GIS in Public Health

The Role of GIS in Public Health

As seen on GovLoop.

Geographic information systems (GIS) answer the question of where: where diseases are prevalent; where vulnerable populations live; and where resources are most needed to improve health conditions. GIS consists of the data, technology and people who answer these questions. And it has never been more relevant than it is today.

In the past year alone, health professionals have used it to address the COVID-19 pandemic, opioid epidemic, vaping-related respiratory illness and other diseases and injuries.  GIS is helping public, private and non-profit organizations make effective and efficient decisions, from collecting data to analyzing it to presenting it in a user-friendly manner.Snow Cholera Map

History of Mapping and Public Health

In the nineteenth century, John Snow was the first to use mapping in epidemiological research. In 1854, London suffered from an outbreak of cholera, and Snow mapped the locations of those stricken by the disease. By looking at where cholera victims lived, he observed a spatial pattern and identified the water source suspected of being responsible for the outbreak. This event marked the founding of epidemiology – the study of patterns, causes and distribution of diseases and health-related events.

This image is of John Snow’s map of cholera cases in London 1854.

Uses in Public Health

GIS benefits public health by:

  • Collecting information. The prevention of disease is paramount in developing healthy individuals and communities. But first, we need to understand what conditions exist that compromise health and safety. Policymakers cannot make evidence-informed decisions without qualitative or quantitative data to back it up. To collect the data, for example, an app can be created in which users report signs of blight in their neighborhood, which municipal agencies can use to prioritize cleanup crews.
  • Analyzing spatial patterns. Instances of disease can be mapped and analyzed to reveal patterns in its distribution, as evident in John Snow’s cholera map. But this just scratches the surface of GIS’ analytical capabilities. For example, you could use a proximity analysis to identify “food deserts” — an area that has limited access to affordable and nutritious food — in relation to schools or youth-centered establishments to help school districts create policies that make accessible nutrition a priority for students.
  • Allocating resources. You wouldn’t want to build a hospital in an area where there are several others. Nor would you want to deprive a rural community of access to much needed health care. GIS enables planners to figure out the best location for health care services based on the population served.
  • Presenting data in an easy-to-understand way. Most humans are visual beings, and looking at a map or data dashboard compared to reading rows of numbers is a good way to help users understand the distribution of health issues. For instance, it is easier to tell where there are cancer clusters in a region by a heat map than by looking at a spreadsheet.

GIS Tools

No matter which GIS software you use, four basic tools can help any public health professional in their role as a disease-fighting superhero:

  1. Maps — the most basic of GIS tools. It can contain geopolitical layers such as census tracts, zip codes, city council districts or health agency sub-regions. It can include layers of demographic data, such as the number of households that live below the area’s median income. And it can also include health data, such as the percentage of the population with a substance use disorder.
  2. Story maps. As the name implies, they narrate a story in a compelling way with maps, photographs, text, videos and charts.
  3. Crowdsourcing apps. These apps are a great way to collect data in the field by being accessible on a mobile device. The methodology in collecting the data is a good way to encourage people to be active and engaged stakeholders in their community.
  4. Data dashboards. These provide key insights on data. You can combine maps, charts, gauges, lists and text on a single computer screen to present data.

Even with all these tools, the most valuable asset in GIS is the public health professional – the one with the innovation and creativity to collect data, map it, analyze it and present it.

Meredith Gibson
Media Director, IPS

Meredith Gibson is the Media Director for the Binge and Underage Drinking Initiative, Countywide Media Advocacy Project, and Partnerships for Success. She generates news articles to promote awareness of public health issues, collaborates on opinion editorials (op-eds) with community leaders, and pitches ideas and spokespersons to news outlets, amassing media coverage at the local and national levels.

Equitable Housing

Equitable Housing: A Place-Based Solution to Racism

Since the beginning of 2020, we have become acutely aware of how systemic racism has impacted people of color in America. With far greater percentages of Blacks and Latinx succumbing to COVID-19, the disparities in health and health care among these populations have been laid bare. And with elevated rates of infant mortality, heart disease, and other chronic illnesses among communities of color, some health experts and lawmakers call racism a public health emergency.

