Spatial Analysis,

GIS, and Remote Sensing

Applications in the Health
Sciences

Editors

Donald P.Albert
Wilbert M.Gesler
Barbara Levergood

Ann Arbor Press

Chelsea, Michigan
 This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
Library of Congress Cataloging-in-Publication Data
Spatial analysis, GIS and remote sensing: applications in the health sciences/
edited by Donald P.Albert, Wilbert M.Gesler, Barbara Levergood.
p. cm.
Includes bibliographical references and index.
ISBN 1-57504-101-4 (Print Edition)
1. Medical geography. 2. Medical geography–Research–Methodology. I. Albert,
Donald Patrick. II. Gesler, Wilbert M., 1941— . III. Levergood, Barbara.
RA792 .S677 2000
614.4′2—dc21 99—089917

ISBN 0-203-30524-8 Master e-book ISBN

ISBN 0-203-34374-3 (Adobe eReader Format)

ISBN 1-57504-101-4 (Print Edition)

© 2000 by Sleeping Bear Press

Ann Arbor Press is an imprint of Sleeping Bear Press
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 To

Julie, Elizabeth, and Kenny

 Acknowledgments

The editors would like to express their appreciation to Lesa Strikland with Medical
Media, VA Medical Center (Durham, North Carolina), Department of Veterans
Affairs for her assistance in scanning figures and maps.
 About the Authors

Donald P.Albert, Ph.D., is an Assistant Professor in the Department of Geography

and Geology at Sam Houston State University in Huntsville, Texas. His interests
include applications of geographic information systems within the context of medical
geography, health services research, and law enforcement.
Kelly A.Crews-Meyer, Ph.D., is a recent graduate of the University of North
Carolina at Chapel Hill and an Assistant Professor of Geography at the University of
Texas at Austin. Her current work in population-environment interactions draws
upon previous research experience in state government, consulting, and university
settings in landuse/landcover change, geographic accessibility, and decision-making
as applied to environmental policy and valuation. Her educational background
includes a B.S. in Marine Science and a M.A. in Government and International
Studies, both from the University of South Carolina, as well as a Masters Certificate
in Public Policy Analysis from the University of North Carolina at Chapel Hill.
Charles M.Croner, Ph.D., is a geographer and survey statistician with the Office
of Research and Methodology, National Center for Health Statistics, Centers for
Disease Prevention and Control (CDC). His research interests are in the use of GIS
for disease prevention and health promotion planning, small area analysis, and
human visualization and cognition. He is Editor of the widely circulated bimonthly
report “Public Health GIS News and Information” (free by request at cmc2@cdc.gov).
Rita Fellers, Ph.D. Student, Department of Geography, University of North
Carolina at Chapel Hill. Rita Fellers is a medical geographer with a particular
interest in potentially environmentally related diseases such as cancer, and in
statistical techniques that improve the quality of information that ecologic studies
can produce.
Wilbert Gesler, Ph.D., Dr. Wilbert Gesler is a Full Professor of Geography at the
University of North Carolina in Chapel Hill. His major research interests are in the
Geography of Health, including studies of accessibility to health care in rural areas,
socio-spatial knowledge networks involved in prevention of chronic diseases, and
places which have achieved a reputation for healing.
vi

Ron D.Horner, Ph.D., Director, Epidemiologic Research and Information Center

at Durham, North Carolina. His research interests are in racial/ethnic and rural/
urban variations in the patterns of care for cerebrovascular disease.
Barbara Levergood, Ph.D., Electronic Document Librarian, University of North
Carolina at Chapel Hill. Her interests include providing public access to Federal
information products in electronic media, statistical data, and geographic
information systems.
Joseph Messina, Ph.D. Student, Department of Geography, University of North
Carolina at Chapel Hill. He served in the U.S. Army using battlefield GIS to support
indirect fire control missions. He worked as a GIS Applications Specialist for the
SPOT Image Corporation. While with SPOT, he assisted in the development of the
GeoTIFF format, developed new products and remote sensing algorithms, and served
as contributing technical editor for SPOTLight magazine. He holds degrees in
Biology and Geography from George Mason University.
Peggy Wittie, a medical geographer and GIS specialist, is a doctoral candidate at
the University of North Carolina at Chapel Hill and GIS Coordinator for North
Carolina Superfund. Her research integrates GIS techniques to study health care
access, environmental health and environmental justice issues.
 Preface

This book is an expression of the myriad ways in which the range of geospatial
methods and technologies can be applied to the analysis of issues related to human
and environmental health. Since the study and management of the many diverse
issues related to human health is one of the most important aspects of human
endeavor it is not surprising that it has been a fruitful area for application of geo-
spatial analysis tools. Contributions to this book run the gamut of these diverse
applications areas from more classical medical geography to the study of infectious
disease to environmental health. The tools used in these studies are also diverse–
ranging from GIS as a core and unifying technology to geo-spatial statistics and the
computer processing of remotely-sensed imagery.
This book should prove useful for practitioners and researchers in the health care
and allied fields as well as geographers, epidemiologists, demographers, and other
academic researchers. Today one sees a continual increase in the power and ease of
use of GIS, better integration and easier availability of related technologies, such as
remote sensing and global positioning systems and rapidly falling costs of platforms,
peripherals, and programs. Thus, one now sees an increasingly large cadre of users
of geo-spatial technology in all fields, including health related ones. The methods and
examples provided in this work are a starting point for this growing group of users
who will find the power of spatial analysis tools and the increasing availability of
data sources to enable them to obtain answers and to arrive at solutions to a host of
critical health care related issues. The tools and knowledge are readily available and
the skills can be developed by any dedicated user; therefore, what direction users of
GIS in health related fields choose to take this and related technologies is now
primarily limited by their imaginations.
Dr. Mark R.Leipnik, Ph.D.
Director GIS Laboratory,
Texas Research Institute for
Environmental Studies,
Assistant Professor,
Department of Geography and Geology,
Sam Houston State University
Huntsville, Texas
 Contents

1. Introduction 1
D.P.Albert, W.M.Gesler, B.Levergood, R.A.Fellers, and J.P.Messina
2. How Spatial Analysis Can be Used in Medical Geography 10
W.M.Gesler and D.P.Albert
3. Geographic Information Systems: Medical Geography 38
D.P.Albert, W.M.Gesler, and P.S.Wittie
4. Geographic Information Systems in Health Services Research 55
D.P.Albert, W.M.Gesler, and R.D.Horner
5. GIS-Aided Environmental Research: Prospects and Pitfalls 77
R.A.Fellers
6. Infectious Disease and GIS 111
D.P.Albert
7. A Historical Perspective on the Development of Remotely Sensed Data as 128
Applied to Medical Geography
J.P.Messina and K.A.Crews-Meyer
8. The Integration of Remote Sensing and Medical Geography: Process and 147
Application
J.P.Messina and K.A.Crews-Meyer
9. Conclusions 177
D.P.Albert, W.M.Gesler, and B.Levergood
Master GIS/RS Bibliographic Resource Guide 178
D.P.Albert, B.Levergood, and C.M.Croner

Glossary 200
Subject Index 207
Geographical Index 218
 Spatial Analysis, GIS,
and
Remote Sensing Applications
in the
Health Sciences
 Chapter One
Introduction

Medical geography is a very active subdiscipline of geography which has traditionally

focused on the spatial aspects of disease ecology and health care delivery. Until fairly
recently, as was the case with most other geographic fields of study, medical
geographers collected and analyzed their data using methods such as making on-the-
ground observations (e.g., of malarial mosquito habitats) and drawing maps (e.g., of
hospital catchment areas) by hand. With the advent of geographic information
systems (GIS) and remote sensing (RS) technologies, computers which could handle
large amounts of data, and sophisticated spatial analytic software programs, medical
geography has been transformed. It is now possible, for example, to make many
measurements from far above the earth’s surface and produce dozens of maps of
disease and health phenomena in a relatively short time. This explosion of new
capabilities, however, needs to be systematically organized and discussed so that
researchers in medical geography can get to know what resources are now available
for their use. In this book we set out to accomplish that task of organization and
description.
This volume represents an effort to collect, conceptualize, and synthesize research
on geomedical applications of spatial analysis, geographic information systems, and
remote sensing. Our purpose is to present a resource guide that will facilitate and
stimulate appropriate use of geographic techniques and geographic software
(geographic information systems and remote sensing) in health-related issues. Our
target audience includes health practitioners, academicians (students and
instructors), administrators, departments, offices, institutes, centers, and other
health-related organizations that wish to explore the interface between health/
disease and spatial analysis, geographic information systems, and remote sensing.
This chapter first sets out the scope of this volume using definitions of
geotechniques and health science disciplines. The definitions provide parameters
used to determine whether to include or exclude articles for our review. The editors
and authors apologize up front for omissions; however, due to space (as well as
human) limitations some interesting research might fail to appear in this volume.
2 SPATIAL ANALYSIS, GIS, AND REMOTE SENSING APPLICATIONS IN THE HEALTH SCIENCES

Second, this chapter describes the annual output of the published research using a
basic diffusion model. The model describes stages in the rate of growth of phenomena
(i.e., output of research publications) over time. The progression is one that follows
from innovation, early majority, late majority, and laggard stages of the diffusion
process. Finally, this chapter outlines the organization of the volume; included also is
a brief abstract of each chapter.

DEFINITIONS
This volume limits its review of research to studies that have interfaced
geotechniques (spatial analysis, geographical information systems, and remote
sensing) with health and disease topics. Although two of the editors and several of
the contributing authors are medical geographers, studies summarized in this
volume emanate not only from medical geography, but also biostatistics,
environmental health, epidemiology, health services research, medical entomology,
public health, and other related disciplines.
Defining terms is problematic because complementary and contradictory definitions
often compete for supremacy or acceptance. Of the three geotechniques, the least
definable is GIS. One of the major critiques of GIS is the absence of a universally
accepted definition. Fortunately, the eclectic scope of this volume permits the editors
to accept the full definitional spectrum of GIS. One might view spatial analysis, GIS,
and remote sensing as converging rather than distinct techniques and technologies.
For the moment, however, note the following definitions of spatial analysis, GIS, and
remote sensing.

Geotechniques

Spatial Analysis: The study of the locations and shapes of geographic features
and the relationships between them (Earth Systems Research Institute, 1996).
Geographic Information Systems:…computer databases that store and
manipulate geographic data (Aronoff, 1989).
Remote Sensing:…imagery is acquired with a sensor other than (or in addition
to) a conventional camera through which a scene is recorded, such as by electronic
scanning, using radiation outside the normal visual range of the film and camera
–microwave, radar, infrared, ultraviolet, as well as multispectral, special
techniques are applied to process and interpret remote sensing imagery for the
purpose of producing conventional maps, thematic maps, resource surveys, etc.,
in the fields of agriculture, archaeology, forestry, geology, and others (Campbell,
1987, p. 3).
 INTRODUCTION 3

Interfacing Disciplines
In recent years the use of geotechniques, especially GIS, has been diffusing into the
private and public sectors and across disciplines (e.g., city and regional planning,
transportation, government, and marketing). This is no less true for disciplines that
have health and/or disease as their foci. Some of the disciplines exploring the use of
GIS/RS include biostatistics, epidemiology, environmental health, health services
research, medical entomology, medical geography, and public health. Definitions of
these disciplines are presented below. Again, as with the definition of geographic
information systems, there exist complementary, contradictory, and competing
statements that define these disciplines. However, for the purposes of providing a
broad-based review of geomedical/ geotechnical applications, the definitions set out
below were deemed to be adequate. Each of these disciplines offers a distinct set of
knowledge, methods, and approaches; note, however, that there is a substantial
overlap among these sciences.

