GIS and Public Health 2nd Edition

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GIS and Public Health
GIS and
Public Health
SECOND EDITION

Ellen K. Cromley
Sara L. McLafferty

THE GUILFORD PRESS

New York London
© 2012 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com

All rights reserved

No part of this book may be reproduced, translated, stored in a retrieval system, or

transmitted, in any form or by any means, electronic, mechanical, photocopying,
microfilming, recording, or otherwise, without written permission from the publisher.

Printed in the United States of America

This book is printed on acid-free paper.

Last digit is print number: 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Cromley, Ellen K.
GIS and public health / by Ellen K. Cromley and Sara L. McLafferty. — 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-60918-750-7 (hardback)
1. Geographic information systems. 2. Public health—Data processing.
I. McLafferty, Sara, 1951– II. Title.
RA566.C764 2012
610.285—dc23
2012019585
To Robert, Gordon, and Ed
and
Avijit, Smita, and Priya
Acknowledgments

In 2005, The Guilford Press invited us to update the first edition of GIS and
Public Health. We were grateful for the success of the book and recognized how
much significant change was occurring in the use of geographic information
systems (GIS) in the sphere of public health. We set out to capture these new
developments by building on the framework we adopted in the first edition. The
second edition expands the scope of the work that motivated us to write about
GIS and public health in the first place, and we remain grateful to all of the indi-
viduals we previously acknowledged.
We are grateful to Kristal Hawkins, editor at The Guilford Press, for her
encouragement and support for this project and also thank everyone at Guilford
who helped us see this project through to completion. In particular, we thank
Guilford for publishing the online supplement, which is an important feature
of the second edition. Jared Butler has our thanks for testing the exercises in
that supplement and suggesting needed corrections and improvements. We also
thank the reviewers for their careful reading of the first draft of the manuscript
and their constructive and insightful comments and suggestions.
An important consideration that convinced us to attempt a second edition
was the prospect of working together again. This edition, like the first, has been a
true collaboration. We are also grateful to all of the people we have worked with
for providing us new opportunities in the field to learn how we can work together
to improve public health.
I (Ellen K. Cromley) especially thank my advisors Allen Fonoroff and Howard
Biel (Case Western Reserve University), Kevin Cox (The Ohio State University),
and Gary Shannon (University of Kentucky) for everything they taught me and
for their contributions to their fields. I also acknowledge Bob Brems, Zanesville/
Muskingum County Health Department; Julia Dickson, Medical College of Wis-
consin; Bill Elwood, OppNet, National Institutes of Health; Dr. Carol Horowitz,
vi
Acknowledgments vii

Mount Sinai School of Medicine, and colleagues at the Center to IMPACT

Diabetes in East Harlem; Blair Johnson, Center for Health, Intervention, and
Prevention (CHIP), University of Connecticut; Stanley Lemeshow, Mary Ellen
Wewers, and faculty and students at the Summer Program in the College of
Public Health at The Ohio State University; Patricia Mabry, National Institutes
of Health; Wendy Nelson and Pat Francis, URISA’s GIS in Public Health Con-
ference; Rachel Pruchno, University of Medicine and Dentistry of New Jersey;
Lorraine Reitzel, Lorna Haughton McNeill, and Dave Wetter, Department
of Health Disparities Research, MD Anderson Cancer Center; Timothy Sahr,
Health Policy Institute of Ohio; Jean Schensul, Marlene Berg, and Emil Coman,
The Institute for Community Research, and Kamla Gupta and S. K. Singh, Inter-
national Institute for Population Sciences, along with members of the ASHRA
project team in Mumbai; Philip Troped and Heather Whitcomb, Department of
Health and Kinesiology, Purdue University; Francine Laden, Channing Labora-
tory, Brigham and Women’s Hospital and Harvard Medical School; Steve Melly,
Exposure, Epidemiology and Risk Program, Harvard School of Public Health;
Robin Puett, Department of Environmental Health Sciences, University of South
Carolina; Joan Twiggs and Darcé Costello, Connecticut Department of Children
and Families; Margaret Weeks, The Institute for Community Research; and the
faculty and staff of the Department of Community Medicine and Health Care,
University of Connecticut School of Medicine. I also thank Emily Marble, at The
Institute for Community Research in Hartford, Connecticut, for assistance in
research administration. Rich Mrozinski, Department of Geography, University
of Connecticut, and Howard Sternberg, Connecticut Department of Environ-
mental Protection, deserve special thanks for their great expertise in GIS and
their willingness to share it.
I (Sara L. McLafferty) extend thanks to colleagues and current and for-
mer students at the University of Illinois, Hunter College, and elsewhere for
their many contributions to this book. Many years ago, my PhD advisor, Gerard
Rushton of the University of Iowa, challenged and encouraged me to explore
the links between geographical analysis and social and health inequalities. A
renowned leader in GIS and public health, Gerry’s insights, intellect, and inspi-
ration provided the academic foundation that made this book possible and is
reflected in so many ways in my contributions to the book. I also consider myself
fortunate to have worked with many colleagues in investigating diverse health
issues in Illinois and in the New York metropolitan region. Special thanks to
Fahui Wang of Louisiana State University; Vince Freeman of the University of
Illinois at Chicago; Keith Clarke of the University of California at Santa Bar-
bara; Victor Goldsmith of Pace University; Nick Freudenberg of Hunter College;
Roger Grimson of SUNY Stony Brook; the members of the West Islip Breast
Cancer Coalition; Dr. Christina Hoven of Columbia University; and Dr. James
Childs of the Centers for Disease Control and Prevention. The New York City
Department of Health generously gave permission to use individual-level rat bite
data to prepare several figures in this book. I am also extraordinarily grateful
to the many talented graduate students I have worked with on issues related to
viii Acknowledgments

