Welcome back to this blog series focused on helping health organizations secure funding for their strategic health geographic information system (GIS) initiatives. This installation covers high value health GIS workflows along with ready-to-go solutions that match with federal funding programs, specifically, the American Rescue Plan Act of 2021 (ARPA). Please see my first blog in the series, Your Quick Guide to Security ARP Funding for your Health GIS Strategies to learn more about how the ARPA funding supports health.
This funding is a big deal – it is the beginning of long-awaited investments in our health care and public health systems. The pandemic has exposed and magnified our technical shortcomings. It’s exploited tears in our social fabric, baring the naked truth of societal inequity and resulting health disparity. I think of this funding as an opportunity to course correct the trajectory of our health infrastructure. We cannot wait. We will not automatically do better in the next crisis just by virtue of our lived experience (the Delta variant has demonstrated that). Rather, we must be deliberate in applying lessons learned toward stronger systems and more resilient communities.
The focus of this blog is to help you identify programs where GIS could be useful so that you can advance your organizational mission while also taking advantage of current federal investments in the health sector.
As a reminder, in the first blog, I grouped the various funding opportunities into three distinct buckets as follows:
- Direct funding− These monies are, as titled, directly allocated to all state and local governments for a variety of health and non-health-related functions.
- Funding from the U.S. Department of Health and Human Services (HHS)− These health-focused funds are awarded through the various agencies and offices of U.S. HHS.
- Funding from Non-Health Related Agencies− Several national U.S. agencies not formally related to health are supporting health initiatives through their ARP funds.
I’ll consistently refer back to these buckets as I discuss five broad categories worthy of GIS investment:
- Public Health Preparedness and COVID-19 Response and Recovery
- Humans in Crisis
- Access to Care/Services
- Strategic Planning
- Health Equity
Feel free to skip around to the areas that are of interest to you. I’ll cover each topic from the geographic solution perspective and offer connections to the specific federal funding buckets most applicable. At the end of this blog, you’ll find a link to a document feature many pre-configured solutions and other resources associated with each of the five categories that can help you get specific in your health GIS strategy and funding objectives and deploy solutions in a matter of days.
Category 1: Public Health Preparedness and COVID-19 Response and Recovery
Emergencies are interesting. They are ‘all-consuming’ events. And yet, emergencies are also a strong force for change. They provide a sense of urgency that can be used to strengthen systems that might otherwise be allowed to become antiquated or disused. In evidence, I would note the tremendous innovation and effort focused on various evolving needs in this public health emergency, from real-time dashboards to human movement data and global vaccine distribution. One thing is especially clear – place matters. The geographic approach to public health preparedness and pandemic response ranges wide and includes (but is not limited to): situational awareness with map-based dashboards; resource allocation to support developing community needs (like vaccination, testing sites, shelters during weather events and other essentials); analyses, models and simulations that provide answers to questions of system capacity and local risk; civic engagement tools that both inform decision-makers and connect people with the information they’ll need in the crisis; and effective communication and collaboration tools that enable otherwise disconnected stakeholders to work together to solve problems.
The last two years effectively demonstrated how a crisis drives rapid innovation. Many new GIS tools have been developed to address the specific needs brought about by a global pandemic. Combine those new GIS capabilities with the tried and true preparedness and response applications of the last two and a half decades. Then mix in significant funding for modernization and you have a recipe for greater resilience as this crisis continues and the next one begins. Look for the best funding opportunities in buckets 1 and 2. For state and local governments that already purchased or wish to begin using GIS to support COVID-19 response efforts see State & Local Fiscal Recovery Funds. Those wanting to develop high-quality modern infrastructure to support public health emergency response for COVID-19 and beyond, see Coronavirus Capital Projects and HHS.gov guidance on grant opportunities related to coronavirus.
Ways you should leverage GIS for public health preparedness and pandemic response and recovery:
- Map-based dashboards for situational awareness. These have been used for monitoring cases, deaths, vaccination progress, equity, contact tracing progress, and policy practices during COVID-19, but are equally useful for coordinating authoritative information around other health threats and disasters.