Biostatistics: The science of statistics applied to biological or medical data

(Illustrated Stedman’s Medical Dictionary, 1982, p. 172).
Environmental Health:…includes both the direct pathological effects of
chemical, radiation and biological agents, and the effects (often indirect) on
health and well-being of the broad physical, psychological, social and aesthetic
environment, which includes housing, urban development, land use and
transport (World Health Organization, 1990).
Epidemiology: The study of the prevalence and spread of disease in a
community (Illustrated Stedman’s Medical Dictionary, 1982, p. 474).
Health Services Research: The central feature of health services research is
the study of the relationships among structures, processes, and outcomes in the
provision of health services (White et al., 1992, p. xix).
Medical Geography: The application of geographical concepts and techniques
to health-related problems (Hunter, 1974, p. 3).
Medical Entomology: Zoology which deals with insects that cause disease or
serve as vectors of microorganisms that cause disease in man
(Dorland’sIllustrated Medical Dictionary, 1985, p. 448).
Public Health: The art and science of community health concerned with
statistics, epidemiology, hygiene, and the prevention and eradication of epidemic
diseases (Illustrated Stedman’s Medical Dictionary, 1982, p. 622).

Together, the interface between geotechniques (spatial analysis, GIS, and remote
sensing) and some specific disciplines (biostatistics, epidemiology, environmental
health, health services research, medical entomology, medical geography, and public
health) sets our parameter limits. The intersection among the three geotechniques
4 SPATIAL ANALYSIS, GIS, AND REMOTE SENSING APPLICATIONS IN THE HEALTH SCIENCES

and seven disciplines produces a scope for this volume that is wide and inclusive
rather than narrow and exclusive.

DIFFUSION OF GEOGRAPHIC TECHNOLOGIES USEDIN THE

HEALTH SCIENCES
Spatial analysis came to the fore during the “Quantitative Revolution” of the 1960s
and 1970s. The linkages between health/disease with GIS/RS began with just a
smattering of interest in the 1980s. For the most part, geomedical applications of
GIS/RS are a phenomenon of the 1990s. The standard geographic diffusion model
provides a means to track the conception and development of geomedical GIS/RS
applications research. This model describes diffusion in terms of the number of
adopters of an innovation (i.e., publications) over some time period.
There was just a small number of publications through 1990. From 1991 to 1994
the number of publications hovered around two dozen per year. The number of
publications continued to increase each year between 1995—1997. From a diffusion
standpoint, research output originated in the late 1980s and 1990 (stage 1) and
moved into early expansion (stage 2) from 1991—1997. Our suspicion is that research
output will remain in the early expansion stage for several more years before
entering the late expanding stage (stage 3) of the diffusion process. Further, it will be
a decade or more before saturation sets in (stage 4) and the diffusion process is
completed and geographic information systems and remote sensing become standard
technologies in the investigation of issues of health and disease.

AN OVERVIEW OF THE TEXT

This book contains nine chapters, a master geographic information systems/ remote
sensing bibliography, a glossary, and subject and geographical indices.
The next seven chapters (2—8) provide reviews of geomedical applications of spatial
analysis (Chapter 2), geographic information systems (Chapters 3—6), and remote
sensing (Chapter 7 and 8). Each of these core chapters uses a concept as an
organizational theme from which to “hang” existing research. Chapter 2 uses points,
lines, areas, and surfaces, or dimensions 0, 1, 2, and 3 respectively, to organize
research incorporating spatial analysis and medical geography. Chapters 3 through 6
present specific applications of geographic information systems in medical geography
(Chapter 3), health services research (Chapter 4), environmental and public health
(Chapter 5) and infectious diseases (Chapter 6). Chapter 3 places articles of interest
to medical geographers into one of four basic literature groups (potential, caution,
preliminary, and application). Chapter 4 assesses the contribution of geographic
information systems to health services research using a four-group classification of
operations and functions of geographic information systems software (Aronoff 1989).
The focus of Chapter 5 is on infectious diseases and GIS. There are two conceptual
 INTRODUCTION 5

themes operating within Chapter 5. First, each of the five infectious diseases
discussed (dracunculiasis, babesiosis, Lyme disease, LaCrosse encephalitis, and
malaria) is placed within the context of its geographic distribution and current
infection trends. Second, a comparison of variables, analyses, and conclusions across
studies is made to evaluate the divergence or convergence of research results.
Chapter 6 points to some of the problems and pitfalls of using geographic information
systems to examine environmental and public health issues. Chapter 7 uses the four
resolutions (spatial, temporal, radiometric, and spectral) of remote sensing to
analyze the contribution of satellite data in identifying and predicting risk areas for
such diseases as leishmaniasis, trypanosomiasis (sleeping sickness), shistosomiasis,
Rift Valley fever, malaria, hantavirus, Rocky Mountain Spotted Fever, Lyme
disease, and onchocerciasis (river blindness). Chapter 8 discusses the specific
processes of remote sensing and their ramifications for developing medical geography
applications.

SYNOPSES OF THE INDIVIDUAL CHAPTERS

Chapter 2, “How Spatial Analysis Can be Used in Medical Geography,” is a review of
how geographers and others have used spatial analysis to study disease and health
care delivery patterns. Point, line, area, and surface patterns, as well as map
comparisons and relative spaces are discussed. Problems encountered in applying
spatial analytic techniques are pointed out. The authors present some suggestions
for the future use of spatial analytic techniques in medical geography.
Point pattern techniques include standard distance, standard deviational ellipses,
gradient analysis and space and space-time clustering. Line methods include random
walks, vectors and graph theory or network analysis. Under areas, location quotients,
standardized mortality ratios, Poisson probabilities, space and space-time clustering,
autocorrelation measures and hierarchical clustering are discussed. Surface
techniques mentioned include isolines and trend surfaces. For map comparisons,
coefficients of areal correspondence and correlation coefficients have been used. Case-
control matching, acquaintance networks, multidimensional scaling and cluster
analysis are examples of methods that are based on relative or non-metric space.
Chapter 2 continues with a discussion of several general points: problems
encountered in spatial analysis, theory building and verification and the appropriate
role of technique and computer use. Some suggestions are made for further use of
spatial analytic techniques including more use of Monte Carlo simulation
techniques, network analysis, environmental risk assessment, difference mapping,
and multidimensional scaling.
Chapter 3, “Geographic Information Systems and Medical Geography,” examines
the use of geographic information systems to analyze spatial dimensions of health
care services and disease distributions. This chapter chronicles the early years
(through 1993) of the diffusion of geographic information systems into medical
6 SPATIAL ANALYSIS, GIS, AND REMOTE SENSING APPLICATIONS IN THE HEALTH SCIENCES

geography and related disciplines. It documents a small but vibrant body of research
that was grappling with the introduction of GIS into the realms of health and
disease. While some scholars were optimistically urging use of this emerging
technology, others were advocating caution before jumping on the GIS bandwagon.
All the while, a handful of investigators began to develop and operationalize
applications of geographic information systems having specific foci on health and/or
disease. Such applications as emergency response, AIDS prevention, hospital service
areas, toxic air emissions, lead exposure, measles surveillance, radon risk, and
cancer clusters are highlighted.
Chapter 4, “Geography Information Systems in Health Services Research,”
outlines research contributions that explore physician locations, hospital service and
market areas, public health monitoring and surveillance programs, and emergency
response planning within the context of geographic information systems. Aronoff’s
(1989) classification of GIS functions into (1) maintenance and analysis of the spatial
data, (2) maintenance and analysis of the attribute data, (3) integrated analysis of
the spatial and attribute data, and (4) cartographic output formatting functions
provides a structure to evaluate the extent to which health services researchers have
utilized the full potential of GIS. The chapter also presents multiple definitions of
GIS and health services research, outlines some general concerns about geographic
information systems, and makes a general appraisal of the contribution of this
technology to the health of human populations.
Chapter 5, “GIS-Aided Environmental Research: Prospects and Pitfalls,” is a fairly
comprehensive review of the ways in which GIS can improve research into the
human-environment relationship, as well as the special problems investigators
encounter when they attempt to adapt this powerful analytic tool to such projects.
The chapter catalogs the elements involved in human exposure from the toxicity of
the pollutant through the ways the pollutant can change as it travels through the
environment, to the final stage of manifesting in a diagnosable health effect. Two
major groups of human-environment studies are being performed: analyses of the
impact of existing hazards, and assessments of potential hazard from proposed
industrial or residential developments in the planning phase.
Public health professionals will want to use this chapter as an aid in determining
just how credible are their data, where they might go for additional data, and why
combining data collected at different scales is risky. Not all statistical techniques are
appropriate for studies such as these, either. Most of the commonly used techniques,
such as analysis of variance and linear regression, assume that the observations
were measured without error. These techniques are easily biased by characteristics
common in the study of disease in space, such as the ways that events affect their
surrounding areas and the ways that they influence future events in the same area.
Techniques which are better able to handle these conditions without producing
biased results are reviewed, such as mixed models, multilevel models, and structural
equation modeling. Hopefully, the reader will find helpful suggestions for getting
 INTRODUCTION 7

better results from ecologic studies that involve data collected at different scales,
from the individual level to the aggregate.
Chapter 6, “Infectious Disease and GIS,” reviews applications of geographic
information systems that investigate spatial aspects of dracunculiasis (Guinea worm
disease), LaCrosse encephalitis, Lyme disease, and malaria. For each infectious
disease the text follows a sequence that includes a description of disease and its
transmission chain, the geographic distribution and recent statistics, and a review of
select research using geographic information systems. A cross-comparison of
conclusions suggests that a targeted approach is more effective than broad-based
approaches in eliminating or reducing vectors and corresponding rates of infection.
These studies show the benefit of incorporating elements of human and physical
geography into GIS databases used to combat vectored diseases.
Remote sensing is the process of collecting data about objects or landscape features
without coming into direct physical contact with them. The application of remotely
sensed data and image processing techniques can seem daunting and simply too
expensive to implement. Chapters 7 and 8 are intended to take the novice remote
sensing person through the entire process. Given the nature of this book, the focus is
on the medical geography application of remotely sensed data. Chapter 7 is really the
first part of a two-chapter sequence. It is intended that this chapter provide the
framework to enable the layperson to act as an informed reader of the body of
medical geography literature utilizing remotely sensed data. As such, it contains a
brief history of remote sensing and introduces the basic vocabulary. The development
of the technology of remote sensing parallels the use of the data within medical
geography and helps to predict the direction of the discipline within the context of
future applications.
Chapter 8 is a detailed look at the application of remotely sensed data within the
existing body of medical geography literature. Each of the authors’ use of the data is
presented contextually in order to best explain the various techniques and to
promote general comprehension, not only of the remote sensing vocabulary, but also
in order to inspire ideas about how the data may be used in alternative case studies.
Chapter 8 includes a number of technique-specific insets. These insets are designed
to be more in-depth evaluations and discussions of the various methods used by the
medical geography community when applying remotely sensed data. Chapter 8 also
contains an overview of basic remote sensing terminology.
Both chapters may be reviewed independently, but of course are best understood
within the context of the whole. These chapters intentionally differ from the existing
body of medical remote sensing literature that usually follows a disease-specific
formula in describing remote sensing applications. The approach used is application-
specific rather than disease-specific in order to promote a more general
understanding of the nature of the data and associated techniques applicable to a
variety of diseases and disease vectors.
8 SPATIAL ANALYSIS, GIS, AND REMOTE SENSING APPLICATIONS IN THE HEALTH SCIENCES

The chapters are interspersed with tables and figures that represent sample output
from numerous geomedical applications of spatial analysis, GIS, and remote sensing
applications. These tables and figures have been drawn from the original source
articles with publishers’ permissions. Instructors might use this volume as a source
of illustrations useful in demonstrating geomedical applications of spatial analysis,
GIS, and remote sensing.
This volume highlights geomedical applications of spatial analysis, geographic
information systems, and remote sensing. Our aim is to describe “what” rather than
“how.” Knowing what has been done provides one with a sense of the big picture (i.e.,
current usage of geomedical GIS/RS applications). Knowing what also positions one
to be able to springboard to extend existing applications or create new geomedical
applications of spatial analysis, GIS, and remote sensing. Those requiring knowing
how should consult the original source articles. To address how would require a
detailed and technical account of data requirements and manipulations, software and
hardware specifications, and the mathematics of geotechniques. This is beyond our
scope since it is not the intent of this volume. Our reviews of particular geomedical
applications highlight studies that build upon and extend one another. This seems a
more rational approach than forcing the contents and findings of numerous and often
redundant studies under a single subject heading (e.g., malaria, sleeping sickness,
onchoceriasis). However, a master GIS/RS bibliographic reference guide includes some
400 articles that have been listed by subject.
This volume also includes a “Master GIS/RS Bibliographic Resource Guide,”
“Glossary,” and “Index.” The “Master GIS/RS Bibliographic Resource Guide” provides
over 400 references to geomedical applications. Represented within this bibliography
are citations from academic journals, trade publications, proceedings, and electronic
documents (i.e., World Wide Web). The bibliography has been arranged by subject for
the reader’s convenience.
This volume also includes a glossary of spatial analysis, GIS, and remote sensing
terminology. Here, terms from the text and other terms familiar to geoscientists are
defined. To assist in accessing information, we have included both a subject and
geographical index. We hope that combined, the appendix, bibliography, glossary,
and indices constitute valuable reference tools for tapping the full potential of this
resource guide as well as pointing to other outside sources.

