June 2000EC 6th Workshop on GI and GIS Sustaining Health and Human Services: Encouraging the...

June 2000 EC 6th Workshop on GI and GIS

Sustaining Health and Human Services:

Encouraging the Creative Application of GIS

Gregory Elmes, Gerard Rushton, and Robert McMaster

University Consortium for Geographic Information Science


UCGIS

University Consortium for Geographic Information Science Formed to serve as an effective, unified voice

for the geographic information science research community in the US

To foster multidisciplinary research and education

To promote the informed and responsible use of geographic information science and geographic analysis for the benefit of society


UCGIS RESEARCH CHALLENGES

Spatial Data Acquisition and Integration Distributed & Mobile Computing Extensions to Geographic Representation Cognition of Geographic Information Interoperability of Geographic Information Spatial Analysis & Modeling in a GIS Future of the Spatial Information Infrastructure Uncertainty in Spatial Data Scale GIS and Society


CROSS-CUTTING EXERCISE

Major application areas examined in light of the ten research challenges

Crime Analysis Emergency Preparedness Urban and Regional Planning Water Resources Transportation Planning and Monitoring Public Participation GIS Public Health and Human Services

Journal of Urban and Regional Information Systems Association, Spring 2000, Vol. 12, 2


Objective: Improving Health and Human Services Using GIS

UCGIS analysis of health status and health care with particular regard to challenges being faced in research and education (Rushton et. al, 2000). Emphasize roles played by geomatics and

spatial analysis in reducing burden of mortality and morbidity, and in improving the efficiency and equity of public health services.

Pose some educated guesses as to the emerging roles for GIS in the near future.


US National Significance

US ranked 37th in recent WHO assessment of national health care systems

Three classes: Top 10% - afford any care available Middle class – vulnerable to catastrophic costs Bottom third – equivalent to health care conditions

in many developing nations Geography of disease incidence and care access

– Appalachia, Mississippi Delta, First Nations Excess disease burden in other regions - not well

documented at local levels


Public Health and Human Services

Health care represents ~ 13 % US GDP Effective application of GI to reduce

expenditures on health through improved surveillance, health care delivery, access to care, or evaluation of outcomes of intervention projects will be of national significance.

Although technological benefits can be rapidly adopted world-wide, many barriers remain


National Security IssuesHealth System vulnerability to

globalization of disease West Nile Fever, Encephalitis

Vulnerability to bio-terrorism, natural disasters

Vulnerability to polarization of health and health care disease re-emergence fragmentation of society


Background

Reviews of GIS in Public Health & Services Clarke et al., 1996; Croner et al., 1996; Richards et al., 1999; Rushton et al.,

1997; Rushton,1999; Vine et al., 1997; Yasnoff and Sondik, 1999

Centers for Disease Control and Prevention CDC supports development of GIS software (Dean,

1999)

National Cancer Institute NCI supports development of software for disease

cluster identification, (Kulldorff, et al., 1998).


Background (cont.)

CDC and ATSDR Four annual meetings on GIS and Public

Health. CDC also collaborates with the National

Center for Health Statistics and the US Department of Health and Human Services on an annual conference on health data and statistics

increasingly has geographic information and internet technology components.


Background (cont.)

National institute of Environmental Health Sciences (NIEHS), under US Public Law 103-43 requested proposals to develop a health-related GIS for Long Island, NY.

“The prototype health-related GIS will provide researchers a new tool to investigate relationships between breast cancer and the environment on Long Island, and to estimate exposures to environmental contamination.” (NCI, 1999, p.3).

Private sector Contract awarded to AverStar Inc.


Background (cont.)

NIH - Spring 2000 call for proposals First such call to emphasize integrating

social environment Add to traditional emphasis on clinical work Recognition of geographic context and

geographical tools and methods High level of proof required for research

ethics and practice of medical community


Research Issues

Improving Disease Surveillance Data Systems Systematic studies of access, health treatment

choice, and health outcomes Spatial-Temporal Aspects of GIS and Health Risk factors as contributors to disease and ill-health

Ecological Studies of Environmental Factors and Disease Transmission

Targeting health resources to demand, under-served

Communicating GIS results with the public Maintaining the confidentiality of health records


GIS Research for Public Health and Human Services

Focus on advancing health analysis beyond the conventional areas of mapping, towards interactive models of analysis, visualization and multimedia, and sharing spatial information.