GIS and health, including Lan Luo, Alisa Shockley, Miriam Cope, Trevor Fuller,
Ranjana Chakrabarti, Travis Leonard, Jong-Hyung Lee, Carmen Tedesco, John
Pan, Sue Grady, Doug Williamson, Barbara Tempalski, Henry Sirotin, Cheryl
Weisner, Linda Timander, Brett Gilman, Delene Pratt, Julie Kranick, Sonia Tat-
lock, Colin Reilly, and Chris Hanson-Sanchez. This book benefited in innumer-
able ways from their insights, expertise, collaboration, and camaraderie as we
probed the frontiers of GIS and public health.
Preface to the Second Edition

When we wrote the first edition of this book, the field of geographic informa-
tion systems (GIS) and public health was in its infancy, a “new” field that was
just beginning to attract attention among health researchers and policymakers.
Hearkening back to that time, we approached the task of preparing the second
edition as a relatively straightforward process of tweaking and updating. In short
order, we were overwhelmed by the size of the task at hand. In the past 10 years,
the field of GIS and public health has flourished to the point where literally
hundreds of articles appear in the research literature each year. From infectious
diseases to cancer to obesity to health care, researchers are embracing GIS in
their efforts to understand health concerns and direct interventions to improve
public health and reduce health disparities. The rapid expansion of the field is
also reflected in new journals and conferences that facilitate interaction among
researchers and practitioners.
In preparing this second edition, we have tried to convey the amazing
breadth, diversity, and dynamism of these health–GIS applications without losing
sight of basic concepts and earlier work that laid the foundations for more wide-
spread adoption of GIS. Chapters 1 through 10 have been substantially revised,
expanded, and updated to reflect developments in the research literature. A new
chapter on health disparities (Chapter 11) considers neighborhood influences on
health and the methods used to investigate contextual effects. The final chapter
of the book (Chapter 12) addresses the institutional context of GIS by focusing on
public participation GIS, a topic that we feel is of great importance in promoting
community involvement in efforts to improve public health. We have also sought
to expand the book’s geographic scope beyond the United States to comprise
research developments and applications throughout the world, reflected in the
large section of references. In response to requests from readers of the first edi-
tion, we have prepared a series of GIS laboratory exercises with data to accom-
pany the second edition. These exercises are available as an online supplement
(at www.guilford.com/p/cromley) to the book.

ix
x Preface to the Second Edition

The past decade has also witnessed major advances in geographic infor-
mation science that are represented in the second edition. Especially notewor-
thy are the emergence of Internet-based geovisualization and mapping systems;
the enormous increase in availability of georeferenced data from cell phones
and other GPS-enabled devices; developments in spatial analysis methods that
emphasize “local” patterns and processes; and the growing use of GIS in pro-
moting community participation. All chapters have been revised to discuss how
these developments in GIScience can contribute to public health research and
practice.
Although extensively revised and updated, this book continues to reflect our
belief that understanding core geographic concepts like space, place, location,
and distance, and core principles related to spatial data, mapping, and spatial
analysis, is essential in applying GIS to public health issues. The book retains
many sections dealing with these topics, illustrated with maps, diagrams, and
real-world applications, and with material written in a way that we hope is acces-
sible to the diverse audiences interested in public health and GIS.
Contents