A CAUTIONARY NOTE
The editors encourage readers to become grounded in the fundamental components
and dynamics of their subject (health care system or disease) prior to forging on with
geotechniques. It is important that one is knowledgeable about the basic sciences
and/or clinical findings of the particular subject under investigation. Therefore,
before diving headfirst into the realm of geomedical/technical application the
following sequence is recommended.
 INTRODUCTION 9

• Know your subject. If you don’t know, find out. It is very difficult to develop a
sophisticated GIS application if you are not familiar with the health care
service or disease under question. So, depending on your subject, you might
want to become familiar with the organization, structure and dynamics of a
health management organization; the factors influencing the prevention and
transmission of diseases; the current spatial and temporal trends in disease
incidence; and even the clinical symptoms of a particular disease.
• Read sections of this volume that relate to the subject area in which you are
interested. If you need more information or more details, search the Master
GIS/RS Bibliography to locate articles on your topic. Going to the original
source often provides information as to the type of hardware, software, data,
and analyses that were used in a particular study.
• Evaluate whether some of the existing GIS/RS applications highlighted in the
text or referred to in the bibliography would be worth using or modifying for
your project or program needs. Perhaps you have ideas that might enhance
existing research. If your evaluation is affirmative, then...
• Explore the feasibility of developing your own GIS/RS capabilities (consult
Aronoff, 1989), collaborating with existing GIS/RS facilities within your
organization or system, or contracting out your project.
• Publish your results in official reports, newsletters, trade journals, and even
academic journals so that others can benefit from your experience.

REFERENCES
Aronoff, S.1989. Geographic Information Systems: A Management Perspective.Ottawa: WDL
Publications.
Campbell, J.B.1987. Introduction to Remote Sensing.New York: Guildford Press.
Dorland’s Illustrated Medical Dictionary,1985,26th ed. Philadelphia: W.B.Saunders Company.
Environmental Systems Research Institute. 1996. Introduction to ArcView GIS: Two-dayCourse
Notebook with Exercises and Training Data.Redlands, California: Environmental Systems Research,
Inc.
European Conference on Environment and Health. 1990. Environment and Health: TheEuropean
Charter and Commentary: First European Conference on Environment andHealth, Frankfurt, 7—8
December 1989.Copenhagen: World Health Organization, Regional Office for Europe.
Hunter, J.M.1974. The challenge of medical geography. In The Geography of Health andDisease: Papers
of the First Carolina Geographical Symposium,J.M.Hunter (Ed.), pp. 1—31. Chapel Hill: University of
North Carolina, Department of Geography.
Stedman, T.L.1982. Stedman’s Medical Dictionary, Illustrated,24th ed. Baltimore: Williams and
Wilkins.
White, K.L., J.Frenk, C.Ordonez, C.Paganini, and B.Starfield. 1992. Health ServicesResearch: An
Anthology.Washington, DC: Pan American Health Organization.
References

1 Chapter One Introduction

Aronoff, S.1989. Geographic Information Systems: A

Management Perspective.Ottawa: WDL Publications.

Campbell, J.B.1987. Introduction to Remote Sensing.New

York: Guildford Press.

Dorland’s Illustrated Medical Dictionary,1985,26th ed.

Philadelphia: W.B.Saunders Company.

Environmental Systems Research Institute. 1996.

Introduction to ArcView GIS: Two-dayCourse Notebook with
Exercises and Training Data.Redlands, California:
Environmental Systems Research, Inc.

European Conference on Environment and Health. 1990.

Environment and Health: TheEuropean Charter and Commentary:
First European Conference on Environment andHealth,
Frankfurt, 7—8 December 1989.Copenhagen: World Health
Organization, Regional Office for Europe.

Hunter, J.M.1974. The challenge of medical geography. In

The Geography of Health andDisease: Papers of the First
Carolina Geographical Symposium,J.M.Hunter (Ed.), pp. 1—31.
Chapel Hill: University of North Carolina, Department of
Geography.

Stedman, T.L.1982. Stedman’s Medical Dictionary,

Illustrated,24th ed. Baltimore: Williams and Wilkins.

White, K.L., J.Frenk, C.Ordonez, C.Paganini, and

B.Starfield. 1992. Health ServicesResearch: An
Anthology.Washington, DC: Pan American Health Organization.
2 Chapter Two How Spatial Analysis Can Be
Used in Medical Geography

Cleek, R.K.1979. Cancers and the environment: The effect of

scale. Social Science andMedicine13D(4): 241—247.

Cliff, A.D.1970. Computing the spatial correspondence

between geographical patterns. Transactions of the
Institute of British Geographers50:143—154.

Cliff, A.D., P.Haggett, J.Ord, K.Bassett, and R.Davies.

1975. Elements of SpatialStructure: A Quantitative
Approach.Cambridge, MA: Cambridge University Press.

Court, A.1970. Map comparisons. Economic

Geography46:435—438.

Cressie, N.A.C.1993. Statistics for Spatial Data.New York:

Wiley.

Cromley, E.K. and G.W.Shannon. 1986. Locating ambulatory

medical care facilities for the elderly. Health Services
Research21(4):499—514.

Dear, M., R.F.Fincher, and L.Currie. 1977. Measuring the

external effects of public programs. Environment and
Planning A9:137—147.

Diggle, P.J.1983. Statistical Analysis of Spatial Point

Patterns.London: Academic Press.

Ebdon, D.1977. Statistics in Geography: A Practical

Approach.Oxford: Blackwell.

Francis, A.M. and J.B.Schneider. 1984. Using computer

graphics to map origin-destination data describing health
care delivery systems. Social Science and
Medicine18(5):405—420.

Gatrell, A.C.1983. Distance and Space: A Geographical

Perspective.Oxford: Clarendon Press.

Gatrell, A.C. and T.C.Bailey. 1996. Interactive spatial

data analysis in medical geography. Social Science and
Medicine42(6):843—855.

Gatrell, A.C. and T.C.Bailey. 1997. Can GIS be made to sing

and dance to an epidemiological tune? In Proceedings of the
International Symposium on ComputerMapping in Epidemiology
and Environmental Health,R.T.Aangeenbrug, P.E.Leaverton,
T.J.Mason, and G.A.Tobin (Eds.), pp. 38—52. Alexandria, VA:
World Computer Graphics Foundation.

Gesler, W.1986. The uses of spatial analysis in medical

geography: A review. SocialScience and
Medicine23(10):963—973.

Gesler, W.M. and M.S.Meade. 1988. Locational and population

factors in health care-seeking behavior in Savannah,
Georgia. Health Services Research23(3):443—462. Gesler,
W.M., C.Todd, C.Evans, G.Casella, J.Pittman, and H.Andrews.
1980. Spatial variations in morbidity and their
relationship with community characteristics in Central
Harlem Health District . Social Science and Medicine
14D(4):387—396. Getis, A. and B.Boots. 1978. Models of
Spatial Processes: An Approach to the Study ofPoint, Line,
and Area Patterns.Cambridge, MA: Cambridge University
Press. Giggs, J.A.1973. The distribution of schizophrenia
in Nottingham. Transactions of theInstitute of British
Geographers59:55—76. Giggs, J.A., D.S.Ebdon, and
J.B.Bourke. 1980. The epidemiology of primary acute
pancreatitis in the Nottingham Defined Population Area.
Transactions of theInstitute of British
Geographers5:229—242. Giles, G.G.1983. The utility of the
relative risk ratio in geographic epidemiology: Hodgkin’s
disease in Tasmania 1972—1980. In Geographical Aspects of
Health: Essaysin Honor of Andrew Learmonth,N.D.McGlashan
and J.R.Blunden (Eds.), pp. 361— 374. London: Academic
Press. Gilg, A.W.1973. A study in agricultural disease
diffusion: The case of the 1970—71 fowl-pest disease.
Transactions of the Institute of British
Geographers59:77—97. Girt, J.L.1972. Simple chronic
bronchitis and urban ecological structure. In
MedicalGeography: Techniques and Field
Studies,N.D.McGlashan (Ed.), pp. 211—230. London: Methuen.

Glick, B.1979. The spatial autocorrelation of cancer

mortality. Social Science andMedicine13D(2): 123—130.

Glick, B.J.1982. The spatial organization of cancer

mortality. Annals of the Associationof American
Geographers72(4):471—481.

Gober, P. and R.J.Gordon. 1980. Intraurban physician

location: A case study of Phoenix. Social Science and
Medicine14D(4):407—417.

Godlund, S.1961. Population, regional hospitals,

transportation facilities, and regions: Planning the
location of regional hospitals in Sweden. In Lund Studies
inGeography No. 21, Series B.Lund: Department of Geography,
Royal University of Lund.

Gould, M.S., S.Wallenstein, and L.Davidson. 1989. Suicide

clusters: A critical review. Suicide and LifeThreatening
Behavior19(11):17—29.

Greenwald, P., J.S.Rose, and P.B.Daitch. 1979. Acquaintance

networks among leukemia and lymphoma patients. American
Journal of Epidemiology110(2):162—177.

Grimson, R.G., K.C.Wang, and P.W.C.Johnson. 1981. Searching

for hierarchical clusters of disease: Spatial patterns of
sudden infant death syndrome. Social Scienceand
Medicine15D(2):287—293.

Haggett, P.1976. Hybridizing alternative models of an

epidemic diffusion process. Economic Geography52:136—146.

Haggett, P., A.D.Cliff, and A.Frey. 1977. Locational

Methods.London: Arnold.

Haining, R.P.1990. Spatial Data Analysis in the Social and

Environmental Sciences.Cambridge, MA: Cambridge University
Press.

Harner, E.J. and P.B.Slater. 1980. Identifying model

regions using hierarchical clustering. Social Science and
Medicine14D:3—10.

Hjalmars, U., M.Kulldorff, G.Gustafsson, and N.Nagarwalla.

1996. Childhood leukaemia in Sweden: Using GIS and a
spatial scan statistic for cluster detection. Statistics in
Medicine15(7/9):707—715.

Hugg, L.1979. A map comparison of work disability and

poverty status in the United States. Social Science and
Medicine13D(4):237—240.

Isaaks, E.H. and R.M.Srivastava. 1989. Applied

Geostatistics.New York: Oxford University Press.

Jacquez, G.M., L.A.Waller, R.Grimson, and D.Wartenburg.

1996a. The analysis of disease clusters, Part I: State of
the art. Infection Control and Hospital
Epidemiology17(5):319—327.

Jacquez, G.M., R.Grimson, L.A.Waller, and D.Wartenburg.

1996b. The analysis of disease clusters, Part II:
Introduction to techniques. Infection Control and
HospitalEpidemiology17(6):385—397.

Joseph, A.E. and G.B.Hall. 1985. The locational

concentration of group homes in Toronto. Professional
Geographer37(2):143—154.

Journel, A.G. and C.J.Huijbregts. 1978. Mining

Geostatistics.London: Academic Press.

Kaluzny, S.P. et al. 1998. S+Spatial Stats: User’s Manual

for Windows and UNIX.New York: Springer.

Kane, R.L.1975. Vector resolution: A new tool in health

planning. Medical Care 13(2):126—136. Kellerman, A.1981.
Centrographic Measures in Geography. CATMOG 32. Norwich:
Geo Abstracts. King, L.J.1969. Statistical Analysis in
Geography.Englewood Cliffs, NJ: Prentice-Hall. King,
P.E.1979. Problems of spatial analysis in geographical
epidemiology. SocialScience and Medicine13D(4):249—252.
Knox, E.G.1994. Leukaemia clusters in childhood:
Geographical analysis in Britain. Journal of Epidemiology
and Community Health48(4):369—376. Knox, E.G., and
E.Gilman. 1992. Leukaemia clusters in Great Britain. 2.
Geographical concentrations. Journal of Epidemiology and
Community Health46(6):573—576. Knox, G.1963. Detection of
low intensity epidemicity: Application to cleft lip and
palate. British Journal of Preventive and Social
Medicine17:121—127.

