Focus: Public health initiatives looking at resource access in Alaska, Texas and Nepal are technology-aided
The current special issue of Technology and Innovation - Proceedings of the National Academy of Inventors-, is devoted to public health research using Geographic Information Systems (GIS) to help provide beneficial data for public health researchers focusing on health risks and food access in rural Alaska; racial disparities in health care and resources in Fort Worth, Texas; and pathways for health care development in remote areas of Nepal.
GIS describes a system designed to capture, store, manipulate, analyze, manage and present geographical data. GIS merges cartography, statistical analysis and database technology. The researchers whose work is presented in this issue used GIS to better understand the relationship between their populations of inquiry and resources within the populations' spatial dimensions.
In this special issue of T&I, researchers report on their use of the GIS as a research tool and also on the challenges encountered in enlisting GIS.
GIS research in rural Alaska
Tenaya M. Sunbury, Department of Health Sciences, University of Alaska Anchorage, used GIS to carry out environmental public health tracking of non-fatal falls in rural Alaskan villages and also in accessing the quality and accessibility of healthy foods in Anchorage.
"Considerable potential exists for GIS to play a key role in Alaska and other rural places," said Sunbury. "GIS has the potential to transform public health and bring the 'public' back to 'public health' by bridging the gap between complex epidemiological data and a variety of audiences."
Sunbury evaluated non-fatal falling injuries using data from the Alaska Trauma Registry to geocode patients hospitalized between 1991 and 2009, as well as population data from the U.S. Census. GIS identified spatial patterns at the town/village levels. To get a better understanding of food access and barriers to getting healthy food in Anchorage, she also described how GIS was used to display data about Alaska's local food distribution system. Using GIS researchers in Alaska were able to spatially analyze food locations, bus routes, road network, and socio-economic data.
Health care development in remote areas of Nepal
GIS data helped Catherine L. Sanders (University of Montana) and Kimber H. McKay (ISIS Foundation) to represent "landscapes" of health and health-seeking behaviors in the Humla District, Nepal.
"Nepalese agro-pastoralists experiences with forces of change in the last generation have altered villagers' abilities to gain access to health services, clean water, and nutrition in Humla District, Nepal," wrote the authors. "We describe the strengths and weaknesses of GIS as a tool for enhancing our understanding of this 'health landscape'."
According to Sanders and McKay, topography is a major determinant of health care access. "With the help of GIS imagery and analyses, this paper reveals the ways in which the natural and human-made landscape shapes access to healthcare in Humla.-Using GIS-generated imagery, we show that wealthier people do have better access to health care resources."
They noted that GIS can connect social network information to the landscape properties. Subsequent GIS analysis of variation among villages and individuals in a single community also points to ways in which proponents of development can improve upon the success of their programs in order to build a more accessible health care landscape.
"Identifying those features that affect development success is key to the design of health development programs, and one forte of GIS analysis," they concluded.
GIS analysis of race-based health disparities in Fort Worth, Texas
Because they considered the availability of healthy food and recreation space important factors in the "built environment," researchers in Fort Worth, Texas, used a GIS map to highlight types of food available and space accessible for recreation - grocery stores, fast food restaurants, city parks and franchise gyms - in ethnic minority neighborhoods and predominantly white neighborhoods in the city
"Analysis of the map revealed neighborhoods with greater racial diversity had fewer grocery stores, fast food restaurants, and corporate gyms compared to less diverse neighborhoods" wrote researchers Naomi Meier (School of Public Health, University of North Texas Health Science Center) and Shamekka Kuykendall (Heller School of Social Policy and Management, Brandeis University).
The researchers said that GIS mapping provided the ability to combine spatial information from a range of sources into a single framework, but also emphasized that GIS should be used in conjunction with on-the-ground research and connections with neighborhood residents to gain the best understanding.
Authors in all three studies noted that there were weaknesses and challenges in using GIS to gather data, such as 'spatial error' (lack of geographic accuracy), but that GIS remains a powerful tool.
"The potential of GIS to display complex data is ironically its greatest weakness, as end-users may infer causal relationships or make inferences about individuals from population/aggregated data," said Sunbury.