Communicating GIS

To Health ProfessionalsTo Government To Public

Regiontwo.shpINSUFFICIENT DEATHSSUFFICIENT DEATHS

Regions with Insufficient Datafor Rate Calculation

Black Males 65+-1.5 - -1.0 Std. Dev.-1.0 - -0.5 Std. Dev.-0.5 - 0.0 Std. Dev.Mean0.0 - 0.5 Std. Dev.0.5 - 1.0 Std. Dev.1.0 - 1.5 Std. Dev.1.5 - 2.0 Std. Dev.2.0 - 2.5 Std. Dev.2.5 - 3.0 Std. Dev.> 3 Std. Dev.

Mortality Rates Black Males 65 years and older(Not age adjusted)

COMPACTNESS

EQUALITYBetween Regions

HOMOGENEITYWithin Regions

Mortality RateBlack Males 65 yrs +Multiple Objective Region

Standardized RatesInsufficient Data-5.68 - -0.87-0.87 - 0.060.06 - 1.111.11 - 2.71

IHD Mortality Rates from Spatial Filter(Standardized)Black Males 65+


Spatial-Temporal Aspects

National Institute of Environmental Health Sciences - Geospatial Lifelines (Mark and Egenhofer 1999)

Capture individuals' location at regular or irregular temporal intervals methods to trace locations of individual patients or controls

back in time, to discover spatial clusters or environmental exposures

designing, prototyping, and assess computational models for geospatial lifelines

examining the ethical and legal implications of recording individuals' geospatial lifelines in databases, and procedures for appropriate restrictions on data analysis and dissemination.


UCGIS-USGS Workshops

Universities, Federal Agencies, Pacific Ring Health initiative (UCSD)

Vector-borne diseaseSpatial Analysis in GIS

Set of tools for professionals Multiple disciplines Best practice analysis in a GIS environment

Unresolved Research Issues


UCGIS-USGS Workshop: Proposed Topics

Geography of Disease How are vector-borne

diseases unique? Environmental

determinism

Spatial Analysis MAUP Small Number Problem Spatial Autocorrelation

Data Integration Data Structures

Common data structures Interrelating multiple

point themes

Transformations Aggregation and

disaggregation Best interpolation

Techniques How to map ‘junk’


Proposed Workshop Topics (cont.)

Spatial Modeling Spatial econometrics

multicollinearity

Spatial Metrics Spatial Factor

Analysis Causal/Path Analysis Probabilistic Modeling Association

Relating cases to land cover

Decision Support Utility

Risk: Harm, hazards, uncertainty

Cost-benefit analysis of education, migration...

Forecasting

Accuracy Under and over-reporting Positional, temporal, etc. Disclosure reporting


EMERGING THEMES

Data integration New sensors at every scale New data sources and forms

Data mining and knowledge discovery warehousing, selection, cleaning, transformation,

geo-registration, mining, model selection, interpretation, and use.

Participatory GIS Involving the public, local knowledge, new

representations


Participatory GIS

Local groups to mission agenciesAgencies with overlapping or

conflicting mandates SCALE

Irregular development of capabilities INEQUITY

Community Integrated GIS

West Virginia University

Catholic University of Mozambique - Beira

University of Pretoria

Local CIGIS

CollaboratoryCollaboratoryUniversity


Data Acquisition

Characterized by massive increase in spatio-temporal resolution Georeferenced mobiles and appliances IKONOS and similar imagery Remote monitoring of individual’s health

In Home In Body

Nanotechnology


Recommendations

Recommendation #1 Establish greater levels of professional

interaction between medical professionals, epidemiologists, statisticians, and geographers.

Recommendation #2 Establish international dialog on the

improvement, standardization, and security of the quality and quantity of spatial information associated with health statistics


SUMMARY

Public Health and Health Services relatively late on GI adoption curve

Considerable professional and public resistance to GI for very different reasons

GI has potential to contribute to health care cost containment in many ways

GI also has potential to exacerbate inequalities or reduce them

Policy is essential but extremely contentious

June 2000EC 6th Workshop on GI and GIS Sustaining Health and Human Services: Encouraging the...

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