Kwofie, K.M.1976. A spatio-temporal analysis of cholera

diffusion in Western Africa. Economic Geography52:127—135.

Lam, N.S., M.Fan, and K.Liu. 1996. Spatial-temporal spread

of the AIDS epidemic, 1982—1990: A correlogram analysis of
four regions of the United States. Geographical
Analysis28(2):93—107.

Lowell-Smith, E.G.1993. Regional and intrametropolitan

differences in the location of freestanding ambulatory
surgery centers. Professional Geographer45(4):398—407.
Loytonen, M. and S.I.Arbona. 1996. Forecasting the AIDS
epidemic in Puerto Rico. Social Science and
Medicine42(7):997—1010.

Mayer, J.D.1983. The role of spatial analysis and

geographic data in the detection of disease causation.
Social Science and Medicine17(16):1213—1221.

Mayhew, L.D.1981. Automated isochrones and the location of

emergency medical services in cities. Professional
Geographer33:423—428.

McConnel, C.E. and L.A.Tobias. 1986. Distributional change

in physician manpower, United States, 1963—80. American
Journal of Public Health76(6):638—642.

McGlashan, N.D.1972. Geographical evidence on medical

hypotheses. In MedicalGeography: Techniques and Field
Studies,N.D.McGlashan (Ed.). London: Methuen.

Meade, M. 1983. Cardiovascular disease in Savannah,

Georgia. In Geographical Aspectsof Health: Essays in Honour
of Andrew Learmonth,N.D.McGlashan and J.R.Blunden (Eds.),
pp. 175—196. London: Academic Press.

North, P.M.1977. A novel clustering method for estimating

numbers of bird territories. Applied Statistics26:149.

Ohno, Y. and K.Aoki. 1981. Cancer deaths by city and county

in Japan (1969—1971): A test of significance for geographic
clusters of disease. Social Science and
Medicine15D:251—258. Openshaw, S., M.Charlton, C.Wymer, and
A.Craft. 1987. A mark I geographical analysis machine for
the automated analysis of point data sets.
InternationalJournal of Geographical Information Systems1:
335—358. Pisani, J.F., J.J.Angulo, and C.K.Takiguti. 1984.
An objective reconstruction of the chain of contagion.
Social Science and Medicine18(9):775—782. Pyle, G.F.1973.
Measles as an urban health problem: The Akron example.
EconomicGeography49: 344—356. Pyle, G.F. and B.F.Lauer.
1975. Comparing spatial configurations: Hospital service
areas and disease rates. Economic Geography51:50—68. Raine,
J.W.1978. Summarizing point patterns with the standard
deviational ellipse. Area10:328—333. Ribeiro, J.M.,
C.F.Seulu, T.Abose, G.Kidane, and A.Teklehaimanot. 1996.
Temporal and spatial distribution of anopheline mosquitos
in an Ethiopian village: Implications for malaria control
strategies. Bulletin of the World Health
Organization74(3):299—305. Ricketts, T.C., L.A.Savitz,
W.M.Gesler, and D.N.Osborne (Eds.). 1994.
GeographicMethods for Health Services Research: A Focus on
the Rural-Urban Continuum.Lanham, MD: University Press of
America. Ripley, B.D.1981. Spatial Statistics.New York:
Wiley. Rogers, E.M.1979. Network analysis of the diffusion
of innovations. In Perspectives onSocial Network
Research,P.W.Holland and S.Leinhardt (Eds.), pp. 137—167.
New York: Academic Press.

Rushton, G.1975. Planning Primary Health Services for Rural

Iowa: An Interim Report. Technical Report No. 39. Iowa
City: Center for Locational Analysis, Institute of Urban
and Regional Research, University of Iowa.

Rushton, G. and P.Lolonis. 1996. Exploratory spatial

analysis of birth defect rates in an urban population.
Statistics in Medicine15(7/9):717—726. Rushton, G.,
R.Krishnamurthy, D.Krishnamurti, P.Lolonis, and H.Song.
1996. The spatial relationship between infant mortality and
birth defect rates in a U.S. city. Statistics in
Medicine15(17/18): 1907—1919.

Schneider, D., M.R.Greenberg, M.H.Donaldson, and D.Choi.

1993. Cancer clusters: The importance of monitoring
multiple geographic scales. Social Science
andMedicine37(6):753—759.

Scott, A.J.1970. Location-allocation systems: A review.

Geographical Analysis.2:95— 119.

Shannon, G.W. and M.P.Cutchin. 1994. General practitioner

distribution and population dynamics: Munich, 1950—1990.
Social Science and Medicine39 (1):23—38.

Shannon, G.W., R.L.Bashshur, and C.W.Spurlock. 1978. The

search for medical care: An exploration of urban black
behavior. International Journal of Health
Services8(3):519—530.

Smith, A.H., J.D.Kark, J.C.Cassel, and G.F.Spears. 1977.

Analysis of prospective epidemiologic studies by minimum
distance case-control matching. AmericanJournal of
Epidemiology105(6):567—574.

Smith, C.J.1983. Locating alcoholism treatment facilities.

Economic Geography59:368— 385.

Smith, C. and R.Q.Hanham. 1981. Any place but here! Mental

health facilities as noxious neighbors. Professional
Geographer33(3):326—334.

Stimson, R.J.1983. Research design and methodological

problems in the geography of health. In Geographical
Aspects of Health: Essays in Honour of Andrew
Learmonth,N.D.McGlashan and J.R.Blunden (Eds.), pp.
321—334. London: Academic Press.

Tanaka, T., S.Rhu, M.Nishigaki, and M.Hashimoto. 1981.

Methodological approaches on medical care planning from the
viewpoint of a geographical allocation model: A case study
on South Tama District. Social Science and
Medicine150:83—91.

Thomas, R.W.1979. An Introduction to Quadrat Analysis.

CATMOG 12. Norwich: Geo Abstracts.

Tinkler, K.J.1977. An Introduction to Graph Theoretical

Methods in Geography. CATMOG 14. Norwich: Geo Abstracts.

Unwin, D.1975. An Introduction to Trend Surface Analysis.

CATMOG 5. Norwich: Geo Abstracts.

Unwin, D.1981. Introductory Spatial Analysis.London:

Methuen.

Waller, L.A. and B.W.Turnbull. 1993. The effects of scale

on tests for disease clustering. Statistics in
Medicine12(19/20):1869—1884.

Waller, L.A. and G.M.Jacquez. 1995. Disease models implicit

in statistical tests of disease clustering.
Epidemiology6(6):584—590.

Walsh, S.J, P.H.Page, and W.M.Gesler. 1997. Normative

models and healthcare planning: Networkbased simulations
within a geographic information system environment. Health
Services Research32 (2):243—260.

Walter, S.D.1993. Assessing spatial patterns in disease

rates. Statistics in Medicine12(19/20): 1885—1894.

Wartenberg, D. and M.Greenberg. 1993. Solving the cluster

puzzle: Clues to follow and pitfalls to avoid. Statistics
in Medicine12(19/20):1763—1770.

White, R.R.1972. Probability maps of leukemia mortalities

in England and Wales. In Medical Geography: Techniques and
Field Studies,N.D.McGlashan (Ed.), pp. 173— 185. London:
Methuen.

Williams, G.1984. Time-space clustering of disease. In

Statistical Methods for CancerStudies,R.G.Cornell (Ed.),
pp. 167—227. New York: M.Dekker.

Wilson, J.L.1993. Mapping the geographical diffusion of a

Finnish smallpox epidemic from historical population
records. Professional Geographer 45(13):276—286. Wojdyla,
D., L.Poletto, C.Cuesta, C.Badler, and M.E.Passamonti.
1996. Cluster analysis with constraints: Its use with
breast cancer mortality rates in Argentina. Statistics in
Medicine15(7/9): 741—746.
3 Chapter Three Geographic Information
Systems: Medical Geography

Estes, J.E., K.C.McGwire, G.A.Fletcher, and T.W.Foresman.

1987. Coordinating hazardous waste management activities
using geographical information systems. International
Journal of Geographical Information Systems1(4):359—377.

Fandrich, J.E.1993. Using a GIS to evaluate radon potential

and its effect on housing. Abstracts: 89th Annual Meeting
of the Association of American Geographers.Washington, DC:
Association of American Geographers.

Fishenden, J.1991. Towards more healthy living. In

Geographic Information 1991: TheYearbook of the Association
for Geographic Information,pp. 126—127. London: Taylor &
Francis. Fitzpatrick, C.1993. Teaching geography with
computers. Journal of Geography92(4):156— 159.
Fitzpatrick-Lins, K., T.L.Johnson, and J.K.Otton. 1990.
Radon potential defined by exploratory data analysis and
geographic information systems. U.S. GeologicalSurvey
Bulletin1908:E1—E10.

Fost, D.1990. Using maps to tackle AIDS. American

Demographics12(4):22.

Fowler, G.L., M.A.Lazar, R.K.Dillow, J.W.Bash, and

R.J.Dutton. 1993. A hazardous substances GIS for public
health assessment. Abstracts: 89th Annual Meeting of
theAssociation of American Geographers.Washington, DC:
Association of American Geographers. Gould, M.I.1992. The
use of GIS and CAC by health authorities: Results from a
postal questionnaire. Area24(4):391—401. Guthe, W.G.,
R.K.Tucker, E.A.Murphy, R.England, E.Stevenson, and
J.C.Luckhardt. 1992. Reassessment of lead exposure in New
Jersey using GIS technology. Environmental Research59(2):
318—325.

Heywood, I.1990. Geographic information systems in the

social sciences. Environmentand Planning A22 (7):849—854.

Hunter, J.M.1974. The challenge of medical geography. In

The Geography of Health andDisease: Papers of the First
Carolina Geographical Symposium.J.M.Hunter (Ed.). Chapel
Hill: Department of Geography, University of North
Carolina.

King, G.Q.1991. Geography and GIS technology. Journal of

Geography90(2):66—72.
Korte, G.B.1992. The GIS Book: A Practitioner’s
Handbook,2nd ed.Sante Fe, NM: On Word Press.

Lam, N.S.1986. Geographical patterns of cancer mortality in

China. Social Science andMedicine23(3): 241—247.

Lam, N.S. and D.A.Quattrochi. 1992. On the issues of scale,

resolution, and fractal analysis in the mapping sciences.
Professional Geographer44(1):88—98. Lewis, L.1993. Using
GIS for development of a rural 9—1—1 system. Abstracts:
89thAnnual Meeting of the Association of American
Geographers.Washington, DC: Association of American
Geographers. Marble, D.F.1990. Geographic information
systems: An overview. In IntroductoryReadings in Geographic
Information Systems,D.J.Peuquet and D.F.Marble (Eds.), pp.
8—17. London: Taylor & Francis.

Martin, D.1991. Geographic Information Systems and Their

Socioeconomic Applications.London: Routledge.

Matthews, S.A.1990. Epidemiology using a GIS: The need for

caution. Computers,Environment and Urban
Systems14(3):213—221.

McDonald, R.E.1993. Delaware watershed pesticide impact

assessment model. Abstracts: 89th Annual Meeting of the
Association of American Geographers.Washington, DC:
Association of American Geographers.

Mohan, J. and D.Maguire. 1985. Harnessing a breakthrough to

meet the needs of health care. Health and Social Service
Journal95(4947):580—581.

Moore, T.J.1991. Application of GIS technology to air

toxics risk assessment: Meeting the demands of the
California air toxics “Hot Spots” Act of 1987. GIS/LIS
’91Proceedings2:694—714.

Nicol, J.1991. Geographical information systems within the

National Health Service: The scope for implementation.
Planning Outlook34(1):37—42.

Openshaw, S., M.Charlton, C.Wymer, and A.Craft. 1987. A

mark I Geographical Analysis Machine for the automated
analysis of point data sets. InternationalJournal of
Geographical Information Systems1 (4):335—358.