This extends to housing. People of color have been forced to live in concentrated poverty areas far more often than their White counterparts. According to a study by the Brookings Institute, poor Blacks were almost five times as likely as poor Whites to live in an extremely poor neighborhood. Poor Latinx were three times as likely.

With fewer social services and limited access to health care, lower-performing schools, and fewer job-seeking networks, most residents of poor neighborhoods get trapped in a cycle of chronic poverty that is often perpetuated through generations.

Aggravated by these conditions, higher rates of crime are also common to such neighborhoods. Police working in extremely poor neighborhoods often live in a completely different area and have little connection with the people they serve. They also have little understanding of implicit bias and the historical racist practices that their agency still upholds. Therefore, in responding to a bad situation, police officers seek only to suppress and return conditions to “normal.” But in a community struggling for the basic necessities of life, America’s normal for people of color is unacceptable.

We need to remember that the frustration and hopelessness expressed by communities of color are not just about police brutality or even chronic poverty. Their origin lies in the systemic racism that has continued to keep Black and other people of color separate – physically and otherwise – from the rest of society and excluded from its benefits.

More than anything else, it was a series of public policies, conceived in an era known as “separate but equal,” that allowed racism to become institutionalized throughout American neighborhoods. It began early in the 20th century when Black Americans migrated from the rural south to cities in the north. Desperate to maintain the status quo, policymakers created zoning codes that specified where Blacks could not live, aggressively funneling them away from white neighborhoods.

Later came the process of redlining, introduced by the Federal Housing Administration in 1934. The agency was created to advance homeownership through loan guarantees, but it explicitly refused to back loans to Black people or even other people who lived near Black people. Although the Fair Housing Act of 1968 was passed to stop redlining, this behavior still continued through restrictive covenants, discriminatory steering by real estate agents, and restricted access to private capital. All of this has circumvented any investment where Black people and other communities of color live, making their homes and communities a product of racism.

When a specific group of people has been separated by geographical boundaries, as Black people have now for hundreds of years, racial stereotypes grow, eventually becoming entrenched in the culture. Today, Black stereotypes are commonly linked to violence and criminality. We are witness to such beliefs almost daily through movies and cop shows.

However, through social media, we also witness people calling for equity in America. This includes equal access to quality health care and social services, good education, a right to fair representation in law enforcement, and especially a place where home is just as safe for a Black family as it might be for others.

It’s time to rewrite the rules to support affordable housing being built in wealthy neighborhoods. A 2015 Supreme Court ruling made this possible by affirming that the Fair Housing Act could be used to actively promote racial integration. Ensuring that people of color have access to better health care, education, and job opportunities is perhaps the one thing that could make America whole again.

Brenda Simmons
CEO/President, IPS

Brenda Simmons began her career at IPS in 2003 as a community organizer in San Diego County. She was promoted multiple times before she was elevated to CEO/President in April 2019. She has a broad range of experience working in very conservative rural and frontier communities in Montana, ultra-progressive communities including Los Angeles and West Hollywood, and everything in between. Brenda has been involved in projects ranging in focus from substance abuse prevention to community revitalization to child-sex trafficking. As CEO, Brenda oversees more than a dozen IPS projects in Southern California.

GIS Disparities

How GIS Exposed Racial and Socioeconomic Disparities in San Diego’s South Bay

As seen on GovLoop.

Geographic information systems (GIS) is playing an important role in helping San Diegans address health inequities along the U.S.-Mexico border.

An Upstream Approach to Substance Use Prevention

The Partnerships 4 Success (P4S) project uses geospatial technology to map conditions in San Diego’s South Bay. This area is known for its diversity and Latino cultural heritage. However, it is also known for its binge and underage drinking along the U.S.-Mexico border as well as methamphetamine use and cross-border juvenile drug smuggling.

The project aims to advance opportunities and policies that create a healthy and vibrant South Bay by reducing substance use. The team does this by addressing the factors that lead to the region’s harmful conditions, specifically among the Latino population.

P4S takes a community-level approach to substance use prevention, because the neighborhood where a person lives often determines if they experience positive or negative health outcomes. It influences their quality of life and even their life expectancy.