- Identification of vulnerable populations. Depending on the challenge being addressed, vulnerability will be defined in different ways. For COVID-19 and other infectious diseases, we can look at vulnerability related to transmission risk and exposure risk. Specific health challenges may have varying susceptibility risk – like being older or younger or having certain comorbid conditions. Many health challenges also have a set of socioeconomic risk factors that must be considered. GIS supports risk identification and ranking across many parameters at the local level where disparities happen. Once identified, vulnerable populations can be better served according to their specific needs.
- Spatial analysis and modeling. In blue skies, analysis and modeling often focuses on historical hazards, understanding causal relationships, and anticipating potential future hazards. In the midst of a health emergency, much of the analytic effort gets directed toward prediction. Which hospitals will be overwhelmed with cases and have capacity issues? Where is the disease spreading to next? What will flu season look like on top of the pandemic case load?
- Community contact tracing. The contact tracing process can be managed using GIS with a combination of data collection surveys and dashboards. A key component needed for advanced contact tracing is location information (the key places a case or contact has visited). When that data is collected during the contact tracing interview, it becomes available for advanced link analysis with centrality methods to discern person-to-person-to-place connections. When done this way, we call it Community Contact Tracing to signify its value in situations of community spread of disease. Please note, this method is NOT the same as tracking.
- Site selection for expansion of services. A common GIS use case is to employ location analytics to determine the best locations for new or expanded services such as testing sites, food distribution centers, expanded hospital bed capacity, and vaccine venues. Various parameters for decision-making are overlaid, allowing optimization on accessibility, social vulnerability, cost/budget, human capacity issues and site availability.
- Outreach and routing services. Public health and health care organizations are often faced with populations that need more intentional outreach to attain their best health. This may include home visits for services like safety checks, vaccination or medical care. GIS has supported the full home visit workflow from identification of candidates for outreach to call center needs (script, data capture and appointment setting), mobile worker route optimization, and monitoring of progress.
- Communication needs. Public risk communication is critical. Transparency and clarity are important ingredients to build trust with community members. Hub sites are frequently used as ‘initiative websites’ to share the local situation with residents, connect people to the resources nearest them, and invite participation in surveys (like vaccine intent or health literacy).
Category 2: Humans in Crisis
What do we mean by ‘humans in crisis’? Well, from my point of view, this is the inevitable outcome of that tear I mentioned in our social fabric. Issues such as homelessness, the opioid epidemic and food insecurity are both worsened by the pandemic and make the pandemic worse. People experiencing homelessness are disproportionately impacted by the pandemic and America’s drug epidemic is exacerbated by various pressures brought on by prolonged isolation, employment challenges and childcare/education challenges to name a few. Federal funding can help jurisdictions respond to these issues in crisis mode as well as deliver sustainable solutions to reverse the negative trends over the long haul. GIS provides the framework to respond by organizing data geographically, enabling real-time updates, communicating information to stakeholders, deploying tactics and allocating resources where necessary, while keeping decision-makers and the community informed.
You’ll want to take a close look at funding opportunities in buckets 2 and 3 to advance your initiatives to help humans in crisis. I suggest looking at ARPA under the following sections:
- Title I: Subtitles A & B from USDA for nutrition programs
- Title II: Subtitle C for Human Services and Community Supports
- Title II: Subtitle H for Mental Health and Substance Use Disorder
- Title III: Subtitle B for Housing Provisions
Also take a look at the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Grant Announcements and Awards page and the U.S. Department of Housing and Urban Development’s (HUD) Funding Opportunities page.
Ways you should leverage GIS to address humans in crisis:
- Point-in-Time-Count (PITC). Digital survey tools not only modernize the annual and bi-annual homeless census needs and make reporting easier with automated reports ready to share with HUD, but the data serves as a foundation for collaborators participating in year-round street outreach, cutting down on the need to transfer data from clipboards to databases and from human services organizations or continuums of care to public safety colleagues.
- Dashboards. Operational dashboards support real-time monitoring of PITC activities, enabling decisions at-a-glance, improving coordination and reviewing trends.
- Analysis. Homelessness is a multi-factorial problem with various policy perspectives for resource allocation. Spatial analysis helps to identify highest risk areas and sort through solution options to ensure the best approach for each place.
- Collaboration. Solving for homelessness requires partnerships and high-level coordination. ArcGIS Hub offers a solution for shared data and resources that keep everyone aligned and working from the same playbook.