Openshaw, S., A.W.Craft, M.Charlton, and J.M.Birch. 1988.

Investigation of leukaemia clusters by use of a
Geographical Analysis Machine . LancetFebruary 6:272—273.
Padgett, D.A.1993. Spatial correlation between
racial/socioeconomic class and hazardous waste releases.
Abstracts: 89th Annual Meeting of the Association of
AmericanGeographers.Washington, DC: Association of American
Geographers. Parr, D.M.1991. Introduction to Geographic
Information Systems Workshop. The Urban & Regional
Information Systems Association.

Peuquet, D.J. and D.F.Marble1990. Introductory Readings in

Geographic InformationSystems.London: Taylor & Francis.

Public Technology, Inc., Urban Consortium for Technology

Initiatives, and International City Management Association.
1991. The Local Government Guide to Geographic Information
Systems: Planning and Implementation.Washington, DC: Public
Technology, Inc. and International City Management
Association.

Scholten, H.J. and M.J.de Lepper. 1991. The benefits of the

application of geographical information systems in public
and environmental health. World Health Statistics
Quarterly44(3):160—170.

Stallones, L., J.K.Berry, and J.R.Nuckols. 1992.

Surveillance around hazardous waste sites: Geographic
information systems and reproductive outcomes.
EnvironmentalResearch59(1):81—92.

Star, J. and J.Estes. 1990. Geographic Information Systems:

An Introduction.Englewood Cliffs, NJ: Prentice Hall.

Solarsh, G.C. and D.F.Dammann. 1992. A community paediatric

information system: A tool for measles surveillance in a
fragmented health ward. South African
MedicalJournal82(2):114—118. Taylor, D.R.F. (Ed.). 1991.
Geographic Information Systems: The Microcomputer andModern
Cartography.Oxford, England: Pergamon Press. Taylor, P.J,
and M.Overton. 1991. Further thoughts on geography and GIS.
Environment and Planning A23:1087—1094. Tiefenbacher,
J.P.1993. Application of GIS to the analysis of residential
exposure to airborne pesticide drift: Prospects and needs.
Abstracts: 89th Annual Meeting of theAssociation of
American Geographers.Washington, DC: Association of
American Geographers. Thomas, R.1992. Geomedical Systems:
Intervention and Control.London: Routledge.

Twigg, L.1990. Health based geographical information

systems: Their potential examined in the light of existing
data sources. Social Science and Medicine30(1):143—155.
Tyler, S.1990. Computer assistance for the California
earthquake rescue effort. ThePolice Chief57(3): 42—43.

Van Creveld, I.1991. Geographic information systems for

ambulance services. In Geographic Information 1991: The
Yearbook of the Association for Geographic Information,pp.
128—130. London: Taylor & Francis.

Verhasselt, Y.1993. Geography of health: Some trends and

perspectives. Social Scienceand Medicine36 (2):119—123.

Walsh, S.J.1992. Spatial education and integrated hands-on

training: Essential foundations of GIS instruction. Journal
of Geography91(2):54—61.

Wartenberg, D.1992. Screening for lead exposure using a

geographic information system. Environmental
Research59(2):310—317.

Whately, C.O.1993. Northcentral Florida overhead powerline

corridor study. Abstracts: 89th Annual Meeting of the
Association of American Geographers.Washington, DC:
Association of American Geographers. White, K.L. and
M.Simms. 1993. Geographic information systems as an
educational tool. Journal of Geography92(2):80—85.

Wittie, P., W.Gesler, S.McKnight, H.Swofford, and T.Fowler.

1993. Using GIS to create cancer incidence data sets.
Abstracts: 89th Annual Meeting of the Associationof
American Geographers.Washington, DC: Association of
American Geographers.

Wrigley, N.1991. Market-based systems of health-care

provision, the NHS Bill, and geographical information
systems. Environment and Planning A23(1):5—8. Young,
J.A.T.1986. A U.K. Geographic Information System for
Environmental Monitoring,Resource Planning & Management
Capable of Integrating & Using Satellite RemotelySensed
Data.Nottingham: Remote Sensing Society. Zwarenstein, M.,
D.Krige, and B.Wolff. 1991. The use of a geographical
information system for hospital catchment area research in
Natal/KwaZulu. South AfricanMedical Journal80(10):497—500.
4 Chapter Four Geographic Information
Systems: Health Services Research

Albert, D.1995. Is there a doctor near the house? MapInfo

analyzes health care access in North Carolina.
GlobalNews(Summer):7.

Antenucci, J.C., K.Brown, P.L.Croswell, M.J.Kevany, and

H.Archer. 1991. GeographicInformation Systems: A Guide to
the Technology.New York: Van Nostrand Reinhold.

Aronoff, S.1989. Geographic information systems: A

Management Perspective.Ottawa: WDL Publications.
Association of Health Services Research. 1997. Mission
Statement. Health ServicesResearch32(1):xix. Barnes, S. and
A.Peck. 1994. Mapping the future of health care: GIS
applications in health care analysis. Geo Info
Systems4(4):30—39. Bashshur, R.L., G.W.Shannon, and
C.A.Metzner. 1970. The application of three-dimensional
analogue models to the distribution of medical care
facilities. MedicalCare8(5):395—407. Briggs, D.J. and
P.Elliot. 1995. The use of geographical information systems
in studies on environment and health. World Health
Statistics Quarterly48(2):85—94. Challender, S. and J.Root.
1994. Isochrones: a method of tracking and analyzing
geographic access to rural health care. Geo Info
Systems4(6):33—34.

Coleman, D.1994. GIS Canada: Road network partnerships

paying off. GIS World7(2):30.

Cowen, D.J.1990. GIS versus CAD versus DBMS: What are the
differences? In Introductory Readings in Geographic
Information Systems,D.J.Peuquet and D.F.Marble (Eds.), pp.
52—61. London: Taylor & Francis.

Croner, C.M., J.S.Sperling, and F.R.Broome. 1996.

Geographic information systems (GIS): New perspectives in
understanding human health and environmental relationships.
Statistics in Medicine15 (17—18):1961—1977.

Dunn, C.E. and D.Newton. 1992. Optimal routes in GIS and

emergency planning applications. Area(3) 24:259—269.

Eddy, W.F. and A.Mockus. 1994. An example of the estimation

and display of a smoothly varying function of time and
space: The incidence of the disease mumps. The Journal of
the American Society for Information Science45(9):686—683.

Furbee, P.M.1995. GIS in Raleigh County: Small towns with a

big database. Journal ofEmergency Medical Services20(6):77,
79, 81.

Furbee, P.M. and J.Spencer. 1993. Using GIS to determine

travel times to hospitals. Geo Info Systems
(September):30—31.

Fost, D.1990. Using maps to tackle AIDS. American

Demographics12(4):22.

Glass, G.E., J.L.Aron, J.H.Ellis, and S.S.Yoon. 1993.

Applications of GIS Technology toDisease Control.Baltimore:
The Johns Hopkins University, School of Hygiene and Public
Health, Department of Population Dynamics.

Gordon, A. and J.Womersley. 1997. The use of mapping in

public health and planning health services. Journal of
Public Health in Medicine19(2):139—147.

Heywood, I.1990. Geographic information systems in social

sciences. Environment andPlanning A22(7): 849—854.

Jacoby, I.1991. Geographic distribution of physician

manpower: The GMENAC legacy. Journal of Rural Health7(4
Suppl):427—426.

Jankowski, P. and G.Ewart. 1996. Spatial decision support

for health practitioners: Selecting a location for rural
health practice. Geographical Systems3:279—299.

Jones, A.1993. Using GIS to link road accident outcomes

with health service accessibility. Mapping Awareness & GIS
in Europe7(8):33—37.

Kohli, S., K.Sahlen, A.Sivertun, O.Lofman, E.Trell, and

O.Wigertz. 1995. Distance from the primary health center: A
GIS method to study geographical access to health care.
Journal of Medical Systems 19(6):425—436. Lee, H.1996.
Health care for San Francisco’s homeless. Geo Info
Systems6(6):46—47.

Love, D. and P.Lindquist. 1995. The geographical

accessibility of hospitals to the aged: A geographic
information systems analysis within Illinois. Health
Services Research29(6):629—651. Marks, A.P., G.I.Thrall,
and M.Arno. 1992. Siting hospitals to provide
cost-effective health care. Geo Info Systems2(8):58—66.

Matthews, S.A.1990. Epidemiology using a GIS: The need for

caution. Computer,Environment and Urban
Systems14(3):213—221. Miller, P.1994. Medical Center uses
desktop mapping to cut costs and improve efficiency. Geo
Info Systems4(4):40—41.

Mott, K.E., I.Nuttall, P.Des jeux, and P.Cattand. 1995. New

geographical approaches to control of some parasitic
zoonoses. Bulletin of the World Health
Organization73(2):247—257.

Nicol, J.1991. Geographic information systems within the

National Health Service: The scope of implementation.
Planning Outlook34(1):37—42.

Openshaw, S., M.Charlton, C.Wymer, and A.Craft. 1987. A

Mark 1 geographical analysis machine for the automated
analysis of point data sets. InternationalJournal of
Geographical Information Systems1 (4):335—358.

Pan American Health Organization. 1996. Use of geographic

information systems in epidemiology (GISEpi).
Epidemiological Bulletin17(1):1—6.

Parr, D.M.1991. Introduction to Geographic Information

Systems Workshop.Wilmington, NC: The Urban and Regional
Information Systems Association.

Phibbs, C.S. and H.S.Luft. 1995. Correlation of travel time

on roads versus straight line distance. Medical Care
Research and Review52(4):532—542.

Pickles, J.1997Tool or science? GIS, technoscience, and the

theoretical turn. Annalsof the Association of American
Geographers87(2):363—372.

Public Technology, Inc. Urban Consortium for Technology

Initiatives, and International City Management Association.
1991. The Local Government Guide to Geographic Information
Systems: Planning and Implementation.Washington, DC: Public
Technology Inc. and International City Management
Association.

Popovich, M.L. and B.Tatham. 1997. Use of immunization data

and automated mapping techniques to target public health
outreach programs. American Journalof Preventive
Medicine13(2 Suppl): 102—107.

Prabhu, S.1995. A generalized framework for information

systems for physician recruitment/referral. Journal of
Management in Medicine9(4):24—30.
Scholten, H.J. and M.J.de Lepper. 1991. The benefits of
geographical information systems in public and
environmental health. World Health Statistics
Quarterly44(3):160—170.

Solarsh, G.C. and D.F.Dammann. 1992. A community paediatric

information system: A tool for measles surveillance in a
fragmented health ward. South African
MedicalJournal82(2):114—118.

Star, J. and J.Estes. 1990. Geographic Information Systems:

An Introduction.Englewood Cliffs, NJ: Prentice Hall.

Taylor, D.R.F. (Ed.). 1991. Geographic information systems:

The Microcomputer and Modem Cartography.Oxford, England:
Pergamon Press.

Twigg, L.1990. Health based geographical information

systems: Their potential examined in the light of existing
data sources. Social Science and Medicine30(1):143— 155

Van Creveld, I.1991. Geographic information systems for

ambulance services: In Geographic Information 1991: The
yearbook for the Association of Geographic Information,pp.
128—130. London: Taylor & Francis.

Walsh, S.J., P.H.Page, and W.M.Gesler. 1997. Normative

models and healthcare planning: Networkbased simulations
within a geographic information system environment. Health
Services Research32 (2):243—260. White, K.L., J.Frenk,
C.Ordonez, C.Paganini, and B.Starfield. 1992. Health
ServicesResearch: An Anthology.Washington, DC: Pan American
Health Organization. Wright, D.J., M.F.Goodchild, and
J.D.Proctor. 1997a. GIS: Tool or science? Demystifying the
persistent ambiguity of GIS as “Tool” versus
“Science.”Annals of the Associationof American
Geographers87(2): 346—362. Wright, D.J., M.F.Goodchild,
and J.D.Proctor. 1997b. GIS: Tool or science? Demystifying
the persistent ambiguity of GIS as “Tool” versus
“Science.”Annalsof the Association of American
Geographers87:373. Wrigley, N.1991. Market-based systems of
health-care provision, the NHS Bill, and geographical
information systems. Environment and Planning A23(1):5—8.
Zwarenstein, M., D.Krige, and B.Wolff. 1991. The use of a
geographic information system for hospital catchment area
research in Natal/KwaZulu. South AfricanMedical
Journal80(10):497—500.
5 Chapter Five GIS-Aided Environmental
Research: Prospects and Pitfalls

Arbuckle, J.L.1997. AMOS (Analysis of Moment Structures).