Communities of color historically experience greater health disparities than their white counterparts due to factors such as a lack of access to transportation, health care, quality education, housing security and economic opportunity. These communities also may experience more crime, violence, blight and exposure to high-risk businesses such as bars and liquor stores.

Moreover, all these factors are heavily influenced by racism, discrimination and social injustice. They can create what is referred to as community trauma. It is not surprising then that all this toxic stress can lead to a high risk of substance abuse.

Using GIS to Guide Policy Decisions

By using ArcGIS Pro, the P4S team identified the census tracts in the South Bay most in need of intervention by creating a trivariate choropleth map. In laymen’s terms, this is a map that depicts three different data layers in an easy-to-interpret map. The map shows the Hardship Index, Child Opportunity Index and the percentage of the Latino population.

The Hardship Index is a composite of six scores:

  1. Unemployment rate
  2. Dependency (% of the population older than 65 or younger than 18)
  3. Low education attainment (% of those over the age of 25 with less than a high school education)
  4. Per capita income
  5. Housing overcrowding (more than 1 occupant/room)
  6. Poverty level (less than 100% of federal poverty)

The greater the hardship, the darker the color of the census tract on the map.

The Child Opportunity Index is an index that captures neighborhood conditions that matter for children’s healthy development in terms of education, health and environment, and social and economic opportunity. The lower the childhood opportunity, the darker the color of the census tract.

The Hardship Index and Child Opportunity Index were combined into one color scheme. The third data set is the Latino population. The larger the point symbol, the higher the Latino population.

With this GIS map, the P4S team identified two distinct areas in the South Bay where there was low childhood opportunity, high hardship and a significant Latino population where intervention would be most valuable.

Supporting Positive Outcomes 

A core group of experts in public health, social services, education, faith organizations, mental health and government will lead the project and work with these communities to advocate for improved community conditions.

By giving the South Bay the chance for greater health opportunities, the project hopes to build a community where everyone has an equal chance at the type of life they want to live.

Meredith Gibson
Media Director, IPS

Meredith Gibson is the Media Director for the Binge and Underage Drinking Initiative, Countywide Media Advocacy Project and Partnerships for Success. She generates news articles to promote awareness of public health issues, collaborates on opinion editorials (op-eds) with community leaders, and pitches ideas and spokespersons to news outlets, amassing media coverage at the local and national levels.

Grocery Worker

Essential Workers Risk their Lives and We Benefit. What Can We Do in Return?

COVID-19 has made it clear that many of our cities have built their communities along the same racial and economic divide that has disadvantaged communities of color for centuries. And yet, these same communities of color house our essential workers. There live our grocers, truck drivers, custodians, meat packers, and other unsung heroes. They are risking their lives, and their families’ lives, when they enter their work place every day.

Those who benefit must consider this question: Do our essential workers have the resources they need to cope with the disproportionate impact COVID-19 is having on their communities? Do we care enough?

The answer to both questions, unfortunately, is no.

In San Diego, the communities in the South region – where 78% of the county’s minority residents live  — have the highest rates of infection. Health officials are seeing similar trends in cities like New York, Chicago, Milwaukee, and Los Angeles. It is clear that the virus is disproportionately affecting black Americans, Latinx, and Native Americans in the US.

These statistics are a reflection of society’s inherently racist infrastructure. The infection rates highlight the inequities that these communities face nationwide. And as COVID-19 spreads, our nation’s health disparities are simultaneously exposed and worsened.

Officials all over the country are demanding that testing sites be placed in infection hot spots. And while getting more testing nationwide is crucial to reducing our COVID-19 numbers, the reality is that our communities of color are more susceptible to the virus because of the environmental conditions they live in.

Public health officials directly correlate physical health with many environmental factors. Neighborhoods riddled with poor air quality, broken or missing sidewalks, no safe green spaces, and a lack of grocery stores make residents susceptible to poor health. Additionally, the combination of low living wages and poor access to health care or healthcare services contributes to the likelihood of a person deciding to skip a doctor’s visit – and its co-payment – to buy food for the week.

