintaining appropriate safeguards for confidentiality. Increased confidentiality. Increased public access to GIS public access to GIS information provides new information provides new insights to develop strategies that are appropriate for specific geographic insights to develop strategies that are appropriate for specific geographic areas and to align health status indicators with health resources.”areas and to align health status indicators with health resources.”

2.1.3.1 Does the LPHS use information technology for surveillance activities 2.1.3.1 Does the LPHS use information technology for surveillance activities (e.g., (e.g., geographic information systems, geographic information systems, word processing, spreadsheets, word processing, spreadsheets, database analysis, and graphics presentation software)?database analysis, and graphics presentation software)?

Updated local public health system assessment instrument available at http://www.cdc.gov/od/ocphp/nphpsp/documents/local/Local.BookletA.pd

Building GIS Capacity in Local Health DepartmentsBuilding GIS Capacity in Local Health Departments

Miranda et al., Building Geographic Information System Capacity in Local Health Departments: Lessons from a North Carolina Project, American Journal of Public Health. 2005; Vol

95, No. 12

“Many GIS-based projects have been successful in supporting public and environmental health practice, including those investigating toxic exposure, vector-borne disease, health information access, and the built environment”

Video demonstrating ArcGIS:Video demonstrating ArcGIS:

Buffering, Geoprocessing and Spatial Statistics: Buffering, Geoprocessing and Spatial Statistics: Pandemic Flu: Prepare or Panic Pandemic Flu: Prepare or Panic (6:45)(6:45)

GIS and Infectious Diseases-GIS and Infectious Diseases-

Research and ApplicationsResearch and Applications

Pandemic Influenza and GISPandemic Influenza and GIS

GIS facilitates:GIS facilitates:• ContainmentContainment

• Modeling the Spread Modeling the Spread

• Syndromic SurveillanceSyndromic Surveillance

• Resource AllocationResource Allocation– people,people,

– vaccines / antiviralsvaccines / antivirals

– ventilatorsventilators

• Situational AwarenessSituational Awareness

• Decision Making during Exercises (e.g., Mass Decision Making during Exercises (e.g., Mass Vaccination)Vaccination)

• Identifying Vulnerable PopulationsIdentifying Vulnerable Populations

Seasonal Influenza and GISSeasonal Influenza and GIS

GIS facilitatesGIS facilitates::

• Status mapsStatus maps

• Analysis of spreading Analysis of spreading patternspatterns

• Vaccine allocationVaccine allocation

• Mapping vaccination Mapping vaccination ratesrates

• Planning Vaccination Planning Vaccination Clinics and OutreachClinics and Outreach

HIV and GIS (and other STIs)HIV and GIS (and other STIs)

GIS Facilitates:GIS Facilitates:• Showing location of services in relation to need Showing location of services in relation to need

(Service Availability Mapping)(Service Availability Mapping)

• access to and gaps in providing:access to and gaps in providing:

-HIV counselling and testing (VCT)-HIV counselling and testing (VCT)

-treatment (ART) and-treatment (ART) and

-mother-to-child transmission (PMTCT) -mother-to-child transmission (PMTCT) servicesservices

• Accurate surveillance reports through geocodingAccurate surveillance reports through geocoding• More refined knowledge of localized sexually More refined knowledge of localized sexually

transmitted infection activitytransmitted infection activity• Improved assessment of disease intervention Improved assessment of disease intervention

staffing needsstaffing needs• Greater understanding and rationale for targeted Greater understanding and rationale for targeted

prevention effortsprevention efforts

Tuberculosis and GISTuberculosis and GIS

GIS facilitates:GIS facilitates:

• Identifying areas of TB transmission and incidenceIdentifying areas of TB transmission and incidence

• Analyzing access to care and treatmentAnalyzing access to care and treatment

• Network analysis to more efficiently route case Network analysis to more efficiently route case workers to home visits (to save time)workers to home visits (to save time)

• PDA/GPS devices used to locate clinic attendees' PDA/GPS devices used to locate clinic attendees' homes homes

• Performance management – monitoring and Performance management – monitoring and evaluationevaluation

• Kriging …to predict the prevalence of Bovine Kriging …to predict the prevalence of Bovine Tuberculosis… “an excellent tool to predict BTB Tuberculosis… “an excellent tool to predict BTB distribution with major potential savings.”distribution with major potential savings.”

Legionnaire’s and GIS (non-infectious)Legionnaire’s and GIS (non-infectious)

GIS facilitates:GIS facilitates:• Outbreak analysisOutbreak analysis

• Tracking movement of Tracking movement of patientspatients

• In this example, traced to an In this example, traced to an air scrubber as sourceair scrubber as source

• The high velocity, large drift The high velocity, large drift and high humidity may have and high humidity may have contributed to the wide contributed to the wide spread spread

• GIS very helpful for exposure GIS very helpful for exposure analysisanalysis

Vector-Borne Diseases and GISVector-Borne Diseases and GIS

GIS utilized in the prevention and control of GIS utilized in the prevention and control of Malaria, Lyme Disease, and many other Malaria, Lyme Disease, and many other vector-borne diseases. Sipe and Dale vector-borne diseases. Sipe and Dale examined literature in 2003 and found major examined literature in 2003 and found major uses of GIS include:uses of GIS include:

• Map incidence and prevalenceMap incidence and prevalence

• Map of relationships between malaria incidence/prevalence and Map of relationships between malaria incidence/prevalence and other potentially related variablesother potentially related variables

• Remote Sensing (data collection)Remote Sensing (data collection)