Ver 3.6. Covariance structure model programming and
graphing software. Chicago: Small waters Corporation.

Atkinson S.F., F.A.Schoolmaster, D.I.Lyons, and J.M.Coffey.

1995. A geographic information systems approach to sanitary
landfill siting procedures: A case study. Environmental
Professional17(1):20—26. Bentham, G.1991. Chernobyl fallout
and perinatal mortality in England and Wales. Social
Science and Medicine33(4):429—434.

Bollen, K.A.1989. Structural Equations with Latent

Variables.New York: John Wiley & Sons.

Briggs, D.J. and P.Elliott. 1995. The use of geographical

information systems in studies on environment and health.
World Health Statistics Quarterly48(2):85—94.

Burke, L.M.1993. Race and environmental equity: A

geographic analysis in Los Angeles. Geo Info
Systems3(9):44, 46—47, 50. Campbell, R.T., E.Mutran, and
R.N.Parker. 1986. Longitudinal design and longitudinal
analysis: Comparison of three approaches. Research on
Aging8(4):480—502. Caraballo, R.S., G.A.Giovino,
T.F.Pechacek, P.D.Mowery, P.A.Richter, W.J.Strauss,
D.J.Sharp, M.P.Eriksen, J.L.Pirkle, and K.R.Maurer. 1998.
Racial and ethnic differences in serum cotinine levels of
cigarette smokers. Third National Health and Nutrition
Examination Survey, 1988—1991. Journal of the American
MedicalAssociation280(2):135—139.

Carstairs, V. and M.Lowe. 1986. Small area analysis:

Creating an area base for environmental monitoring and
epidemiological analysis. Community Medicine8(1):15—28.
Chakraborty, J. and M.P.Armstrong. 1997. Exploring the use
of buffer analysis for the identification of impacted areas
in environmental equity assessment. Cartographyand
Geographic Information Systems24(3):145—157. Cleek,
R.K.1979. Cancers and the environment: The effect of scale.
Social Science andMedicine13(D): 241—247.

Cnaan, A., N.M.Laird, and P.Slasor. 1997. Using the general

linear mixed model to analyse unbalanced repeated measures
and longitudinal data. Statistics in
Medicine16(20):2349—2380. Coleman, K.A., G.C.Hughes, and
E.J.Scherieble. 1994. Where’s the radon? The geographic
information system in Washington State . Radiation
Protection Dosimetry56(1—4):211—213. Coultas, D.B. and
M.P.Hughes. 1996. Accuracy of mortality data for
interstitial lung diseases in New Mexico, USA.
Thorax51(7):717—720. Croner, C.M., J.Sperling, and
F.R.Broome. 1996. Geographic information systems (GIS): New
perspectives in understanding human health and
environmental relationships. Statistics in
Medicine15(17—18):1961—1977.

Cutter, S., L.Clark, and D.Holm. 1996. The role of

geographic scale in monitoring environmental justice. Risk
Analysis16(4):517—526.

Cutter, S.L.1994. The burdens of toxic risks: Are they

fair?B&E Review41(1):3—7.

Elliott, P., J.A.Beresford, D.J.Jolley, S.H.Pattenden, and

M.Hills. 1992. Cancer of the larynx and lung near
incinerators of waste solvents and oils in Britain. In
Geographical and Environmental Epidemiology. Methods for
Small-Area Studies.P.Elliott,J.Cuzick, D.English, and
R.Stern (Eds.), pp. 359—367. New York: Oxford University
Press.

English, D.1992. Geographical epidemiology and ecological

studies. In Geographicaland Environmental Epidemiology.
Methods for Small-Area Studies.P.Elliott, J.Cuzick,
D.English, and R.Stern (Eds.), pp. 3—13. New York: Oxford
University Press.

Farris, W.T., T.A.Ikenberry, B.A.Napier, D.B.Shipler,

P.W.Eslinger, and J.C.Simpson. 1994a. Atmospheric Pathway
Dosimetry Report, 1944—1992: Hanford EnvironmentalDose
Reconstruction Project.Battelle Pacific Northwest
Laboratories. PNWD-2228 HEDR. Richland, WA.

Farris, W.T., S.F.Snider, B.A.Napier, D.B.Shipler, and

J.C.Simpson. 1994b. ColumbiaRiver Pathway Dosimetry Report,
1944—1992.Battelle Pacific Northwest Laboratories.
PNWD-2227 HEDR. Richland, WA.

Frisch, J.D., G.M.Shaw, and J.A.Harris. 1990. Epidemiologic

research using existing databases of environmental
measures. Archives of Environmental Health45(5):303— 307.

Geschwind, S.A., J.A.J.Stolwijk, M.Bracken, E.Fitzgerald,

A.Stark, C.Olsen, and J. Melius . 1992. Risk of congenital
malformations associated with proximity to hazardous waste
sites. American Journal of Epidemiology135(11):1197—1207.
Glick, B.J.1979. The spatial autocorrelation of cancer
mortality. Social Science andMedicine13(D): 123—130.

Goldstein, H.1999. Multilevel Statistical Models.London:

E.Arnold Publishers.

Graham, J., K.D.Walker, M.Berry, E.F.Bryan, M.A.Callahan,

A.Fan, B.Finley, J. Lynch, T.McKone, H.Ozkaynak, and
K.Sexton. 1992. The role of exposure databases in risk
assessment. Archives of Environmental Health47(6):408—420.

Greenberg, M.1985. Cancer atlases: Uses and limitations.

The Environmentalist5(3):187— 191.

Greenland, S.1992. Divergent biases in ecologic and

individual-level studies. Statisticsin Medicine11(9):
1209—1223.

Greenland, S. and H.Morgenstern. 1989. Ecological bias,

confounding, and effect modification. International Journal
of Epidemiology18(1):269—274.

Greenland, S. and J Robins. 1994. Invited commentary:

Ecologic studies–biases, misconceptions, and
counterexamples. American Journal of
Epidemiology139(8):747—760.

Guthe, W.G., R.K.Tucker, E.A.Murphy, R.England,

E.Stevenson, and J.C.Luckhardt. 1992. Reassessment of lead
exposure in New Jersey using GIS technology. Environmental
Research59(2): 318—325.

Hatch, M.C., J.Beyea, J.W.Nieves, and M.Susser. 1990a.

Cancer near the Three Mile Island nuclear plant: Radiation
emissions. American Journal of Epidemiology 132(3):397—412.
Hatch, M. and M.Susser. 1990b. Background gamma radiation
and childhood cancers within ten miles of a U.S. nuclear
plant. International Journal of Epidemiology19(3):546—552.
Hill, A.B.1965. The environment and disease: Association or
causation?Proceedings ofthe Royal Society of
Medicine58(5):295—300. Hornsby, A.G.1992. Site-specific
pesticide recommendations: The final step in environmental
impact prevention. Weed Technology6(3):736—742. Humphreys,
K. and R.Carr-Hill. 1991. Area variations in health
outcomes: Artefact or ecology. International Journal of
Epidemiology20(1):251—258. Jankowski, P. and M.Stasik.
1996. Architecture for space and time distributed
collaborative spatial decision making. GIS/LIS ’96,Denver,
CO. Kao, J.-J., H.-Y.Lin, and W.-Y.Chen. 1997. Network
geographic information system for landfill siting. Waste
Management and Research15(3):239—253. Knox, E.G.1994.
Leukaemia clusters in childhood: Geographical analysis in
Britain. Journal of Epidemiology & Community
Health48(4):369—376. Knox, E.G. and E.Gilman. 1992.
Leukaemia clusters in Great Britain. 2. Geographical
considerations. Journal of Epidemiology & Community
Health46(6):573—576. Knox, E.G., A.M.Stewart, E.A.Gilman,
and G.W.Kneale. 1988. Background radiation and childhood
cancers. Journal of Radiological Protection8(1):9—18.
Laird, N.M. and J.H.Ware. 1982. Random-effects models for
longitudinal data. Biometrics38:963—974. Langbein, L.I. and
A.J.Lichtman. 1978. Ecological Inference.Sage Publications,
Beverly Hills, CA. Littell, R.C., G.A.Milliken, W.W.Stroup,
and R.D.Wolfinger. 1996. SAS System forMixed Models.SAS
Institute, Inc., Cary, NC. Long, J.S.1983. Covariance
Structure Models: An Introduction to LISREL.Sage
Publications, Thousand Oaks, CA. Louis, T.A.1988. General
methods for analysing repeated measures. Statistics
inMedicine7:29—45. Mannino, D.M., C.Brown, and G.A.Giovino.
1997. Obstructive lung disease deaths in the United States
from 1979 through 1993: An analysis using multiple-cause
mortality data. American Journal of Respiratory and
Critical Care Medicine156(3, pt. 1):814—818. Mannino, D.M.,
R.A.Etzel, and R.G.Parrish. 1996. Pulmonary fibrosis deaths
in the United States, 1979—1991. An analysis of
multiple-cause mortality data . AmericanJournal of
Respiratory Critical Care Medicine153:1548—1552.

Maslia, M.L., M.M.Aral, R.C.Williams, A.S.Susten, and

J.L.Heitgerd. 1994. Exposure assessment of populations
using environmental modeling, demographic analysis, and
GIS. Water Resources Bulletin30(6):1025—1041.

McMaster, R.B., H.Leitner, and E.Sheppard. 1997. GIS-based

environmental equity and risk assessment: Methodological
problems and prospects. Cartography andGeographic
Information Systems24(3): 172—189.

Mohai, P. and B.Bryant. 1992. Race, poverty and the

environment. The disadvantaged face greater risks. EPA
Journal18(1):6—8.

Moore, T.J.1991. Application of GIS technology to air

toxics risk assessment: Meeting the demands of the
California air toxics “Hot Spots” Act of 1987. GIS/LIS
’91,Atlanta, GA: American Congress on Surveying and
Mapping, American Society for Photogrammetry and Remote
Sensing, Association of American Geographers, Urban and
Regional Information Systems Association, and AM/FM
International.
Moore, T.J.1997. GIS, society and decisions: A new
direction with SUDSS in COMMAND. Proceedings of Auto-Carto
13,Bethesda, MD: American Congress on Surveying and
Mapping.

Morgenstern, H.1995. Ecologic studies in epidemiology:

Concepts, principles, and methods . Annual Review of Public
Health16:61—81.

National Research Council. 1990. BEIR V: Health Effects of

Exposure to Low Levels ofIonizing Radiation.Committee on
the Biological Effects of Ionizing Radiation. Washington,
DC.

National Research Council. 1991. Environmental

Epidemiology: Public Health and Hazardous Wastes.National
Academy Press. Washington, DC.

Neuberger, J.S., C.F.Lynch, B.C.Kross, R.W.Field, and

R.F.Woolson. 1994. Residential radon exposure and lung
cancer: Evidence of an urban factor in Iowa.
HealthPhysics66(3):263—269. Nuckols, J.R., J.K.Berry, and
L.Stallones. 1994. Defining populations potentially exposed
to chemical waste mixtures using computer-aided mapping
analysis. In Toxicology of Chemical Mixtures,R.S.H.Yang
(Ed.), pp. 473—504. Orlando, FL: Academic Press. Nyerges,
T., M.Robkin, and T.J.Moore. 1997. Geographic information
systems for risk evaluation: Perspectives on applications
to environmental health. Cartography andGeographic
Information Systems24(3):123—144.

Onsrud, H.J., J.Johnson, and X.Lopez. 1994. Protecting

personal privacy in using geographic information systems.
Photogrammetric Engineering and Remote
Sensing60(9):1083—1095.

