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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.

Environmental Exposure↗

Measuring access to primary medical care: some examples of the use of geographical information systems.

This paper explores the potential for geographical information system technology in defining some variables influencing the use of primary care medical services. Eighteen general practices in Scotland contributed to a study examining the accessibility of their services and their patients' use of the local Accident and Emergency Department. Geo-referencing of information was carried out through analysis of postcode data relating to practices and patients. This information was analyzed using ARC/INFO GIS software in conjunction with the ORACLE relational database and 1991 census information. The results demonstrate that GIS technology has an important role in defining and analyzing the use of health services by the population.

Data Collection↗

The use of geographical information systems in studies on environment and health.

Geographical information systems (GIS) provide a powerful technology for the spatial analysis of environmental and health data. Major areas of application include the assessment and mapping of environmental exposure, mapping of health outcome, and the analysis of spatial relationships between environment and health. The use of GIS nevertheless brings with it many potential problems and pitfalls. This article reviews some of the recent applications in relation to studies of environment and health, and examines some of the research issues involved.

Bias↗

[Dimensions and potentialities of the geographic information system on indigenous health].

OBJECTIVE: To discuss the potentials of the Geographic Information System in the analysis of the epidemiological and socio-demographic profiles of indigenous peoples and of the organization of health services directed towards their care. METHODS: Geoprocessing analysis of tuberculosis, malaria and mortality notification of 374,123 indigenous people distributed in 36 Distritos Sanitários Especiais Indígenas (Special Indigenous Sanitary Districts) in Brazil was conducted. A gradient of risk intensity for tuberculosis, malaria, and infant mortality among indigenous populations was defined for the years 2000 to 2002. These coefficients were then compared with those of non-indigenous populations, during the same period. RESULTS: The analysis showed that the previous available data are fragmentary and do not allow for a comprehensive assessment of life conditions and health situations of these ethnic groups. The construction of gradients of risk indicated incidence of tuberculosis coefficients among the indigenous population more than 1,000 times greater than those found among the general population in Brazil. The mean malaria API among the indigenous population was up to 10 times greater than the mean values found among the non-indigenous population and the coefficient of infant mortality among the indigenous population varied from 74.7/1,000 live births in 2000 to 56.5/1,000 live births in 2001, exceeding the national average (31.8/1,000) for the same period in more than 100%. CONCLUSIONS: The Geographic Information System is a useful administrative tool for assessing health conditions, evaluating population risks, constructing scenarios, and planning intervention strategies in several levels, shifting quickly and efficiently between macro- and micro-level realities.

Brazil↗

A geographical information system (GIS) as a tool for microbial risk assessment in catchment areas of drinking water reservoirs.

The main tributaries of three drinking water reservoirs of Northrhine-Westfalia (Germany) were monitored within a 14-month period mainly for bacterial and parasitic contamination. In this context a detailed geo-ecological characterisation within the differing catchment areas was carried out to reveal a reliable informational basis for tracing back the origin of microbial loads present in the watercourses. To realise a microbial risk assessing geo-ecological information system (MRA-GIS), a Geographical Information System (GIS) has been implemented for the study areas. The results of the microbiological investigations of the watercourses showed an input of pathogens into all three of the tributaries. It could be demonstrated that the use of MRA-GIS database and some GIS-techniques substantially support the spatial analysis of the microbial contamination patterns. From the hygienic point of view, it is of the utmost importance to protect catchment areas of surface water reservoirs from microbial contamination stemming from human activities and animal sources. This constitutes essential part of the multi-barrier concept which stresses the importance of reducing diffuse and point pollution in catchment areas of water resources intended for human consumption. MRA-GIS proves to be helpful to manage multi-barrier water protection in catchment areas and ideally assists the application of the HACCP concept on drinking water production.

Environmental Monitoring↗

Utilizing Geographic Information Systems in community assessment and nursing research.

