New Technologies for Understanding the Relationship between Health and Place

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New Technologies for Understanding the
Relationship between Health and Place

• Lecture 1
• Introduction and Overview
• GIS and RS in Public HealthEdmund Seto,
  Ph.D.School of Public HealthUniversity of
  California, Berkeley

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The Study of Health Place

• Spatial epidemiology
• Medical geography
• Geographic pathology
• Medical ecology
• Geographical epidemiology
• Geomedicine

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A Historical Perspective
Public Health professionals have long recognized
the importance of place in health.
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• A more modern, structured view of how place
  influences health is provided in Meades Medical
  Geography text

Health
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The Three Vertices

• Population
• Susceptibility age, race, and genetics
• Habitat
• Natural climate, vegetation, geology, hydrology
• Built buildings and patterns of settlement
• Behavior
• Exposure, culture, technology how we live and
  interact with each other and the environment
  affects our health

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Epidemiology

• From Lasts Dictionary of Epidemiology
• Epidemiology is defined as the study of the
  distribution and determinants of health-related
  states or events in specified populations.
• It follows then, that a Spatial Epidemiologist
  would be interested in the spatial distribution
  of health events, and the spatial relationship of
  associated health determinants.

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A picture is worth 10,000 words

• Maps are the most fundamental tool for describing
  the spatial distribution of data.

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The earliest map?
6200 BC Ankara, Turkey excavation of Çatalhöyük
site in Anatolia
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History of Disease Maps

• The 1700s were the golden age of mapping, and
  graphs in general.
• Map in 1798 of cases of yellow fever in New York
  by Valentine Seaman.
• Maps documented the spread of cholera from India
  to Europe in the early 1800s.
• Famous John Snow Cholera map of 1855.

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• Spatial epidemiology has only relatively recently
  become popular due to advances in information
  technology
• Availablity of spatial data (both health and
  non-health data)
• Desktop computing power

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The Introduction of GIS

• GIS term first used in the 1960s
• Federal Geographic Data Committee (FGDC)
  definition A Geographical Information System is
  a computer system for the input, storage,
  maintenance, management, retrieval, analysis,
  synthesis, and output of geographic or
  location-based information.

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John Snow 1855 Cholera Outbreak of London
Start
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GIS Pros and Cons

• The availability of GIS has greatly simplified
  the ability to create maps and perform
  exploratory spatial data analysis.
• Perhaps too simple, though.
• Need to critically review the quality of data
  that goes into mapping and the methods used in
  modeling spatial processes
• Evaluate the analyses for potential confounders

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GIScience
Spatial Data
Spatial Analysis
Information
GIS Geographic Information Sciences
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How to lie with maps

• Monmonier writes, "Not only is it easy to lie
  with maps, it's essential...." The cartographer's
  paradox is that "to avoid hiding critical
  information in a fog of detail, the map must
  offer a selective, incomplete view of reality."

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Thematic Maps

• Thematic (or choropleth) maps are maps of polygon
  data, for instance county data that vary in
  shading or color according to a quantity
  associated with each county.
• Thematic or choropleth maps are a model of
  reality. We model the data by creating legends
  that tell a particular story.

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Choropleth Maps
Natural break
The story we tell depends upon how we choose to
create the legend
Equal ranges
Equal counts
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Choosing map data

• If we map number of cases instead of rates

Is the disease risk in A really similar to
B? Misleading because the underlying population
may be much greater in A.
A
B
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Modifiable Area Unit Problem

• The scale at which we perform spatial analyses
  can influence the results.
• The larger the unit of aggregation the more
  likely attributes will be correlated.
• ex. Analysis at the census block level versus the
  census tract level.
• Also by aggregating into different groups you can
  get different results

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Small population problems

• Rates based on small populations and areas and
  for rare diseases in particular may be
  unreliable.
• Example variance of the SMR is proportional to
  (exp deaths)-1
• Possible solutions
• Present the data anyway, but with caveats.
• Use smoothing procedures such as Bayesian
  Smoothing, and document the smoothing procedure
  used.
• Accumulate data over years and area (but MAUP).

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Breast Cancer Incidence forCape Cod 1982-94 from
the Silent Springs Institutes work
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Ecological Fallacy

• Also known as Aggregation bias, or Cross-level
  bias.
• Making inferences from data collected at one
  scale to individuals or communities aggregated at
  other scales.
• Example the hung jury
• vs Atomistic Fallacy

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Some Examples
Things to think about
Spatial Data
Spatial Analysis
Information
Whered the data come from?
How was the map produced?
To whom is the information useful? and How is the
information being communicated?
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Global Distribution of Malaria
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Snail Density, risk factor schistosomiasis
within a Chinese village
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Drinking Water risks
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Pesticide Risks
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THE OCTOBER 17, 1989 LOMA PRIETA
EARTHQUAKEOCTOBER 1989 Introduction At 504
P.M., Tuesday, October 17, 1989, as over 62,000
fans filled Candlestick Park for the third game
of the World Series and the San Francisco Bay
Area commute moved into its heaviest flow, a
Richter magnitude 7.1 earthquake struck. It was
an emergency planner's worst-case scenario. The
20-second earthquake was centered about 60 miles
south of San Francisco, and was felt as far away
as San Diego and western Nevada. Scientists had
predicted an earthquake would hit on this section
of the San Andreas Fault and considered it one of
the Bay Area's most dangerous stretches of the
fault.
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East Bay Hills 1991 Fire
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California Flood Hazards
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Toxics Release Inventory
The TRI is a publicly available EPA database that
contains information on toxic chemical releases
and other waste management activities reported
annually by certain covered industry groups as
well as federal facilities. This inventory was
established under the Emergency Planning and
Community Right-to-Know Act of 1986 (EPCRA) and
expanded by the Pollution Prevention Act of 1990.

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