Openshaw, S.1978. An empirical study of some zone-design

criteria. Environment andPlanning A10: 781—794. Openshaw,
S.1983. The Modifiable Areal Unit Problem.Concepts and
Techniques in Modern Geography, vol. 38. Norwich, England:
Geo Books. Openshaw, S., M.Charlton, C.Wymer, and A.Craft.
1987. A Mark 1 geographical analysis machine for the
automated analysis of point data sets. InternationalJournal
of Geographical Information Systems1 (4):335—358. Openshaw,
S., A.Craft, M.Charlton, and J.M.Birch. 1988. Investigation
of leukaemia clusters by use of a geographical analysis
machine. LancetFebruary 6, 1988:272—273. Pearce, N.E.1989.
Phenoxy herbicides and non-Hodgkin’s lymphoma in New
Zealand: Frequency and duration of herbicide use. British
Journal of Industrial Medicine46(2):143—144. Ramsdell,
J.V., C.A.Simonen, and K.W.Burk. 1994. Regional Atmospheric
TransportCode for Hanford Emission Tracking (RATCHET).
PNWD-2224. Richland, WA: Pacific Northwest Laboratory .
Richardson, S., I.Stücker, and D.Hémon. 1987. Comparison of
relative risks obtained in ecological and individual
studies: Some methodological considerations. International
Journal of Epidemiology16(1): 111—120. Rushton, G.,
D.Krishnamurti, R.Krishnamurthy, and H.Song. 1995. A
geographic information analysis of urban infant mortality
rates. Geo Info Systems5:52—66. Schleien, B. (Ed.). 1992.
The Health Physics and Radiological Health HandbookSilver
Spring, MD: Scinta, Inc. Scholten, H.J. and M.J.C.de
Lepper. 1991. The benefits of the application of
geographical information systems in public and
environmental health. World HealthStatistics
Quarterly44(3):160—170. Schwartz, S.1994. The fallacy of
the ecological fallacy: The potential misuse of a concept
and the consequences. American Journal of Public
Health84(5):819—824. Scott, M.S. and S.L.Cutter. 1997.
Using relative risk indicators to disclose toxic hazard
information to communities. Cartography and Geographic
Information Systems24(3):158—171. Selvin, H.C.1958.
Durkheim’s suicide and problems of empirical research.
AmericanJournal of Sociology63(6):607—619. Sexton, K.,
S.G.Selevan, D.K.Wagener, and J.A.Lybarger. 1992.
Estimating human exposures to environmental pollutants:
Availability and utility of existing databases. Archives of
Environmental Health47(6):398—407.

Shapiro, J.1990. Radiation Protection. A Guide for

Scientists and Physicians.3rd ed. Cambridge, MA: Harvard
University Press.

Shipler, D.B., B.A.Napier, W.T.Farris, and M.D.Freshley.

1996. Hanford Environmental Dose Reconstruction Project–An
overview. Health Physics71(4):532—544. Souleyrette, R.R.,
II and S.K.Sathisan. 1994. GIS for radioactive materials
transportation. Microcomputers in Civil
Engineering9(4):295—303. Stallones, L., J.R.Nuckols, and
J.K.Berry. 1992. Surveillance around hazardous waste sites:
Geographic information systems and reproductive outcomes.
EnvironmentalResearch59(1):81—92. Stockwell, J.R.,
J.W.Sorensen, J.W.Eckert, and E.M.Carreras. 1993. The U.S.
EPA geographic information system for mapping environmental
releases of Toxic Chemical Release Inventory (TRI)
chemicals. Risk Analysis13(2):155—164. Susser, M.1994a. The
logic in ecological: I. The logic of analysis. American
Journal ofPublic Health84 (5):825—829.
Susser, M.1994b. The logic in ecological: II. The logic of
design. American Journal ofPublic Health84(5): 830—835.

Thomas, R.D.1995. Age-specific carcinogenesis:

Environmental exposure and susceptibility. Environmental
Health Perspectives103(Suppl. 6):45—48.

Tim, U.S.1995. The application of GIS in environmental

health sciences: Opportunities and limitations.
Environmental Research71(2):75—88.

Tobias, R.A., R.Roy, C.J.Alo, and H.L.Howe. 1996. Tracking

human health statistics in “Radium City.”Geo Info
Systems6(7):50—53.

Twigg, L.1990. Health based geographical information

systems: Their potential examined in the light of existing
data sources. Social Science and Medicine30(1):143—155.

United Church of Christ. 1987. Toxic Wastes and Race in the

United States.New York: Commission for Racial Justice.

Viel, J.-F. and S.T.Richardson. 1991. Adult leukemia and

farm practices: An alternative approach for assessing
geographical pesticide exposure. Social Science &
Medicine32(9):1067—1073.

Viel, J.-F. and S.T.Richardson. 1993. Lymphoma, multiple

myeloma and leukaemia among French farmers in relation to
pesticide exposure. Social Science & Medicine37(6):771—777.

Vine, M.F., D.Degnan, and C.Manchette. 1997. Geographic

information systems: Their use in environmental
epidemiologic research. Environmental Health
Perspectives105(6):598—605.

Wagenknecht, L.E., L.L.Perkins, G.R.Cutter, S.Sydney,

G.L.Burke, T.A.Manolio, D.R. Jacobs, Jr., K.A.Liu,
G.D.Friedman, and G.H.Hughes. 1990. Cigarette smoking
behavior is strongly related to educational status: The
CARDIA study. PreventiveMedicine19(2):158—169.

Waller, L.A.1996a. Epidemiologic uses of geographic

information systems. Statisticsin Epidemiology
Report3(1):1—7.

Waller, L.A.1996b. Geographic information systems and

environmental health. Health and Environment
Digest9(10):85—88.
Wang, J. and Y.Xie. 1994. Application of geographical
information systems to toxic chemical mapping in Lake Erie.
Environmental Technology15(8):701—714.

Wartenberg, D.1992. Screening for lead exposure using a

geographic information system. Environmental
Research59(2):310—317.

Wartenberg, D., M.Greenberg, and R.Lathrop. 1993.

Identification and characterization of populations living
near high-voltage transmission lines: A pilot study.
Environmental Health Perspectives101(7): 626—632.

Wigle, D.T., R.M.Semenciw, K.Wilkins, D.Riedel, L.Ritter,

H.I.Morrison, and Y.Mao. 1990. Mortality study of Canadian
male farm operators: Non-Hodgkin’s lymphoma mortality and
agricultural practices in Saskatchewan. Journal of the
NationalCancer Institute82(7):575—582.

Wood, D.J. and B.Gray. 1991. Toward a comprehensive theory

of collaboration. Journal of Applied Behavioral
Sciences27(2):139—162.

Wynder, E.L. and S.D.Stellman. 1992. The “over-exposed”

control group. AmericanJournal of
Epidemiology135(5):459—461.

Zito, G.V.1975. Methodology and Meanings: Varieties of

Sociological Inquiry.New York: Praeger.
6 Chapter Six Infectious Diseases and GIS

December 1992. Pos=positive; Neg=negative. Source: American

Journal of Tropical Medicine

andHygiene, 57, R.Thompson et al. The Matola Malaria

Project: A Temporal and Spatial Study of

Malaria Transmission and Disease in a Suburban Area of

Maputo, Mozambique, pp. 550—559, 1997.

Reprinted with permission from The American Society of

Tropical Medicine and Hygiene.

used to generate Lyme disease risk maps based on nymphal

densities, abundance of

adult Ixodes scapularis per white tailed deer, or a

logistic regression model that Glass, G.E.,
P.P.Amerasinghe, J.M.Morgan, and T.W.Scott. 1994.
Predicting Ixodesscapularis abundance on white-tailed deer
using geographic information systems. American Journal of
Tropical Medicine and Hygiene51(5):538—544.

Kitron, U. and J.J.Kazmierczak. 1997. Spatial analysis of

the distribution of Lyme disease in Wisconsin. American
Journal of Epidemiology145(6):558—566. Kitron, U.,
J.K.Houseman, and C.J.Jones. 1991. Use of the ARC/INFO GIS
to study the distribution of Lyme disease ticks in an
Illinois county. Preventive VeterinaryMedicine11:243—248.
Kitron, U., H.Pener, C.Costin, L.Orshan, Z.Greenberg, and
U.Shalom. 1994. Geographic information system in malaria
surveillance: Mosquito breeding and imported cases in
Israel, 1992. American Journal of Tropical Medicine and
Hygiene50(5):550—556. Kitron, U., J.Michael, J.Swanson, and
L.Haramis. 1997. Spatial analysis of the distribution of
LaCrosse encephalitis in Illinois, using a geographic
information system and local and global spatial statistics.
American Journal of Tropical Medicineand
Hygiene57(5):469—475. Mather, T.N., M.C.Nicholson, R.Hu,
and N.J.Miller. 1996. Entomological correlates of Babesia
microti prevalence in an area where Ixodes scapularis
(Acari: Ixodidae) is endemic. Journal of Medical
Entomology33(5):866—870. Nicholson, M.C. and T.N.Mather.
1996. Methods for evaluating Lyme disease risks using
geographic information systems and geospatial analysis.
Journal of MedicalEntomology33(5):711—720.

Openshaw, S.1996. Geographical information systems and

tropical diseases. Transactions of the Royal Society of
Tropical Medicine and Hygiene90(4):337—339.

Ribeiro, J.M., F.Seulu, T.Abose, G.Kidane, and

A.Teklehaimanot. 1996. Temporal and spatial distribution of
anopheline mosquitos in an Ethiopian village: Implications
for malaria control strategies. Bulletin of the World
Health Organization74(3):299—305.

Sharma, V.P. and A.Srivastava. 1997. Role of geographic

information system in malaria control. Indian Journal of
Medical Research106:198—204. Thompson, R., K.Begtrup,
N.Cuamba, M.Dgedge, C.Mendis, A.Gamage-Mendis, S.M.Enosse,
J.Barreto, R.E.Sinden, and B.Hogh. 1997. The Matola Malaria
Project: A temporal and spatial study of malaria
transmission and disease in a suburban area of Maputo,
Mozambique. American Journal of Tropical Medicine
andHygiene57:550—559. World Health. 1996a. Guinea worm
eradication programme. World Health49(3):24.

World Health. 1996b. Technology aids eradication campaign.

World Health49(3):28.
7 Chapter Seven A Historical Perspective
on the Development of Remotely Sensed
Data as Applied to Medical Geography

Avery, T.E. and G.L.Berlin. 1985. Interpretation of Aerial

Photographs,4th ed. New York: Macmillan Publishing Company.

Barinaga, M.1993. Satellite data rocket disease control

efforts into orbit. Science26(5117):31—32.

Barnes, C.M.1991. An historical perspective on the

applications of remote sensing to public health. Preventive
Veterinary Medicine11:163—166.

Brady, J.1991. Seeing flies from space. Nature351:695.

Campbell, J.B.1996. Introduction to Remote Sensing,2nd ed.

New York: The Guilford Press. Clarke, K.C., J.P.Osleeb,
J.M.Sherry, J.P.Meert, and R.W.Larsson. 1991. The use of
remote sensing and geographic information systems in
UNICEF’s dracunculiasis (Guinea worm) eradication effort.
Preventive Veterinary Medicine11:229—236. Cline, B.L.1970.
New eyes for epidemiologists: Aerial photography and other
remote sensing techniques. American Journal of
Epidemiology92(2):85—89. Colvocoresses, A.P.1975.
Evaluation of the cartographic applications of ERTS-1
imagery. The American Cartographer2(1):5—18. Colwell,
R.N.1956. Determining the prevalence of certain cereal crop
diseases by means of aerial photography.
Hilgardia26(5):223—286. Cracknell, A.P.1991. Rapid remote
recognition of habitat changes. Preventive Veterinary
Medicine11: 315—323. Davies, F.G., E.Kilelu, K.J.Linthicum,
and R.G.Pegram. 1992. Patterns of Rift Valley fever
activity in Zambia. Epidemiol Infect.108(1):185—191.
Dottavio, C.L. and F.D.Dottavio. 1984. Potential benefits
of new satellite sensors to wetland mapping.
Photogrammetric Engineering and Remote
Sensing50(5):599—606. Emmons, A.B.1938. Mapping in the
Nanda Devi Basin. Geographical Review28(1):59— 67. Estes,
J.E., C.Sailer, and L.R.Tinney. 1986. Applications of
artificial intelligence techniques to remote sensing. The
Professional Geographer38(2):133—140. Fritz, L.1942. The
efficacy of photogrammetry for the precision and economy,
with special reference to the needs of civil engineering.
In Photogrammetry CollectedLectures and Essays,O.von Gruber
(Ed.), Boston: American Photographic Publishing Company.
Haack, B.N.1982. Landsat: A tool for development. World
Development10(10):899— 909. Haack, B.N.1993. GECA 580
Lecture. George Mason University. Hayes, R.O., E.L.Maxwell,
C.J.Mitchell, and T.L.Woodzick. 1985. Detection,
identification, and classification of mosquito larval
habitats using remote sensing scanners in earth-orbiting
satellites. Bulletin of the World Health
Organization63(2):361—374.