- Housing First. For many communities, a housing first approach is key. ArcGIS Urban makes it easier to design temporary or permanent housing options and perform 3D modeling to visualize and understand neighborhood impact, proximity to health care and homelessness resources, and access to public transit.
- Opioid Epidemic:
- Communicate and combat stigma. Using ArcGIS Hub to support public communication shines a light on the local concerns in clear and interactive ways.
- Build an opioid awareness dashboard to share current and historical overdose incidents and associated demographics in a safe and fully de-identified way.
- Connect people to resources. Gather community resources, such as chemical dependency treatment centers or non-addictive pain control options and share them with those in need with a helpful and location-specific application.
- Food Insecurity:
- Address Access to Healthy Foods. How many local residents are able to secure fresh and healthy foods to support themselves and their families? How many are relying on corner stores or fast-food options? Its much easier to recruit SNAP retailers or ameliorate food deserts when you know exactly where the need is.
Category 3: Access to Care/Services
The articulation of 5 A’s for access to care, developed by Penchansky and Thomas, has stood the test of time for forty years. The five A’s include: affordability, availability, accessibility, accommodation, and acceptability. Despite the years of knowledge and reference to these components of access, it has become clear that we’ve not yet operationalized access to health care and health promoting services very well. It’s no wonder−all of the A’s are steeped in complexity. The A for geographic accessibility, however, is the most straight-forward, thanks to GIS technology. GIS makes it easier to match care from providers, health centers, and preventive services to individual and community needs. The technology facilitates the determination of those needs through location-based considerations of impediments to access such as social, racial, economic, and physical factors. Further, GIS allows for transportation mode to be considered (driving, walking, biking, public transportation) along with average or specific time of day traffic conditions. Geographic accessibility calculations are solvable. That means that lack of access is also clarified, exposing gaps and providing opportunities to intervene.
The idea of access to care is important across the spectrum of health, from access to primary, specialty, and emergency care to government programs and services, to community resources that promote health and well-being, to health insurance organization requirements to deliver an adequate network of accessible providers. Because of the breadth of access perspectives, you’ll find funding opportunities in all 3 buckets of ARPA. The direct funding bucket can support increasing accessibility to COVID-19 resources (e.g. testing, vaccines). In the U.S. HHS supported bucket you’ll see technology investments through HHS to expand health care, especially remote patient monitoring and telehealth services – potential solutions to fill gaps in access exposed by your GIS analysis. And in bucket #3, look to agencies like the Committee on Veterans’ Affairs and the Federal Communications Commission for expansion of broadband and support of enhanced access to care for veterans and for all through tele-health and other programs.
Ways you should leverage GIS to improve access to care/services:
- Map people and providers/programs. There are always at least two parts to every accessibility calculation – the first part involves identifying the people seeking access to a health care or health promoting resource and the second part is the resource to which they need the access. You need both inputs to make access calculations worthwhile. The data can be at the individual address level or aggregated to any shape or jurisdictional boundary.
- Calculate travel time and distance. This is where the magic happens. ArcGIS calculations give the most accurate information available in the world today, from rooftop to rooftop or from centroid to centroid. You can determine travel time and travel distance across modes of travel, days of the week and times of day or night. The calculation relies on highly accurate road network data. Straight line (Euclidean) distance is no longer good enough in today’s world.
- Identify gaps. Once you’ve calculated travel time and distance between your people and programs, it becomes obvious where the limits of geographic accessibility lie. Enrich the population information for gap areas with data on demographics, behaviors, and social vulnerability to further prioritize interventions to improve access.
- Test scenarios and optimize access. Map-based apps help you test scenarios that may impact your organization. What if a provider leaves or retires? How does that impact the network? What is a patient’s experience of access – accounting for inconvenience, disabilities, lack of vehicle ownership or other factors that increase the burden of access to care or services? How can you use the same data to make provider recruitment decisions or determine the best site for a new program location? You may also need this information in emergencies when you need to manage capacity in regional nursing homes impacted by natural disaster or you’re diverting emergency room access during peak times.
Category 4: Strategic Planning
Every health organization participates in some kind of regular strategic planning. Goals are often focused on improving operational efficiency while also pioneering new innovations that make individual and population health better. GIS can support both. You can improve core functions, manage assets, and enhance communications in one enterprise system and make evidence-based decisions on growth, competition, and population fluctuations prompting service area demographic changes. The geographic approach to your strategic planning supports your alignment to community health needs and service offerings. It streamlines your priorities for service delivery. And it allows you to iteratively make predictions, revise strategies and pivot when necessary. This should probably be the unofficial first step for which health professionals leverage GIS.
