GIS for Public Health

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GIS for Public Health

• Eddie Oldfield
• Director, New Brunswick Lung Association

1918
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What can we learn from SARS?

• The National Advisory Committee on SARS and
  Public Health identified many systemic
  deficiencies in responding to SARS in Canada.
  Among these were
• absence of protocols for sharing data,
• poor coordination among health authorities at
  national, provincial, and local levels,
• delays in identification of unknown virus,
• poor understanding of disease etiology and
  transmission vectors.

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The CGDI and Public Health

• GIS applications have become a staple in
  European health policy
• health data management tools in Italy,
• a national public health atlas in The
  Netherlands,
• healthcare planning tools in Switzerland, and
• modular GIS applications in the United Kingdom.
• The expansion of the Canadian Geospatial Data
  Infrastructure and other national SDIs into the
  public health discipline is deemed critical for
  addressing shortcomings in population health
  monitoring, developing effective intervention
  strategies for chronic and infectious disease,
  improving healthcare services, and responding to
  health and safety emergencies.
• SDI Spatial Data Infrastructure

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Potential for Applications in Canada and the US

• All respiratory diseases
• Monitor chronic diseases
• Monitor epidemic outbreaks (influenza),
  communicable disease clusters, and disease
  vectors (e.g. migratory bird routes, zoonotic
  vectors)
• Joint health and safety emergency management
  (e.g. bioterrorism)
• Monitor water (including well-water) and food
  quality
• Aboriginal health status (Tuberculosis, Diabetes
  etc)
• Ambulance vehicle routing
• Public Health Resource management
• Population demographics (for assessing population
  vulnerabilities)
• Global Warming predictive health impacts
  modeling
• Cross-disciplinary research (linking air quality,
  climate change and human health)

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• Example of a thematic map showing the different
  insecticide treatments and the localization of
  bird reports and mosquito pools, in 2003. This
  thematic map shows the different insecticide
  treatments (shaded areas) and the localization of
  bird reports (colored dots) and mosquito pools
  (colored triangles) along with their status, in
  2003.

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• Example of a thematic map showing the status of
  reported dead Corvidae around the Montreal
  Island, in 2005. This thematic map shows the
  status (represented by different colors) of
  reported dead Corvidae for different territorial
  subdivisions around the Montreal Island, in 2005.

• Reference The Integrated System for Public
  Health Monitoring of West Nile Virus (ISPHM-WNV)
  a real-time GIS for surveillance and
  decision-making.
• Pierre Gosselin, Germain Lebel1, Sonia Rivest and
  Monique Douville-Fradet

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Modeling Health Impacts from a Changing Climate
These health issues call for the application of
ecological and systems-based approaches. The
classical toxicological model applied in
environmental epidemiology, where defined
exposure to a specific agent causes an adverse
health effect to identifiable exposed
populations, is generally not adequate for
assessing indirect or multi-causal impacts of
climate change on human health.
World Health Organization Climate Change and
Adaptation Strategies for Human Health

• Extreme Weather Events
• Heat Waves
• Flooding / floodplain management
• Vector Rodent borne diseases
• Water-borne diseases
• Drought / water supply
• Food-borne diseases / food supply
• Predictive Modeling

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• Add slide showing graph / map, air quality
  health in a community

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Gaps in GIS for Public Health

• Lack of infrastructure (protocols for distributed
  access)
• Uneven capacity among health authorities (i.e.
  resource constraints)
• Concerns over data privacy / poor access to data
• Barriers to integration of health data within
  CGDI (i.e. lack of health data standards /
  inconsistencies)
• Inconsistent patchwork approach to development
  of applications (technology does not currently
  satisfy public health requirements)

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Gaps in GIS for Public Health

• Lack of training among public health
  professionals and traditional IT support
• Lack of engagement of provincial epidemiologists
  in GIS-based modeling of health determinants and
  for population health monitoring
• Lack of Canadian methodologies / research
• Inadequate research agenda / cross-jurisdictional
• Inadequate promotion of benefits to
  decision-makers

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Planning for One Scenario? Not likely. Virulence,
Progression, Peak, Rate of Mortality Multiple
Health Responses to Escalating Threats (WHO
Protocols)
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Understanding Spatial Disease Epidemiology

• Baseline Influenza vs Pandemic Indicators
• Transmissibility / Vectors
• Progression Rate / Death Rate
• Vulnerable Populations
• Access to Health Care
• Vaccine Distribution
• Capacity / Demand Surge
• Affected Health Care Workers

From Micro To Macro
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Mapping Public Health Data
Community Health Maps
Kilometers
0
50
100
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Access to Health Care
Asthma Admission / 10,000 Population 2001
Admission / 10,000 Population
Mapping Influenza Cases
0
0.1 - 7.1
7.1 - 9.7
9.7 - 15.7
15.7 - 110.3
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Mapping Public Health Data
New Brunswick Lung Association American Lung
Association of Maine University of New
Brunswick University of Southern Maine Maine
Health Authority / CDC NB Department of
Health Public Health Agency of Canada Emergency
Measures Organization (NB) Service New
Brunswick WHO-PAHO / University of
Laval Cox-Hanson OReilly Matheson Law Firm CARIS
Ltd
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Chief Medical Officer Physician / Nurse Data
Technician
Lab / Verification of Suspected
Cases Identification of disease strain / etiology
Vaccine Distribution
Must be easy to use
Ambulatory Response
Notification
Public Access
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CARIS Spatial Fusion Enterprise
Configuration Manager
http//www.caris.com/products/
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Wireless and Remote Applications
Porting an existing desktop web application
Layered windows


Prototype Thin Client in Action
Map View
Data Entry

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Integrating Data

• Quality Checking (errors, omissions)
• Vertical and Horizontal Alignment
• Scale Matching / Representation
• Matching Health Codes / Identifiers
• Multi-Dimensional DB Design
• Spatial and Temporal Stamps / Querying
• Statistical Modules (average / total, normalized
  by population, etc)

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User CollaborationIncident Management and
Spatial Analysis Tools

• Public Participation GIS municipal model,
  University of New Brunswick
• Existing Incident Management / Tracking and
  Spatial Tools are Independent
• Geo-Conferencing, TGIS
• CARIS Spatial Fusion Enterprise with Incident
  Management Suite
• OGC Standards Development, CGDI Services, WMS/WFS
  compliance

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