Application of Geographic Information Systems (GIS) in health sciences is relatively new, but it appears to be expanding faster than any other areas of GIS application. Although health scientists have long been using geographic information conceptually, the current availability of user-friendly GIS tools has caused a rapid endorsement of GIS in community health research. Locations of disease incidence, surrounding environments, health care facilities, geographic boundaries of the communities, and other essential community infrastructures have always been essential components of epidemiological and health care studies. This article provides an example of the effective use of GIS in a community assessment project. The purpose of this project was to survey the households in Hinds County, Mississippi, to assess community health status and the under-utilization of health care services. Ultimately, the assessment will be used to positively influence health outcomes within defined geographic communities. Community assessment was accomplished using extensive face-to-face surveys coupled with GIS technology to optimize the process and to evaluate the results.

Community Health Nursing↗

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.

Electromagnetic Fields↗

Privileged knowledge and social change: effects on different participants of using geographic information systems technology in natural resource management.

The use of geographic information systems (GIS) technology in natural resource management has expanded rapidly: It is the preferred tool of spatial data analysis addressing large landscapes and is typically the presentation medium for conveying landscape-scale scientific findings to all kinds of audiences. In a case study using the Coastal Landscape Analysis and Modeling Study in western Oregon, it was found that the use of GIS to analyze and display natural resource data in that project produced a variety of responses among different participants and participant groups. The findings offer insights into the workings of groups attempting public involvement in natural resource management.

Conservation of Natural Resources↗

Health based geographical information systems: their potential examined in the light of existing data sources.

There is much potential for the use of geographical information systems (GIS) within the management and analysis of health and health care data. This paper addresses the problems of using routine data in the creation of geographical information systems for health. The numerous sources of British official routine health information however vary greatly in their geographical coverage and geographical detail. Particular attention therefore focuses upon the extent to which existing data sets can readily be used within GIS. Recommendations for changes in the data collection process are forwarded to improve the potential for GIS use. The overall utility of geographical health information systems within health service planning is illustrated using the example of community based activities.

Community Health Nursing↗

Contribution of Geographic Information Systems and location models to planning of wastewater systems.

This paper presents the contributions of Geographic Information Systems (GIS) and location models towards planning regional wastewater systems (sewers and wastewater treatment plants) serving small agglomerations, i.e. agglomerations with less than 2,000 inhabitants. The main goal was to develop a decision support tool for tracing and locating regional wastewater systems. The main results of the model are expressed in terms of number, capacity and location of Wastewater Treatment Plants (WWTP) and the length of main sewers. The decision process concerning the location and capacity of wastewater systems has a number of parameters that can be optimized. These parameters include the total sewer length and number, capacity and location of WWTP. The optimization of parameters should lead to the minimization of construction and operation costs of the integrated system. Location models have been considered as tools for decision support, mainly when a geo-referenced database can be used. In these cases, the GIS may represent an important role for the analysis of data and results especially in the preliminary stage of planning and design. After selecting the spatial location model and the heuristics, two greedy algorithms were implemented in Visual Basic for Applications on the ArcGIS software environment. To illustrate the application of these algorithms a case study was developed, in a rural area located in the central part of Portugal.

Algorithms↗

The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system.

OBJECTIVE: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases. Dense cor group transmission has long been hypothesized. METHODS: We have previously mapped sexually transmitted disease (STD) rates in Baltimore census tracts using STD morbidity data interfaced with a geographic information system. Core areas were defined using a standard definition based on gonorrhea distribution. We studied spatial distance patterns between sexual partners, using the residential addresses of 572 individuals, representing 286 dyad partnerships recruited as part of an epidemiology and behavioral study. To determine if partners lived closer together than would be expected, a modified bootstrap algorithm using Monte Carlo models was developed to compare the distances between partners' residences and all other possible residences. RESULTS: Two distinct (east and west) core areas were previously identified. Compared with randomly selected Baltimore addresses, partners tended to reside closer to one another than would be expected by chance (z = -1.8), with a median distance of 1.7 kilometers. Within the core areas, women resided a median of 547 meters from their partner, and men resided a median of 339 meters from their reported partners. When all partnerships were considered, the median distance was 1,699 meters. Of the 500 simulation models, the minimum median distance was 4,889 meters. CONCLUSIONS: Partners of patients in core areas in Baltimore live remarkably close to one another, and the partner selection patterns in general indicate nonrandom distribution. Geographic information system-determined patterns of STD patients residing in hyperendemic census tracts support the core theory of disease transmission. In these areas, targeted geographically based interventions may be warranted.