• Model malaria riskModel malaria risk

From ESRI user experience, also see many From ESRI user experience, also see many applications including:applications including:

• Field Data CollectionField Data Collection

• Web-based display of data for mosquitoes, sentinels, human cases Web-based display of data for mosquitoes, sentinels, human cases

West Nile Virus SurveillanceGIS Analysis – Reasoning

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Animal Disease and GISAnimal Disease and GIS

• Continued concerns about swine flu, foot and mouth disease, BSE Continued concerns about swine flu, foot and mouth disease, BSE (mad cow), MRSA in pigs and cattle…. GIS facilitates:(mad cow), MRSA in pigs and cattle…. GIS facilitates:

– Routine field data collectionRoutine field data collection

• Outbreak control – quicker access to information about other nearby Outbreak control – quicker access to information about other nearby farms to initiate containment / culling (see farms to initiate containment / culling (see http://www.vet.upenn.edu/schoolresources/communications/publications/bellwether/61/preventing_pandemic.html

• Tracking food from farm to tableTracking food from farm to table

• Kriging to predict the prevalence of Bovine Tuberculosis… “an Kriging to predict the prevalence of Bovine Tuberculosis… “an excellent tool to predict BTB distribution with major potential excellent tool to predict BTB distribution with major potential savings.”savings.”

• Increasing connections to human disease surveillance systems, with Increasing connections to human disease surveillance systems, with geography as common identifiergeography as common identifier

Mobile GIS Rapid Needs AssessmentMobile GIS Rapid Needs Assessment

• In North Carolina, GIS technology introduced a new In North Carolina, GIS technology introduced a new methodology for randomization in the selection of methodology for randomization in the selection of households and also simplified the mapping processhouseholds and also simplified the mapping process

• Hurricane ResponseHurricane Response

• Legionnaire’s InvestigationLegionnaire’s Investigation

More recently, Food Recall scenarioMore recently, Food Recall scenario– According to Steve Ramsey (Preparedness Manager, Guilford County According to Steve Ramsey (Preparedness Manager, Guilford County

(NC) Department of Public Health), “Utilizing desktop and mobile GIS (NC) Department of Public Health), “Utilizing desktop and mobile GIS applications to route our staff to retail establishments, collect data applications to route our staff to retail establishments, collect data electronically at the point of inspection, and plan for future operational electronically at the point of inspection, and plan for future operational periods, we were able to conduct the most efficient response to a food periods, we were able to conduct the most efficient response to a food recall effort in NC.” recall effort in NC.”

GIS and HospitalsGIS and Hospitals

• Asset tracking and “Geo-fencing”Asset tracking and “Geo-fencing”

• Bed managementBed management

• Business intelligence (financials, performance)Business intelligence (financials, performance)

• ED surveillance / Situational AwarenessED surveillance / Situational Awareness

• Strategic PlanningStrategic Planning

• Site Location AnalysisSite Location Analysis

• Outbreak detection and monitoring / Clinical SurveillanceOutbreak detection and monitoring / Clinical Surveillance

Resources for GIS and Public HealthResources for GIS and Public Health

ESRI Health User Group ESRI Health User Group

• ESRI Health GIS User CommunityESRI Health GIS User Community–Listserve for 900+ health professionals worldwideListserve for 900+ health professionals worldwide–Recent inquiries include Tuberculosis, Obesity, and Recent inquiries include Tuberculosis, Obesity, and

several methodology questionsseveral methodology questions–ESRI Health Team has also started networking ESRI Health Team has also started networking

activities for sub-segments such as state & local activities for sub-segments such as state & local health GIS coordinatorshealth GIS coordinators

–Sign up at Sign up at www.esri.com/hug

Health GIS Newsletters and other Health GIS Newsletters and other GIS publicationsGIS publications

• ESRI PublicationsESRI Publications– HealthyGIS (quarterly newsletter to 40,000)HealthyGIS (quarterly newsletter to 40,000)– ArcUser (240,000) ArcUser (240,000) – ArcNews (500,000)ArcNews (500,000)

Resources:Resources:Books from ESRI PressBooks from ESRI Press

Journals and books from other publishersJournals and books from other publishers

• International Journal of Health GeographicsInternational Journal of Health Geographics• Health & PlaceHealth & Place

• Additional book titles (other publishers):Additional book titles (other publishers):• GIS and Public Health (Cromley)GIS and Public Health (Cromley)• Geographic Information Systems and Health Applications Geographic Information Systems and Health Applications

(Khan et al)(Khan et al)

Health GIS ConferencesHealth GIS Conferences Proceedings available atProceedings available at

http://gis.esri.com/library/userconf/health07/index.html andandhttp://gis.esri.com/library/userconf/proc07/track.html#Health%20and%20Human%20Services

The Urban and Regional Information Systems Association recently The Urban and Regional Information Systems Association recently offered its first GIS and Public Health conference offered its first GIS and Public Health conference www.urisa.org/conferences/health

For information about ESRI 2008 Health GIS Conference, please visit For information about ESRI 2008 Health GIS Conference, please visit www.esri.com/hug

Videos demonstrating ArcGIS:Videos demonstrating ArcGIS:

Buffering, Geoprocessing and Spatial Statistics: Buffering, Geoprocessing and Spatial Statistics: Social Distancing Social Distancing (4:50) (4:50)

Bedankt en tot ziens!Bedankt en tot ziens!

Chris Kinabrew, MPH, MSWChris Kinabrew, MPH, MSW

Meer informatie?Meer informatie?

Rdijkstra@esri.nl