How GIS Transformed San Bernardino County's Department of Public Health into a Leading Health Organization

A county responsible for the health and well-being of more than two million residents must have a strategic plan and modern technology in place to be able to adapt to new challenges and provide those it serves with an optimal quality of life. To understand the immense responsibility a public health department in such a county would face, a person must first grasp the enormity of San Bernardino County.

San Bernardino County is geographically the largest county in the country and the 14th most populous. Its landscape of mountains, valleys, and deserts presents a diverse array of unique conditions that can significantly impact public health. Meanwhile, its geographic size presents challenges with ensuring that resources and services reach even the most remote communities.

The county's Department of Public Health (DPH) has a significant responsibility to address many needs with limited resources. To do this, it needed to modernize its approach to public health workflows. The county turned to geographic information system (GIS) technology as an enterprise business system that would help administrators scale their resources; address each community's unique needs; and empower staff, residents, and decision-makers with GIS data, maps, and apps to promote and improve health, wellness, safety, and quality of life in the county.

Their work to scale GIS use across the department started with three main objectives:

• Providing services to residents experiencing homelessness
• Addressing environmental health impacts
• Preventing food waste in vulnerable communities

According to the US Department of Housing and Urban Development, San Bernardino County's homelessness rate is double that of the national average. The county knew it had to make this health crisis a priority and brought together Behavioral Health, Public Health, Aging and Adult Services, the Sheriff's Department, and the Innovation and Technology Department. This collaboration resulted in the InnROADs (Innovative Remote Onsite Assistance Delivery) program, which sets up different engagement teams that reach out to individuals experiencing homelessness to provide health screenings, hygiene services, counseling, and even animal care. This program differs from others, as multiple county agencies now "go to" individuals, as opposed to them "coming to us" for services.

This new service model allowed for an increase in the rate of services provided compared to other service models. The county recognized that without GIS tools, its new outreach method of providing services would not be possible. This is especially important for meeting the federal requirement of the homeless Point-in-Time count and for the hepatitis and COVID‑19 outreach and vaccination programs. All these activities were carried out using ArcGIS Survey123, a complete, form-centric solution for creating, sharing, and analyzing surveys. Once the data was collected, the Department of Public Health mapped and visualized the results using ArcGIS Online, Map Viewer, ArcGIS Web AppBuilder, and ArcGIS Dashboards. Notably, homeless hot spots were mapped in comparison to locations of charitable feeding and shower programs. GIS provided greater efficiency in collaboration, data collection, analysis, and reporting. This made it easier for the county to see at a glance how it could best provide assistance to those in need and identify gaps in services.

For a county of this size, one of San Bernardino's primary concerns is environmental health, the branch of public health responsible for mitigating foodborne illness through food inspections and for providing mosquito and vector control, land-use protection, and water/wastewater inspections. In an effort to ensure the public's health and safety, DPH employed multiple GIS solutions to address nonpermitted vending and to perform pool safety inspections and vector surveillance. The use of ArcGIS Field Maps—an all-in-one app that utilizes data-driven maps to help mobile workers perform data collection and editing, find assets and information, and report their real-time locations—in conjunction with other GIS tools allowed the department to effectively address environmental health concerns. The county was able to track permitted facilities and vendors and to perform pool safety inspections across its jurisdiction while keeping all stakeholders updated on Environmental Health Services (EHS) programs. To remain aligned across the DPH created the Environmental Health Services Dashboard which tracks the performance of all internal EHS programs, their stages of completion, and volume of work and allows the department to remain accountable in addressing these health issues.

In an effort to address food insecurity, San Bernardino DPH launched the Too Good to Waste program in the High Desert region. Parts of the region are considered food deserts due to the area's vast geographic size, limited public transportation, and distances from sources of healthy food. The department used GIS technology to link food establishments and charitable feeding organizations to enhance food recovery. This program resulted in the development of a community-wide assessment of resources, gaps, and availability of partners willing to participate in food recovery efforts. The county was able to use the assessment results to support community decisions and further strengthen the county's connection with food assistance programs and providers. This program also resulted in leadership training at the executive level to ensure that better decisions could be made to effect positive outcomes on issues relating to health equity.

San Bernardino County DPH is a leading health organization due in large part to its embrace of the geographic approach. Through the use of GIS, the largest county in the US is able to create location-specific solutions tailored to its unique geography. This has produced positive program results and allowed collaboration among multiple departments and community organizations, providing more ways to advance health initiatives.

In an effort to remain transparent and accountable to its communities, the county plans to use ArcGIS Hub—an easy-to-configure community engagement platform that organizes people, data, and tools through information-driven initiatives—to create a hub site that displays public health data and programs.