Adult↗

Geographic information systems. A new tool in environmental epidemiology.

PURPOSE: Geographic Information Systems (GIS) are useful tools for identifying populations with potential exposure to environmental contaminants. Using a GIS, features of the local environment around an individual's home, work, or school can be described. We present two examples illustrating methods and issues in identifying populations potentially exposed to agricultural pesticides and to toxic releases from the Toxic Release Inventory (TRI).METHODS: We used USDA Farm Service Agency records as ground reference data to classify a late summer 1984 satellite image into crop species in 3 counties in Nebraska. We located residences from a case-control study of non-Hodgkin's lymphoma (NHL) on the crop maps and calculated the distance to crop fields. Residences from a 4-center study of NHL were mapped and the distance to TRI sites was determined.RESULTS: Twenty-two percent of residences had crop fields within 500 meters of the home, an intermediate distance for the range of drift effects from pesticide applications. After accounting for the extent of primary drift from ground applications of pesticides, we estimated that 30 percent of residences were potentially exposed to crop pesticides. In the 4-center study, residence locations determined by address-matching methods and by a global positioning system were compared; the population 1 mile from specific TRI sites is described.CONCLUSIONS: These examples demonstrate the utility of a GIS in environmental epidemiology studies. A GIS can be a useful addition to questionnaire and other methods of exposure assessment in health studies.

Journal Article↗

[Establishment of minimum medical geographic information systems database in China].

OBJECTIVE: To establish a minimum medical geographic information systems (GIS) database as a spatial decision supporting system (SDSS), and to use the database into public health practice in China. METHODS: Spatial data collected from different sources were standardized as decimal degree format, including: (1) satellite images covering areas of China; (2) digital maps of China in vector files; (3) diseases database and relevant models. RESULTS: Necessary satellite images for the database have been collected from NOAA AVHRR, Landsat TM, etc., including the normalized difference vegetation index (NDVI) images from AVHRR, earth surface temperature images from AVHRR, GTOPO30 DEM images from USGS and landuse images from USGS. The digital vector files for GIS analysis were collected including political (county, provinces, country) boundaries file, environmental (drainage, land cover, soil type) vector file, population data and climate data; Data on diseases mainly generated from survey or case reporting. Relevant models on transmission of Schistosoma japonicum and Plasmodium vivax, and models of Oncomelania hupensis and Anophores sinansis were developed, and the relevant environmental factors related to incidence of cancers were mapped, to test and verify those database. CONCLUSION: The database unified the data from different sources for users. Minimum medical data included in the database could be used in the practice of public health. It is expected that this database be used in a wider range.

Animals↗

Conflict on the coast: using geographic information systems to map potential environmental disputes in Matagorda Bay, Texas.

The sustainable management of coastal natural resources inevitably involves identifying stakeholder conflicts and developing planning processes that prevent these conflicts from becoming intractable disputes. This study links environmental conflict to specific areas within a large ecological system. Specifically, we use Geographic Information Systems (GIS) to map potentially competing stakeholder values associated with establishing protected areas in Matagorda Bay, Texas. By overlaying multiple values associated with a range of stakeholders across space, we are able to identify hotspots of potential conflict as well as areas of opportunity for maximizing joint gains. Mapping stakeholder conflict is an approach to proactively locate potential controversy in response to a specific environmental management proposal and guide decision makers in crafting planning processes that mitigate the possibility of intractable disputes and facilitate the implementation of sustainable coastal policies. Results indicate that under different management scenarios, protected area proposals will generate more conflict in specific areas. Most notably, regulated uses would produce the greatest degree of conflict on or near shore, particularly at the mouth of the Colorado River. Additionally, of all the management scenarios evaluated, the prohibition of coastal structural development would generate the overall highest level of conflict within the Bay. Based on the results, we discuss the policy implications for environmental managers and provide guidance for future research on location-based conflict management within the coastal margin.

Conflict, Psychological↗

Implementation of an Internet-based geographic information system: the Florida experience.