There is a great deal of crossover for this idea of strategic planning with all the other GIS initiatives noted in this blog. When done intentionally, its all strategic planning. So why call it out here? I’ve done so for two key reasons. First, its because there is specific data and software tools (i.e. ArcGIS Business Analyst) available from Esri’s product suite that nicely facilitate the overall concept of strategic planning. The second reason is that strategic planning is an evergreen use case for GIS. No matter what your health organization does, you will always have a need for tools that support your ongoing plans. If you are able to make the case in your funding request for the data and capabilities in ArcGIS Business Analyst, you’ll have a long-term advantage moving forward. So…for the funding, include some of the workflows listed below in your applications across any of the funding buckets mentioned.
Ways you should leverage GIS for strategic planning:
- Understand demographic trends. Location intelligence paves the way to understanding not only the basic demographic characteristics of your population of interest, but also offers spending, behavioral and psychographic insights that help your marketing and messaging needs. Demographic and lifestyle information is the foundation for strategic planning.
- Site selection. Whether you are growing your market or temporarily expanding services to meet emergency needs, automated tools that consider your important decision criteria will give you the evidence you need for wise capital expenditures.
- Territory design and area planning. Do you think of your primary care network as a set of territories? How about POD placement? In fact, using territory design workflows will help you achieve balance across your communities and help you evaluate the performance of sites and determine market penetration.
- Customize infographics. Sometimes you need specific information about specific place. For example, you might want to know about health insurance status, employment and income for the population living within 30 minutes of your site. Customized infographics make it easy to pull data from over 15,000 variables for any specific or customized geography of your choice.
Category 5: Health Equity
Like strategic planning, health equity is cross-cutting. Everything about a geographic approach in health speaks to improving equity (increasing access to care/services, gap analysis, improving resource allocation based on need). But despite the ubiquitous nature of health equity in our global thinking and discussions, the fact is that equity as a concept is complex. There is no universal definition or measurement for equity. And that’s exactly why a geographic approach is so powerful – it allows equity to be understood and managed for the contextual factors associated with a place. Equity should underpin all health workflows. Every decision made should be context driven, locally relevant and acted upon in collaboration with the community.
In reviewing the text of ARPA, I suggest using ‘Ctrl-F’ to search terms like: ‘vulnerable’, ‘disadvantage’, ‘equity’, ‘disparate’, ‘racial’, and ‘justice’. This will help you find the specific mentions related to equity across the various funding buckets. For some additional advice and information, I suggest this resource from the National League of Cities, “How to Spend ARPA Funds with an Equity Lens.” I especially found the section on “Meeting the Needs of Underserved Groups” to be useful as you think of the value of GIS. I think you’ll also like this document from PolicyLink on “10 Priorities for Advancing Racial Equity Through the American Rescue Plan.”
Ways you should leverage GIS to achieve health equity:
- Community health assessment. Use digital tools to streamline your community health assessments and gain immediate insight into who need the most help and where you can make the most impact. Where is lead poisoning a problem? Where is digital exclusion happening?
- Population health management. Deliver programs and services that align with needs. Build a more complete picture of your community, analyze trends, and prepare for future needs.
- Citizen engagement. Addressing health equity requires two-way communication. With GIS, you can share information, provide residents with an accurate snapshot of their community’s health and available services and elicit their participation and feedback for key initiatives.
- Performance monitoring. Develop local metrics and deploy map-based dashboards to improve situational awareness and shift to iterative policy making to address issues in real time. Regularly review at risk areas and interventions to keep progress moving forward.
The ARPA funding is broad and has many opportunities to support health initiatives. Importantly, including GIS in your funding requests will not only give you a ‘leg up’ in reaching your goals, but GIS represents a configurable system that supports location intelligence needs across your organization’s departments and over time. Our team is happy to help you leap into a brighter future.
For links to deployable solutions and other resources for each of the five categories addressed herein, please see this document.
My next (and last) blog in the series will focus on examples from your peers. You’ll learn how they’ve applied funding to achieve their health goals using GIS and hopefully leave with some inspiration on how, you as well, can transform your organization.