Public Participation Health GIS: An Idea Whos Time Has Come

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 Public Participation Health GIS An Idea Whos
Time Has Come?

• Russell S. Kirby, PhD, MS, FACE
• Dept of Maternal and Child Health
• School of Public Health
• University of Alabama at Birmingham

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Objectives

• Consider strategies for taking web-based access
  to mappable health data to the next level public
  participation health GIS
• Describe typologies for serving maps and atlases
  on the Internet
• Identify methodological, administrative and
  political issues that must be overcome
• Have some fun with humor and grace!

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From my former state Wisconsin
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And my current state Alabama
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Brief Summary for Those Who Are Knitting, Doing
Crossword Puzzles, or Discerning the Geometric
Pattern in the Carpeting

• No vendor (hardware or software) or modeling
  approach has the hands-down best solution for
  serving public health maps on the Internet (and
  probably never will).
• Must current applications fail to provide
  appropriate levels of end-user flexibility and
  functionality.
• The technologies for true PPHGIS public health
  mapping applications exist do we have the
  science and political will to make it happen?

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THE TEN COMMANDMENTS OF PUBLIC HEALTH GIS
With apologies to Mel Brooks, and thanks for
editorial assistance to Elizabeth Kirby and for
their insights to the following Internet
contributors Dabo Brantley, DRH, CDC Virginia
Lee, ASTDR Dona Schneider, Rutgers
University Russel Rickard, Colorado Department of
Health and Environment Dianne Enright, NC State
Department of Health Statistics Ravi Sharma,
University of Pittsburgh
R.S. Kirby, December 2005
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The Ten Commandments of Public Health GIS
Number 10
Thou shalt not expect thine health outcomes or
disease states to respect administrative (block,
census tract, ZIP Code, municipal)
boundaries. But without collecting geography in
thine data, thou hast nothing that can be mapped.
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The Ten Commandments of Public Health GIS
Number 9
Thou shalt not unknowingly commit spatial errors.
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The Ten Commandments of Public Health GIS
Number 8
Know thy purpose (in creating and using your
public health GIS). Corollary Thou shalt always
be cognizant that the Scientific Method is not a
built-in feature of any GIS software application.
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The Ten Commandments of Public Health GIS
Number 7
Thou shalt know and understand thine data prior
to bringing it into a GIS. Editors note this
is a more specific example of the recently
rediscovered 16th commandment, Know thy data
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The Ten Commandments of Public Health GIS
Number 6
Thou shalt remember that while thine maps are
abstractions, the maps reflect the physical
environment and are based on data representing
actual events that occurred to individual people.
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The Ten Commandments of Public Health GIS
Number 5
Thou shalt protect individual records containing
X,Y coordinates as thou wouldst protect records
with individual identifiers, as both can reveal
confidential information.
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The Ten Commandments of Public Health GIS
Number 4
Thou shalt not clutter thine health data maps
with unnecessary layers and map elements (i.e.
chartjunk), nor shalt thou ignore information
necessary to interpret the patterns on your map.
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The Ten Commandments of Public Health GIS
Number 4 - addendum
The real art of cartography is knowing more what
to leave out, more than what to put in. -
John Parsons
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The Ten Commandments of Public Health GIS
Number 3
Know thine Metadata.
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The Ten Commandments of Public Health GIS
Number 2
Thou shalt not assume that the default settings
of your GIS software will generate useful and
meaningful maps.
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The Ten Commandments of Public Health GIS
Number 1
Thou shalt show humility to others, and be
gracious even unto those who thought it would
take weeks to accomplish what thou hast done in a
few hours.

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Are there other Top Ten lists?

• Yes just point your browser to
  http//www.soph.uab.edu/kirbytop10
• Would you like to contribute to or suggest a
  topic for a future list?
• Email me at rkirby_at_uab.edu
• Current lists under development include
• The Ten Best Ways to Use Email Badly
• The Ten Best Ways to Misuse Hospital Discharge
  Data, Part 2
• The long term plan?
• Perhaps, a book with the working title
• The Practical Guide to Conducting Bad Health
  Research A Book of Lists

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Topology of Data-Atlas-User Interfaces

• Web interface as method of transmission only
• Web interface for user to access pre-designed
  maps
• Web interface for user to access database for
  generation of customized maps and tables
• Web interface as point-of-service for integration
  of data from multiple geospatial data sources

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Web Interface for Transmission Only

• Utilize Web transactions to distribute static
  images and HTML files
• User requests a map by submitting a request
  (clicking a button, entering a URL, etc)
• GIS server prepares the images requested, sends
  to the Web server which then transmits to the
  user
• User then accesses and manipulates the map with
  local GIS or mapping software
• This method does not provide PPGIS, requires
  end-user to have knowledge of mapping software,
  and is limited in flexibility to customize the
  final map

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Web Interface for User to Access Pre-Designed Maps

• By far the most common current method for serving
  maps and atlases with health data currently
• User connects to map or atlas website
• User selects the desired map from a list, the map
  is then displayed
• Some applications provide customized
  variations, but in reality these are already
  prepared and stored for the user to access when
  selected
• While this method provides end-user access to map
  content, the end-user has limited options and
  often cannot access or format the information as
  desired
• Most of these applications are not PPGIS

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Web Interface for User to Access Pre-Designed
Maps (continued)

• Many health examples
• http//www.cdc.gov/cvh/womensatlas/index.htm
• http//www.cdc.gov/cvh/mensatlas/index.htm
• http//www.cdc.gov/cvh/maps/strokeatlas/index.htm
• http//www3.cancer.gov/atlas/ 
• http//www.dartmouthatlas.org/default.php
• This is a growing list!

