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Mapping for our health

September 23, 2012

On September 26, Eddie Oldfield, BA, Director, NB Climate Change Hub at the New Brunswick Lung Association will be the featured webinar guest hosted by Open Geospatial Consortium (OGC). Following the webinar, Eddie will join #hcsmca to continue the conversation. 

At the New Brunswick Lung Association, Eddie coordinates a Climate Change Public Education Hub, and has led the implementation of geospatial interoperability standards to exchange, integrate, and visualize distributed health and environmental information. He continues to support efforts to create a national portal to bring together climate and health resources for decision-makers in public health, municipal emergency management, and local climate adaptation.

Given the intersection of geospatial mapping, social media, and public health, I`ve invited Eddie to inform us and explore with us the following topics with us on September 26 at 1pm ET.

  1. What is the state of geospatial literacy in the health community?
  2. What are some good examples / best practices for mapping health data?
  3. What are the barriers to obtaining data / maps?
  4. What are some driving health issues, program priorities, or research needs?
  5. What is needed for a successful National Health Portal and SDI in Canada?

To give us some background information on the topic of geospatial mapping for health, Eddie offers this overview.

Post by Eddie Oldfield (@MappingResearch)

Introduction: Disease Ecology

Infectious diseases that were formerly confined to remote areas now have the ability to expand their geographic range, jump species, become resistant to antimicrobial agents, and become more virulent.  The emergence and reemergence of infectious diseases occurs, at least in part, because of “changes in the dynamics of human activity within the context of nature, mediated by new technologies”(1) , for example air travel(2) . Since various pathogens need people as suitable ecological niches to exist and reproduce, we are really talking about enormously complex spaces that control the movement of viruses, including through the interactions and movements of infected and susceptible populations.

Studies have demonstrated geographic and temporal differences(3) of peak mortalities and morbidity during influenza pandemics, and each pandemic (four in the last Century) can differ substantially from previous ones.

Models:

Increasing concern about infectious diseases has brought about developments in statistical and predictive models of viral transmission. Yet, few comprehensive models exist for web-based mapping (geography) of trends in population health, changes to the environment, or the spread of infectious diseases, across international borders. The reasons for this are numerous, including prohibitive cost of systems, complexity of models, unfamiliarity with open geospatial standards and web service capabilities, and limited access to distributed public health and surveillance data.

Maps:

Examples of map-making in service of public health extend more than 400 years(4) , though perhaps the most infamous example is of John Snow, M.D., who mapped a Cholera outbreak in Soho District of London, in 1854, seeking evidence that diseases such as cholera were caused by pollution or a noxious form of “bad air”. Since the germ theory of disease had not yet been developed, Dr. Snow did not understand the mechanism by which the disease was transmitted. By mapping the spatial distribution of mortalities, a local water pump was identified as a likely central source for the epidemic.

The need to exchange geospatial data with a wider audience will increase as the public health community confronts new epidemics, multiple exposures to environmental determinants, and chronic illness in ageing populations. Sound epidemiological and statistical methods can provide the foundation for all data analyses to be displayed on maps. This can in turn lead to evidence-based decisions for improving access to health services or responding to novel virus outbreaks.

Map Technology:

Technologies in sharing, visualizing, and tracking infectious disease data are needed to support evidence-based decision making, collaboration, and international strategies to prevent and respond to infectious disease outbreaks(5). Computers have enabled real-time geospatial and statistical representation of health-related data. Computer based mapping technologies offer more efficient communication of the nature, cause, and transmission of diseases among vulnerable populations(6).  For example, geographic mapping played an important role in the study and control of SARS(7).

Geographic Information Systems (GIS) can facilitate more cost-effective disease surveillance, prevention and control programs. GIS is used to study patterns of global climate change and their possible impacts on vector-borne disease(8) , for example West-Nile Virus and Malaria. Other studies have focused on mapping risks to public health from heat events, pollution, flooding, and extreme weather. GIS enables public health professionals to better identify and understand issues of proximity to health care by populations who have the most need and are at risk(9), and has the functional capacity to collect, analyse, and disseminate data to public health programs(10).