These social and environmental circumstances are the reason why chronic conditions such as diabetes, heart disease, and advanced stages of cancer are much more rampant in communities of color. Further, all of these conditions make a virus like COVID-19 far deadlier. And yet, we continue to ask our essential workers living in underserved communities to show up to work every day despite the augmented risk. Because without them, our society crumbles.

The truth of the matter is that our essential workers are living in places where their zip code has a greater impact on their lives than their genetic code. And this needs to change. These communities are the backbone of our country. They are our essential communities.

Where do we go from here? What can we do to help the essential workers who risk their lives every day for our benefit? We can support the change that’s underway. Counties all over the nation accelerate their funding to programs that provide bilingual assistance to all those navigating the county’s system for relief resources. We can demand the same from our elected officials. We can demand that more resources flow to disadvantaged neighborhoods, not just during this time of crisis. We need to take advantage of this momentum and ensure these programs continue on, even after COVID-19.

Programs like these are the foundation needed to keep working families sheltered, fed, and connected. They help ensure our essential workers and their communities stay healthy enough to protect us.

We owe them that much.

Breny Aceituno
Prevention Specialist, IPS

Breny Aceituno is a Prevention Specialist for Partnerships for Success, a program that aims to disarm the health disparities present in Latino communities living near the San Diego border. Breny graduated from UCLA with a bachelor’s in Political Science. She earned a master’s degree in Conflict Management from the University of Haifa in Israel. Breny considers herself a life-long learner who is driven by the actionable accountable measures that can improve our communities.


Has COVID-19 Evened the Playing Field?

Most of us couldn’t predict the head spinning change that would come with the advent of COVID-19. We are living in unprecedented times where terms like “social distancing” and “stay-at-home orders” have become household terms across the nation.

It would seem COVID-19 has placed us all on the same playing field. For the first time in recent history, a deadly virus that knows no boundaries, transcends all borders, and discriminates against no one has taken the world center stage, and we are all sitting in the front row. Rich and poor people alike are being subjected to stay-at-home orders and are sheltering in place. From Prince Charles, to British Prime Minister Boris Johnson, to the tens of thousands suffering in the developing world, this virus has proven it is not a respecter of persons.

In reality, however, the playing field isn’t even at all. While the virus itself does not discriminate against anyone, the distribution of resources does. Those with greater opportunity also have better access to quality health care and testing. If they need a ventilator, they are more likely to get one. In other words, they are more likely to survive.

Conversely, people of color are more likely to die. A study conducted by a team of epidemiologists and clinicians from four universities suggests that more African Americans are dying from the coronavirus in the United States than are whites or other ethnic groups. They found that counties with higher populations of Back residents accounted for 52% of coronavirus diagnoses and 58% of COVID-19 deaths nationwide.

Additionally, people of color across the country are those more likely deemed essential because they hold frontline service or retail jobs. They often work for minimum wage, and with no health benefits, yet are incurring greater exposure to the deadly virus. Many feel compelled to work even if they are sick because they have no other means to pay the rent or put food on the table. Plus, they are more likely to use public transportation, putting themselves and their families at greater risk.

Staying at home while recovering from the virus is not the same for the poor. While the wealthy and middle class can safely stay in the privacy of their own home and even enjoy the luxury of a backyard, with a tutor helping their children learn from home, it is not uncommon for Latinx to live in households of more than five in small quarters. This living arrangement makes it dangerous for the entire family, and overwhelmingly stressful, especially if they do not have sick leave.

People of color have historically been marginalized and in many ways, they have been socio-economically quarantined. They do not have the same access as the wealthy to resources that would improve their health and quality of life.

This is a travesty not only for them but for the nation.

Maybe we can all learn something good from this pandemic. If we all advocate for policies and economies that are more inclusive and promote equity in the areas of life that matter most, we would be doing our country and our economy a great service.

Maybe then we can finally even the playing field for everyone.

Susan Caldwell
Senior Program Strategist, IPS

Susan Caldwell, Senior Program Strategist, started her career with IPS in 2005. Her experience includes program development, project management, media advocacy, grant writing and policy strategy. Susan values diverse relationships and working to advance initiatives in unique communities through multi-sector partnerships.