Hough, H.1991. Satellite Surveillance. Loompanics

Unlimited.Port Townsend, Washington.

Hugh-Jones, M.1989. Applications of remote sensing to the

identification of the habitats of parasites and disease
vectors. Parasitology Today5(8):244—251.

Hugh-Jones, M.1991. Introductory remarks on the application

of remote sensing and geographic information systems to
epidemiology and disease control. PreventiveVeterinary
Medicine11:159—162.

Huh, O.K.1991. Limitations and capabilities of the NOAA

satellite advanced very high resolution radiometer (AVHRR)
for remote sensing of the Earth’s surface.
PreventiveVeterinary Medicine11: 167—184.

International Research Council. 1970. Remote Sensing with

Special Reference to Agriculture and Forestry. Washington,
DC: National Academy of Sciences.

Jensen, J.R.1986. Introductory Digital Image Processing: A

Remote Sensing Perspective.Englewood Cliffs, NJ:
Prentice-Hall. Jensen, J.R.1996. Introductory Digital Image
Processing: A Remote Sensing Perspective,2nd ed. Upper
Saddle River, NJ: Prentice Hall.

Jovanovic, P.1989. Satellite medicine. World

HealthJan-Feb:18—19.

Kingman, S.1989. Remote sensing maps out where the

mosquitoes are. New Scientist123(1682):38.

Lee, W.T.1922. The Face of the Earth as Seen from the Air:
A Study in the Application ofAirplane Photography to
Geography.American Geographical Society Special Publication
No. 4. Washington, DC: Conde Nast Press.

Linthicum, K.J., C.L.Bailey, D.R.Angleberger, T.Cannon,

T.M.Logan, P.H.Gibbs, C.J. Tucker, and J.Nickeson. 1991.
Towards real-time prediction of Rift Valley fever epidemics
of Africa. Preventive Veterinary Medicine11:325—334.

Nizam, Y.1996. Mapping urban growth in metropolitan Beirut.

In Raster Imagery inGeographic Information
Systems,S.A.Morain and S.L.Baros (Eds.), Santa Fe, New
Mexico: Onword Press.

Parsons, J.J. and W.A.Bowen. 1966. Ancient ridged fields of

the San Jorge River Floodplain, Colombia. The Geographical
Review61(3):317—343.

Paul, C.K. and A.F.Mascarenhas. 1981. Remote sensing in

development. Science214(451):139—145.

SPOT Image Corporation. 1998. Satellite Imagery: An

Objective Guide.Reston, VA: SPOT Image Corporation.

Seavoly, R.E.1973. The shading cycle in shifting

cultivation. Annals of the Associationof American
Geographers63(4):522—528.

Shaefer, F.K.1953. Exceptionalism in geography: A

methodological examination. Annals of the Association of
American Geographers43(3):226—249.

Steiner, R.1966. Reserved lands and the supply of space for

the southern California metropolis. Geographical
Review61(3):344—362.

Stephenson, J.1997. Ecological monitoring helps researchers

study disease in environmental context. JAMA278(3):189—191.
Tennakoon, S.B., V.V.N.Murty, and A.Eiumnoh. 1992.
Estimation of cropped area and grain yield of rice using
remote sensing data. International Journal of
RemoteSensing13(3):427—439.

Travis, J.1997. Spying diseases from the sky: Satellite

data may predict where infectious microbes will strike.
Science News152(5):72—73.

Washino, R.K. and B.L.Wood. 1994. Application of remote

sensing to arthropod vector surveillance and control.
American Journal of Tropical Medicine and
Hygiene50(6):133—144. Wolf, P.R.1983. Elements of
Photogrammetry: With Air Photo Interpretation and
RemoteSensing,2nd ed. New York: McGraw-Hill, Inc.
8 Chapter Eight The Integration of Remote
Sensingand Medical Geography: Process and
Application

Avery, T.E. and G.L.Berlin. 1985. Interpretation of Aerial

Photographs,4th ed. New York: Macmillan. Beck, L.R.,
M.H.Rodriquez, S.W.Dister, A.D.Rodriguez, E.Rejmankova,
A.Ulloa, R.A. Mesa, D.R.Roberts, J.F.Paris, M.A.Spanner,
R.K.Washino, C.Hacker, and L.J. Legters. 1994. Remote
sensing as a landscape epidemiologic tool to identify
villages at high risk for malaria transmission. American
Journal of Tropical Medicineand Hygiene51:271—280. Beck,
L.R., B.L.Wood, and S.W.Dister. 1995. Remote sensing and
GIS: New tools for mapping human health. Geo Info
Systems(September):32—37.

Brady, J.1991. Seeing Flies from Space. Nature351:695.

Chwastek, J. and T.Z.Dworak. 1990. Satellite Remote Sensing
of Industrial Air Pollution in the Cracow Special Protected
Area. JEPTO10(6):288—289.

Clarke, K.C., J.P.Osleeb, J.M.Sherry, J.P.Meert, and

R.W.Larsson. 1991. The use of remote sensing and geographic
information systems in UNICEF’s dracunculiasis (Guinea
worm) eradication effort. Preventive Veterinary
Medicine11:229—235.

Cracknell, A.P.1991. Rapid remote recognition of habitat

changes. Preventive Veterinary Medicine11: 315—323.

Corbley, K.P.1999. Identifying villages at risk of malaria

spread. Geo Info Systems.9(1):34—38.

Cross, E.R., C.Sheffield, R.Perrine, and G.Pazzaglia. 1984.

Predicting areas endemic for Schistosomiasis using weather
variables and a Landsat data base.
MilitaryMedicine149:542—544. Cross, E., C.J.Tucker, and
K.C.Hyams. 1997. The use of AVHRR and weather data to
detect the seasonal and geographic occurrence of Phebotomus
papatasi in South-west Asia. In Proceedings of the
International Symposium on Computer Mapping inEpidemiology
and Environmental Health,R.T.Aangeenbrug, P.E.Leaverton,
T.J. Mason , and G.A.Tobin (Eds.), pp. 24—26. Alexandria,
VA: World Computer Graphics Foundation.

Davies, F.G., E.Kilelu, K.J.Linthicum, and R.G.Pegram.

1992. Patterns of Rift Valley fever activity in Zambia.
Epidemiology and Infection108:185—191.

ER-Mapper. 1995. ER-Mapper 5.0 Reference.Earth Resource

Mapping Pty. Ltd.

Gonzalez, R.C. and R.E.Woods. 1992. Digital Image

Processing.Reading, MA: Addison-Wesley Publishing.

Hayes, R.O., E.L.Maxwell, C.J.Mitchell, and T.L.Woodzick.

1985. Detection, identification, and classification of
mosquito larval habitats using remote sensing scanners in
earth-orbiting satellites. Bulletin of the World Health
Organization63(2):361—374.

Hugh-Jones, M.1989. Applications of remote sensing to the

identification of the habitats of parasites and disease
vectors. Parasitology Today5(8):244—251.

Hugh-Jones, U., N.Barre, G.Nelson, K.Wehnes, J.Warner,

J.Gavin, and G.Garris. 1992. Landsat-TM identification of
Amblyomma variegatum (Acari: Ixodidae) habitats in
Guadeloupe. Remote Sensing of Environment40:43—55.

Huh, O.K.1991. Limitations and capabilities of the NOAA

satellite advanced very high resolution radiometer (AVHRR)
for remote sensing of the Earth’s surface.
PreventiveVeterinary Medicine11: 167—184.

Jackson, R.D. and A.R.Huete. 1991. Interpreting vegetation

indices. Preventive Veterinary Medicine11: 185—200.

Jensen, J.1996. Introductory Digital Image Processing: A

Remote Sensing Perspective.New Jersey: Prentice Hall.

Kitron, U. and J.J.Kazmierczak. 1997. Spatial analysis of

the distribution of Lyme disease in Wisconsin. American
Journal of Epidemiology145(6):558—566. Kleinbaum, D.G.,
L.L.Kupper, K.E.Muller, and A.Nizam. 1998. Applied
RegressionAnalysis and Multivariable Methods,3rd ed.
Pacific Grove, CA: Duxbury.

Lillesand, T.M. and R.W.Kiefer. 1987. Remote Sensing and

Image Interpretation, 2nd ed.New York: John Wiley & Sons.

Linthicum, K.J., C.L.Bailey, F.G.Davies, and C.J.Tucker.

1987. Detection of Rift Valley fever viral activity in
Kenya by satellite remote sensing imagery.
Science235(4796):1656—1659.

Linthicum, K.J., C.L.Bailey, D.R.Angleberger, T.Cannon,

T.M.Logan, P.H.Gibbs, C.J. Tucker, and J.Nickeson. 1991.
Towards real-time prediction of Rift Valley fever epidemics
of Africa. Preventive Veterinary Medicine11:325—334.
Malone, J.B., O.K.Huh, D.P.Fehler, P.A.Wilson,
D.E.Wilensky, R.A.Holmes, and A.I. Elmagdoub. 1994.
Temperature data from satellite imagery and the
distribution of schistosomiasis in Egypt. American Journal
of Tropical Medicine and Hygiene50(6):714— 722.

Messina, J.P., K.Crews-Meyer, and G.Valdivia. 1998. The

evaluation of preprocessing levels and classification
techniques towards the better discrimination of suspended
particulates. Proceedings of the 1998 ASPRS Conference.
Messina, J.P.1997. Ephemeris data corrections as applied to
SPOT data for marine applications. Backscatter8(2):22—25.
Perry, B.D., R.Kruska, K.Kundert, P.Lessard, and
R.A.I.Norval. 1991. Estimating the distribution and
abundance of Rhipicephalus appendiculatus in Africa.
PreventiveVeterinary Medicine11:261—268.

Pope, K.O., E.J.Sheffner, K.J.Linthicum, C.L.Bailey,

T.M.Logan, E.S.Kasischke, K. Birney, A.R.Njogu, and
C.R.Roberts. 1992. Identification of central Kenyan Rift
Valley fever virus habitats with Landsat TM and evaluation
of their flooding status with airborne imaging radar.
Remote Sensing of Environment40:185—196.

Roberts, D., H.Savage, L.Legters, M.Rodriguez,

A.Rodriguez-Ramirez, E.Rejmankova, K.Pope, B.Wood, and
J.Salute. 1991. Overview of field studies for tile
application of remote sensing to tile study of malaria
transmission in Tapachulah, Mexico. Preventive Veterinary
Medicine11:269—276.

Rogers, D.J.1991. Satellite Imagery, tsetse and

trypanosomiasis in Africa. PreventiveVeterinary Medicine,
11:201—220.

Wood, B., R.Washino, L.Beck, K.Hibbard, M.Pitcairn,

D.Roberts, E.Rejmankova, J. Paris, C.Hacker, J.Salute,
P.Sebesta, and L.Legters. 1991. Distinguishing high and low
anopheline-producing rice fields using remote sensing and
GIS technologies. Preventive Veterinary Medicine11:277—288.

Wood, B.L., L.R.Beck, R.K.Washino, S.M.Palchick, and

P.D.Sebesta. 1991. Spectral and spatial characterization of
rice field mosquito habitat. International Journal ofRemote
Sensing12(3):621—626.

Wood, B.L., L.R.Beck, R.K.Washino, K.A.Hibbard, and

J.S.Salute. 1992. Estimating high mosquitoproducing rice
fields using spectral and spatial data.
InternationalJournal of Remote Sensing13(15): 2813—2826.