Increasingly, Web-based data dissemination systems are being used to provide public health information. This article describes Florida's experience in augmenting a Web-based data query system, Florida CHARTS, with a geographic information system component. As with any systems development, users' needs guide the product. With a focus on community health assessment and improvement planning, several methods of data display have been established. A variety of issues are explored including the impact of small numbers of events on data display and data confidentiality, the selection of geographic units of analysis, and techniques for geographically coding data.

Florida↗

Geographic epidemiology of gonorrhea in Baltimore, Maryland, using a geographic information system.

The epidemiology of gonorrhea is characterized by geographically defined hyperendemic areas, or "cores." Geographic information system (GIS) technology offers new opportunities to evaluate these patterns. The authors developed a GIS system linked to the disease surveillance database at the Baltimore Health Department and used this system to evaluate the geographic epidemiology of gonorrhea in Baltimore, Maryland, during 1994. There were 7,330 reported cases, of which 87.4% were in persons aged 15-39 years; 56.6% were of the cases were in males; and 60.5% of the cases were reported from the nonsexually transmitted disease (STD) clinic sector. Valid residential addresses were available for 6,831 (93.5%) of cases. In the GIS system, gonorrhea cases were geocoded by reported address using digitized maps, and assigned to census tract. Census tract-specific rates for persons aged 15-39 years were calculated using 1990 census data. Gonorrhea was reported from 196/202 (97%) of census tracts, of which 90 census tracts had >30 cases. For these 90 census tracts, rates were ranked. The core was considered as the top rate quartile, consisting of 13 geographically contiguous census tracts with rates 4,370-6,370 per 100,000; adjacent areas were 19 census tracts in the second quartile (rates: 3,730-4,370 per 100,000). As radial distance from the core areas increased, incidence rates decreased and male/female ratio increased, which is consistent with previous definitions of the core theory of STD transmission. Mapping of cases by provider showed that cases reported from STD clinics had similar geographic distribution to those from the non-STD clinic sector. From an operational perspective, GIS can be effectively integrated with clinical data systems to provide epidemiologic analysis.

Adolescent↗

[Health Geographic Information System (HGIS)--a tool for health planning and epidemiology].

The development of the Health Geographic Information System (HGIS) concept, associated to the wide availability of adapted software applications, has offered an invaluable tool to Public Health Professionals. However its use is still too often limited to the graphic presentation of data or to structural planning, neglecting its main advantages. The HGIS has proven to be a potent tool for risk assessment, decision making, intervention evaluation and health planning. In spite of all the obstacles, the transformation of geographic information systems (GIS) into an epidemiological tool adapted to the health system (HGIS) can now be done in a relatively short span of time, with a minimal investment in terms of budget and manpower. The use of an outsourcing policy enables to limit the operational running costs in health organizations such as the Health Ministry, Hospitals or Sick Funds.

Epidemiologic Methods↗

The development and validation of a geographic information system database for the poultry industry on the Delmarva Peninsula.

A geographic information system (GIS) database of the poultry industry on the Delmarva Peninsula was developed through a cooperative agreement between the Delmarva Poultry Industry, Inc., and the Virginia-Maryland Regional College of Veterinary Medicine. The purpose of this database was to facilitate disease surveillance and assist in managing the response to outbreaks and other emergencies. Two methods of data collection were employed and are described in this paper. The first method was to visit each poultry farm and collect the latitude and longitude coordinates with a handheld global positioning system unit. The second method used property ownership information, aerial photographs, and a GIS to determine the latitude and longitude of each poultry farm. There was no significant difference between the two methods in the accuracy of the results, but there was a large difference in the amount of time and money necessary to obtain the data. These findings indicate that whereas there are many ways to obtain accurate data for a GIS database, other factors may influence which method is chosen. A subset of farms contained within the database was visited to assess the accuracy of the locations contained within the database. Of the 240 farms visited for validation, 212 showed evidence of a functioning or previously functioning poultry operation. The corresponding error rate was 11%. This demonstrates the need to assure that the database is kept up to date to ensure that attrition among poultry growers is recorded. Several potential factors that might contribute to sources of error are discussed.

Agriculture↗