Introduction
Local health departments (LHDs) play a central function in ensuring important public health services. Geographic information system (GIS) technology offers shows potential resources for LHDs to recognize geographic gaps connecting areas of necessitate and the reach of public health services. They explored how great LHDs possibly will better bring up to date planning and investments by using GIS based methodologies to bring into line community needs and health outcomes with public health programs. They presented a framework to drive LHDs in identifying and addressing gaps or mismatches in services or health outcomes.
Methods
These researchers studied four large health departments, two in California and two in Florida, interviewing key informants from all levels of the organization. They identified five critical factors that enable health departments to use GIS methods to inform service planning:
Priority setting-some type of formalized strategic planning activity including traditional health assessments, community-driven planning processes and, in some cases, political mandates. Planning with a geographic focus—identify a purpose for mapping and put program planning and service provision questions into a geographic context. Access to geo-enabled data-availability of population health data and health department service and program data. Resources and technical capacity-resources needed include specialized but widely available GIS software, data management or statistical software, and staff proficient in using the software. Responsive organizational structure-capacity to use information generated through GIS to make changes to services and programs then reevaluate using strategic planning. GIS methodologies provide local health departments with a way to inform decision-making and better align their offerings with community needs and health outcomes. Dubowitz, T, Williams, M, Steiner, ED, Weden, MM, Miyashiro, L,MS, Dawn Jacobson, D, and Lurie, N,MD. (Sept. 2011).
Results
Having an established planning process sets the foundation for using GIS technology as a tool in planning and priority setting. All 4 LHDs in the study engaged in some type of formalized activity to plan programs, services, or outreach; to conduct systematic assessments regarding the health needs of a population; or to receive a request to implement a particular program. Priority setting can include formal strategic planning activities, traditional health assessments, community-driven planning processes such as the National Association of County and City Health Officials’ MAPP process (Mobilizing for Action through Planning and Partnerships), and, in some cases, political mandates or requests from community organizations.
To incorporate GIS technology effectively into the planning process, LHDs must identify a specific purpose for mapping and be able to plan with a geographic focus. Two of the LHDs we assessed used mapping to put program planning and service provision questions in a geographic context (e.g., to determine whether an immunization program is reaching children in high-poverty neighborhoods).
Geo-enabled data are needed to map sociodemographic and health factors as well as the location and reach of LHD programs or services. Each of the LHDs studied used GIS methodologies to map community health outcomes (e.g., life expectancy), distribution of risk factors (e.g., hazardous waste, poverty), and distribution of health care services (e.g., locations of hospitals, clinics, and contracted service providers). Two of the LHDs used maps to evaluate the distribution of public health services other than health care (e.g., tobacco control policies, community education and advocacy efforts). Only one used GIS technology to evaluate mismatches between community’s health needs and LHD services. Dubowitz, T. et al, (2011)
Discussion
All 4 LHDs examined in this study reported that mapping is a promising planning tool that can visually communicate and influence the decision-making process among multiple stakeholders, including but not limited to political decision makers and community leaders. The framework presented here provides a means for LHDs to assess their current capacity to employ GIS technology to map public health services and population health outcomes together on the same map. Although we focused on large health departments that were already using GIS methodologies, our framework provides the basis for creating a feedback loop that drives the questions all LHDs can ask to identify and address gaps or mismatches between services and health outcomes. Dubowitz, T. et al, (2011)
Critique
Differences in access to healthcare services and the resulting adverse health outcomes are major public health priorities. The Institute of Medicine and the Department of Health and Human Services have identified the need for strategies to improve access to healthcare services and to support the improvement of health outcomes. The literature documents health disparities associated with healthcare access and health outcomes from a geographic perspective. Place of residence, location of healthcare services, and geography in general are important factors in the analysis of health. Geographical information systems (GISs) are an emerging technology in the analysis of health from a geographical or location context. As a type of information technology, GISs are potentially powerful assessment tools for the investigation of healthcare access, health outcomes, and the possible resulting health disparities. Their ability to integrate health data with mapping functions allows for visualization, exploration, and modeling of health patterns. Application of GIS technology using health data can help in describing and explaining disparities in healthcare access and health outcomes. The studies reviewed demonstrated the use of GISs to investigate various aspects of healthcare access and health outcomes, including environmental variables of Lyme disease, sociodemographic variables and teen pregnancy, geographical disparities in breast cancer mortality by racial groups, PCP and AIDS prevalence, and factors of a leptospirosis disease outbreak. The literature reviewed shows effective integration and analysis of health data using GIS technology.
Graves BA. Perspect Health Inf Manag. 2008 Jul 29;5:11. Review. PMID:18698429 [Pub Med – indexed for MEDLINE]

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