Health 2.0: Place-Based Intelligence

Are you ready for geo-accounting?

The winds of change are blowing. A White House memo [PDF] recently sent to all executive department heads and agencies provides policy principles for submitting future agency budgets. This memo calls for place-based considerations in 2011 budgets. Picking up on the theme that “everything happens somewhere,” the Obama administration has connected the dots!

This is a good sign for health and human service agencies everywhere, especially those that have struggled mightily for many years to build integrated information systems that support the planning and delivery of health and human services to the public. This directive also strengthens the case for better geographic accountability. Turning to a new, place-based way of thinking about spending also has the potential to vastly improve service accessibility, reduce cost and qualitative disparities, and actually help health-seeking consumers achieve desirable outcomes.

Are health and human service organizations at every level technically ready for a place-based approach to building health intelligence and actually delivering services?

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10 responses to “Health 2.0: Place-Based Intelligence”

  1. At the county health department level in Kern County, we struggle with having the resources to move to the next level–building health intelligence. Staff turn over is a problem, training in the Central Valley is difficult and expensive.
    Most of the time we use GIS at the project level typically on the desktop-building web-based or enterpirse systems are goals, but it is going to be a while.

  2. At the University of Chicago, we are attempting to assist health and human service organizations on the South Side of Chicago through the South Side Health and Vitality Studies. This inter-disciplinary initiative began late in 2008 and has been picking up steam ever since. One crucial component of these studies has been to locate where services are in a pilot study area ( We will be launching a site in the very near future that will not only have a mapping component to distribute this information but also an updating component that will allow service providers or the general public to update information in a Wiki-type format.
    Health and human services in dense urban areas like Chicago may not have the capability or funding to build place-based health intelligence in a comprehensive way. We hope to build a model that will act as a conduit to bridge that gap.

  3. At Uberlândia (Minas Gerais state, Brazil), there is a on going project which uses geocoding to locate traffic accidents and dengue fever cases and larvae findings.
    The big issue here is to (as said above) to educate personnel in city hall to work with this kind of data, and the best way to publish it.
    Some departments would find this extremely useful, such as Disease control and Health (of course), and would for sure, improve their sucesses rates in planning actions that really matter and makes a difference.

  4. As has been noted, the challenges are considerable if the focus is purely domestic (US-based) — and they are all that much greater for organizations with health-related work going on in multiple countries around the globe. Technical readiness varies considerably from one locale to the next (even within the same country). Although technical challenges are often significant, they are arguably the easiest problem to address. More difficult challenges include the presence of barriers to dissemination and use of health-related information due to government policy in many countries. And in Asia in particular, it is common to see restrictions on use of various communications technologies in general, which can greatly impact the extent to which health-related data can readily be disseminated.

  5. In the Bay Area we are working with a number of county level HHS and Public Health agencies to do both advanced spatial analysis and also basic geospatial planning and capacity building. There is a massive spread of “geo-readiness” amongst government health agencies in our region; some are quite sophisticated and manage their own GIS in small units, others have some central spatial IT support (rare) while a number have not yet begun with considering place in their work. This was something of a surprise to me coming from Australia and our very well invested spatial/place-based health focus. There is much to be done locally to help health agencies make the most of their data and to move them towards place based intelligence and planning. From my perspective there is also some serious misunderstanding of HIPAA as it applies to spatial data. Perhaps one of the tasks we should consider is a set of best practices for geospatial health data use and management and linkage.

  6. There is a lack of data for decision-making, and policy-making is not coordinated among the multiple public agencies which finance and deliver health care. However, with the growing awareness of health statistics for decision making; major hospitals like King Faisal Specialist Hospital & Research Center at Riyadh are supporting disease registries with on-going prospective plans of national expansion. Using GIS technologies along with web-based registries we have been successful in capturing interest and support from ministries and other major hospitals around the Kingdom for the use and implementation of these technologies for better health care. At Saudi Arabia; like several other countries in the world; the understanding of temporal and spatial based health is still not built to its full capacity, however, I can say that we are moving towards better health through this newly established understanding and implementation of GIS technologies.

  7. The phrase “at every level” leads to a “no” answer to the question. While greater pockets of innovation, organizational structures, and understanding exist, technical readiness at every level of health and human service agencies does not exist. In most instances, top-down integration systems do not meet the need at the “somewhere” where everything happens—local-level practice. Readiness is not equated with applicability, and neither alone will necessarily result in impact or the desired results: building health intelligence, improving service accessibility, reducing cost and qualitative disparities, and helping health-seeking consumers achieve desirable outcomes. However, with understanding comes acknowledgment, and hopefully, action follows. Most understand and acknowledge that technical readiness IS a prerequisite.

  8. Thanks for the many useful insights. Several things caught my attention – #1. The need for more “best practices” relevant to GIS in the health and human services; and #2. The need to better assess and articulate the information technology needs and readiness of local(sub-national) health related agencies – it appears that many national “trickle down” approaches, regardless of what part of the world they are found, seem insufficient when compared to the willingness of local entities to consume the technologies that would support building sustainable “placed-based” health intelligence. I would appreciate learning more about the specific challenges that sub-national health and human service governmental entities encounter when trying to improve their GIS analytical capabilities.

  9. From a recent outsider’s perspective on the US health/GIS situation, the county level public health administration structure is something of an inhibitor to successful implementation of spatial technology. When I immigrated to California every county public health agency I contacted bar one said they would love to hire a spatial epidemiologist but had no funding to expand into that area. Now we are working with many of those agencies we see the same issue. There is often a GIS unit within the DHS in some counties but they do not work or communicate much with public health folks. Similar problem with the statewide OSHPD; they have seemingly strong GIS capacity but local agencies either don’t know about what they offer or do not have the ability to request assistance or work from them.

  10. Staffing is an issue everywhere, or so it seems. And staffing is particularly challenging in these fiscally adverse times (USA). For a long time now, I’ve been advocating for putting place-based intelligence about healthcare into the hands of the non-GIS folks thereby lowering the barriers to understanding. You can raise people to the bar or you can lower the bar. There is always a need for healthcare experts to make expert use of GIS but that is a high bar indeed. Lowering the bar, or lowering the barriers to understanding, can go a long way towards providing place-based intelligence to the masses.

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