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Web Interface for User to Access Database for
Generation of Customized Maps and Tables

• The application webpage acts as a portal for the
  user to define a request for a map or table
• The web server posts this request to the GIS or
  database server, which formats the request and
  generates the desired results
• The results are then sent to the users screen
• Applications using this methodology vary widely
  in their design and flexibility

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Web Interface for User to Access Database for
Generation of Customized Maps and
Tables(continued)

• Some early applications (e.g. HIT the SPOT) gave
  the user broad ability to define data ranges, map
  format, access to a wide array of statistical
  variables
• http//hitspot.utk.edu/hit/main/SPOT/frames/SPOT/i
  ndex.htm
• Others incorporate various decision rules that
  limit access to results under specified
  conditions
• Most of these applications generate univariate or
  bivariate maps, but typically from a single data
  source

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Web Interface for Point-of-Service for
Integration of Data from Multiple Geospatial Data
Sources

• This may be the future of serving health data
  maps on the web.
• Multiple spatially enabled public health
  databases would be simultaneously queried from a
  single end-user request, with the results
  transmitted to the desktop for further use.
• Most local and state public health agencies are
  far from able to contemplate this type of
  application, although there are numerous
  corporate examples.

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Web Interface for Point-of-Service for
Integration of Data from Multiple Geospatial Data
Sources (continued)

• An early example is the Milwaukee COMPASS site
• http//www.milwaukee.gov/compass
• Let me know if you have similar applications in
  your communities or states.

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Public Participation GIS

• Not a new concept in the literature and GIS
  community since mid-1990s! But not part of the
  lexicon of public health or community assessment.
• Generally PPGIS focuses on the use and value of
  GIS by marginalized peoples and communities
  engaged in social change (Sieber 2003).

Sieber, R.E. (2003), Public participation
geographic information systems across
borders.The Canadian Geographer 47 (1), 50-61.
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Applying PPGIS to Health Issues

• The objectives of the community assessment
  initiative fit squarely within the framework of
  PPGIS.
• However, to create truly PP-H-GIS will require
  transformational thinking beyond most current
  applications for serving maps and atlases on the
  web.
• Some issues are the same

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Hardware-Software Issues

• In developing map/atlas applications
  consideration must be given to
• Statistical server
• GIS server
• Web interface
• GIS software
• Decisions include
• Volume of traffic, number of users, level of
  interactive use

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Hardware-Software Models

• There are many vendors for both hardware and
  software. None is sufficiently better than all
  others to warrant its mentioning specifically.
• A well-designed application may separate the
  database and GIS functions, and utilize a web
  server as the front end. Software might include
  a statistical package, a high-end RDBMS, any of
  several GIS packages, and perhaps some
  specialized spatial statistical applications.
• The most important issue in designing an
  application to serve public health maps on the
  Internet is the capacity to meet all functions in
  a time-efficient manner.

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Transformational Issues

• Public participation implies freedom of choice as
  to what is important.
• This means users need to have the capacity to
  initiate their own inquiries and the PPHGIS
  must be designed to support this functionality.
• End users shouldnt feel constrained by the
  limitations of databases the PPHGIS must be
  designed to handle obvious problems in
  background, things like
• Data elements of interest residing in two or more
  different databases
• Aggregation of data into mappable units (by year,
  spatial unit, etc)
• Records not linked at individual, household,
  ecological scales

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Problems and Pitfalls

• Provincialism of program managers
• Fear of unfamiliar cartographic methods
• Concerns with confidentiality
• Leads to over-restrictive decision rules for data
  release
• Under-powered applications, particularly for
  background processing of data on demand
• Fear of what might happen when the public can
  see our data
• Data quality issues there are no warts until
  someone sees them. But . . . The warts dont
  heal until they are treated! (Beware of
  antibiotic resistant strains . . .)
• Will current data integration initiatives evolve
  to the point where they can support the high-end
  PPHGIS?

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Problems and Pitfalls

• Observation
• None of these issues are new or novel
  observations (Kirby RS, Stat Med 1996)
• What remains lacking is the broad vision of key
  leaders in public health and health data
  organizations to find the ways to overcome these
  obstacle

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And finally,

• Will the thinking of public health professionals
  evolve to the point that health data is
  considered within the framework of broadly based
  determinants of population health?

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CONCEPTUAL FRAMEWORK FOR POPULATION HEALTH
Genetic Endowment
Physical Environment
Social Environment

• Individual
• Response
• Behavior
• Biology

Health Care
Disease
Prosperity
Well-Being
Traditional Medical Model of Health Care
Source modified from Evans RG, Barer ML, Marmor
TR, Eds, Why are some people healthy and others
not? New York Aldine de Gruyter, 1994
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Ten Best Ways to Develop a Bad Public
Participation Health GIS

• Now its your turn what should be included on
  this list?

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Questions, thoughts or reflections after the
conference?

• rkirby_at_uab.edu
• 205-934-2985