List of Figures xv

List of Tables xxiii

Introduction 1
Geographic Foundations for Public Health 1
Organization and Scope 12
GIS and Public Health 14

CHAPTER 1. Geographic Information Systems 15

Definitions of GIS 15
GIS Functions 19
Trends in GIS Applications 33
Public Health Applications of GIS 35
GIS and the Internet 38
Conclusion 41

CHAPTER 2. Spatial Data 43

Field and Object Data 44
Tesselation and Vector Data Models 45
Measuring Location 51
Scale, Projection, and Symbols of Cartographic
Data Sources 53
Geographic Data Quality 63
The Role of Metadata 67
Conclusion 74

xi
xii Contents

CHAPTER 3. Spatial Databases for Public Health 75

Foundation Spatial Data 75
Population Data 86
Health Data 89
Making Population and Health Data Mappable 99
Database Integration 104
Data Sharing 108
Conclusion 112

CHAPTER 4. Mapping Health Information 113

The Mapping Process 113
Representing Health Information 115
Viewing Health Information 133
GIS and Map Publication 144
Conclusion 149

CHAPTER 5. Analyzing Spatial Clustering of Health Events 150

Mapping Disease Rates: The Small Numbers Problem 153
Spatial Clustering Methods 158
Space–Time Clustering 175
Choosing a Clustering Method 178
Uses of Spatial Clustering Methods 181
Conclusion 182

CHAPTER 6. Analyzing Environmental Hazards 183

How Environmental Agents Are Identified as Hazards 185
GIS Analysis of Source Locations
of Environmental Hazards 188
Modeling Fate and Transport and Environmental Quality
in a GIS 198
GIS and Exposure Modeling 210
GIS and Dose 223
GIS and Outcome Surveillance 226
GIS and Environmental Risk Management 230
Issues in Environmental Health Mapping and Analysis 231
Conclusion 232

CHAPTER 7. Analyzing the Risk and Spread 234

of Infectious Diseases
Spatial Diffusion 237
Mapping Case Distributions 238
Mapping the Ecology of Risk 245
Analyzing Temporal and Geographic Trends
in Disease Outbreaks 248
Forecasting Spatial Diffusion
of Communicable Diseases 253
Contents xiii

Planning Public Health Interventions 256

Privacy and Confidentiality 259
Conclusion 262

CHAPTER 8. Exploring the Ecology 263

of Vector-Borne Diseases
The Global Burden of Zoonotic Diseases and the Challenge
of Emerging Infectious Diseases 264
Surveillance and Mapping of Vector-Borne Diseases 268
Modeling of Vector-Borne Diseases 284
Environmental Impacts of Controlling
Vector-Borne Diseases 297
A Syndemic Perspective on Disease 299
Conclusion 302

CHAPTER 9. Analyzing Access to Health Services 303

Access 304
Mapping Service Locations 307
Mapping Health Care Needs and Services 308
Assessing Potential Access to Health Services 310
Analyzing Service Utilization 328
Conclusion 337

CHAPTER 10. Locating Health Services 338

Health Care Shortage Areas 340
Components and Dimensions of Health Service
Delivery Systems 342
Client Population Distribution 345
The Meaning of “Centrality” in Health Service
Facility Location 346
Normative Models of Facility Location
and Service Delivery 349
Incorporating Normative Models of Facility Location
and Service Delivery into GIS 361
Spatial Decision Support Systems 369
Health Services Delivery in Response to Disasters 370
Conclusion 375

CHAPTER 11. Health Disparities 377

Context and Composition 379
Visualizing and Measuring Area Characteristics 381
Defining Neighborhood Contexts 394
Modeling Neighborhood Effects on Health 396
Location Processes and the Link between Location
and Well-Being 402
Conclusion 405
xiv Contents

CHAPTER 12. Public Participation GIS 407

and Community Health
GIS and Society 408
Public Participation GIS 411
Conclusion 423

References 425

Index 485

About the Authors 503