Spatial Data Infrastructure:

The Canadian Spatial Data Infrastructure (CGDI) is a framework which facilitates the sharing of spatial data through the information highway, using open geospatial standards. Open geospatial standards can facilitate the provision of interactive maps to a wider audience through the Internet, enabling re-use of distributed location resources.

Case Study – New Brunswick Lung Association:

The New Brunswick Lung Association’s interoperable web map services were published in the CGDI for online access (2003-2008). The web map services enabled temporal, spatial, and statistical computation of distributed geospatial data on the fly. Web services were chained together to implement complex processes, and result in seamless map visualizations. The application enabled users to visualize time-series thematic maps of chronic respiratory illness, environmental and pandemic surveillance data. The time-series maps revealed corresponding trends and impacts to school absenteeism, hospital admissions, pharmacy sales, and fuel and food supply. Interruptions to public transport, essential services, and critical infrastructure could be plotted on the map. This ‘Common Operating Picture’ enabled decision-makers to monitor circulating strains, identify thresholds for preventative action, plan options for recovery, and ensure the continuity of essential services and government. A mobile application enabled data sharing and visualization between front line health workers and emergency operations center. The general public could query for the nearest flu clinic or simply learn about trends in population health.

Addressing Institutional Complexity:

Over the last decade there has been an explosion of agencies, departments, and organizations with a mandate for disease surveillance and control around the world. The implementation of web services for geospatial data exchange may help to resolve some of the emerging institutional dilemmas by providing decision-makers across borders with access to closest-to-source data. A common spatial data infrastructure in service of public health could support disease surveillance, alerting and response by multiple health authorities, for example, agencies such as World Health Organization, the US Centers for Disease Control, Public Health Agency of Canada, other State and Provincial health authorities.

Conclusion:

The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time(11). Using open geospatial standards, health authorities could publish up-to-date maps showing various dimensions of disease, population health, environment, and statistics. The economy of scale is present when epidemiological research and health planning communities utilize a system to address inequalities in health care provision, access, and promotion, which can be scaled up during health emergencies and pandemic response efforts(12).

  1. Emerging infectious diseases: vulnerabilities, contributing factors and approaches. Lashley, Felissa R; 2004 Expert Review of Anti-Infective Therapy (England). 2(2):299-316.
  2. The Threat of Pandemic Influenza – Are We Ready? Workshop Summary, Institute of Medicine of the National Academies P. 141
  3. Multinational Impact of the 1968 Hong Kong Influenza Pandemic: Evidence for a Smoldering Pandemic, Cécile Viboud, Rebecca F. Gratis, Bernard A. P. Lafont, Mark A. Miller, Lone Simonsen, for the Multinational Influenza Seasonal Mortality Study Group. Journal of Infectious Diseases 2005; 192:233-48 (15 July).
  4. Cartographies of Disease, Tom Koch, ESRI Press, 2006
  5. Online Mapping of Infectious Disease, Sheng Gao, Darka Mioc, Xiaolun Yi, Francois Anton, David J. Coleman, Barbara MacKinnon, Eddie Oldfield, Department of Geodesy and Geomatics Engineering and New Brunswick Lung Association, 2007
  6. Cartographies of Disease, Tom Koch, ESRI Press, 2006
  7. Descriptive review of geographic mapping of severe acute respiratory syndrome (SARS) on the Internet, Magel N Kamel Boulos, University of Bath (UK), International Journal of Health Geographics, January 2004, P. 10
  8. GIS and Public Health, Ellen K. Cromley. Sara L. McLafferty, Guilford Press, 2002, p. 226
  9. Geographical Information Systems and Public Health, Penny Black, California State University, December 2005, P. 42
  10. Statistical Methods in Spatial Epidemiology, Second Edition, Andrew B. Lawson, Department of Epidemiology and Biostatistics, University of South Carolina, John Wiley and Sons, 2000, P. 293
  11. Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom, Maged N Kamel Boulos, International Journal of Health Geographics 2004, 3:1
  12. Preparing for Influenza Epidemics and Pandemics in the New Millennium, Theresa W.S. Tam, MD, FRCPC, Canadian Journal of Public Health, Sept-Oct 1999

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