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The introduction and expansion of GIS into a small local health department drinking-water program.

Introduction

Local Public Health Departments and GIS Research

Many large public health departments across the United States and around the globe are embracing geographic information systems (GIS) as an integral component of daily work. The Centers for Disease Control and Prevention (CDC), known as the world's leading disease-tracking organization, has been using GIS for over a decade, studying how toxic substances affect people's health and how disease spreads from place to place (Lang, 2000). More recently, researchers have noted that GIS is providing great insight into environmental health (its most obvious application) and into the bedrock of public health--infectious-disease control (Melnick & Fleming, 2002).

Because of the large investments that environmental health departments are making into GIS, the potential for these departments to lead change is great (Thornton, 1997). Unfortunately, GIS is still unknown in most smaller local health departments. GIS also has been described as largely uncharted territory for public health researchers: "Those promoting GIS for health research must emphasize the importance of the spatial component to researchers from the health disciplines" (O'Dwyer & Burton, p. 822). O'Dwyer and Burton also hope that future health researchers will use GIS for its spatial analytical capabilities, rather than only for mapping functions.

Most of the over 3,000 local health departments across the United States have limited resources because they are small or rural (Bouton & Fraser, 1999). In 1999, Yasnoff and Sondik stated: "Scant information exists about the current extent and type of GIS use by state and local public health agencies" (p. x). In 2002, "despite its [GIS's] promise, the incorporation of GIS data, methods, and software into public health management and practice is just beginning" (Melnick & Fleming, 2002, p. 2). Cromley and McLafferty (2002) have found that community-based public health GIS projects are difficult to review since

* they are not always well represented in research literature, and

* community-based GIS applications often deal with specific, localized communities that usually seek to document a wide range of neighborhood conditions and a broader view of health.

On the other hand, more recent research (Miranda et al., 2005) seems to indicate that these community-based GIS applications can be well represented in research literature, providing examples of how five local health departments in North Carolina were able to begin using GIS effectively

Seven years ago, the Whatcom County Health Department (WCHD) in Bellingham, Washington, did not use GIS. Since that time, GIS has expanded through the drinking-water program, but still remains relatively unused in the remaining environmental health programs. This paper provides

* reasons for growth of GIS at the WCHD via examples and case studies,

* reasons for better collaboration between public health GIS users and researchers, and

* several examples of common pitfalls that small local health departments may face while using GIS.

Discussion

Case Study 1: A Local Health

Department, Groundwater Pollution, and a New GIS

In 1998, the WCHD Environmental Health Program was relatively small; it had only 13 environmental health specialist staff members. The department had not been introduced to a GIS before 1998. The first introduction of GIS in WCHD came when a source well for a public drinking-water system became contaminated with ethylene dibromide (EDB) from nearby agricultural fumigant applications. The groundwater contamination problem ultimately prompted WCHD, the Washington State Department of Health, and St. Joseph's Hospital to complete a survey for citizens concerned about a geographically clustered group of children diagnosed with acute lymphocytic leukemia (Johnson, VanEenwyk, Chudek, Davis, & Snyder, 1999).

The outcome of the Leukemia Study, in combination with the diversity of water supplies and sources, argued against 1,2 DCP and EDB exposure from drinking water as the cause for the leukemia cluster (Johnson et al., 1999). The Washington State Department of Ecology established a study area, approximately seven square miles, near Lynden, Washington. Federal, state, and local agencies were involved in testing the wells and studying the area to determine the extent of EDB contamination in groundwater. The sampling of 52 wells resulted in EDB detected in nine wells (even though EDB was banned in 1983) (Morgan, 1999). Twenty-four wells also had 1,2 dichloropropane (DCP) contamination. Other chemicals and solvents were detected at low levels. Approximately $380,000 was spent on a new pipeline to a replacement source for the public water system. Morgan noted that "regardless of the philosophies currently being debated in the State of Washington about pesticide risk, one thing is certain: pesticides are leaching into the groundwater of the State" (1999, p. 7).

Because of the groundwater contamination and need for current maps displaying the extent of the problem, WCHD decided to create a second drinking-water position to initiate its first GIS in an effort to organize spatial drinking-water data across the county. The new environmental health specialist developed ArcView GIS maps using the well data on EDB and 1,2 DCP. Furthermore, WCHD had collected 10 years of data from private drinking-water wells via building permit applications. The data addressed contaminants such as fluoride, arsenic, barium, cadmium, chromium, lead, mercury, selenium, silver, sodium, nitrate, chloride, and coliform bacteria and included information from well-drilling logs (i.e., depth of well, static water level, and well pumping capacity).

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

GIS maps were created for this 10-year period for each of these water quality results (approximately 3,500 separate lab results were available for the 10-year period 1990-2000):

* Figure 1 shows nitrate results for 1990-2000 across the western portion of Whatcom County.

* Figure 2 shows a specific region that has relatively shallow wells with high nitrate concentrations.

[FIGURE 3 OMITTED]

* Figure 3 shows the distribution of relatively deep wells in a different portion of Whatcom county with high naturally occurring arsenic levels.

In summary, two study areas were delineated that have high levels of EDB and 1,2 DCP groundwater contamination. WCHD staff still use these study areas today when reviewing water sources for building permits.

Case Study 2: A Local Health

Department, GIS, Wellhead Protection and Research

Public Water System Wellhead Protection Areas The 1986 Amendments to the Safe Drinking Water Act established a program to protect groundwater resources used for water supply from all potential threats due to contamination (Jacobson & Morrice, 2002). The goal of the U.S. Environmental Protection Agency's (U.S. EPA's) State Wellhead Protection Program is to protect humans from contaminants in wellhead areas within the states' jurisdictions. One of the major components of a wellhead protection program is to determine capture zones around public wells, called wellhead protection areas, where contaminant source assessment and management should be addressed (U.S. EPA, 1987).

In an effort to advance the investigative process, WCHD pursued several new projects. In coordination with the Washington State Department of Health, the department mapped all public-water-system sources with a global positioning system and brought them into a GIS. Existing wellhead protection areas were digitized in GIS. These map overlay projects were created to compare the various wellhead protection area models. This work was ultimately published as a research paper (Miller, Chudek, & Babcock, 2003), presented at NEHA's 2004 Annual Educational Conference (Miller, 2004), and published in a follow-up research paper (Miller, 2005).

Emergency Response, GIS, and Wellhead Protection

The quick response needed for public health decision making can be provided by modern-day GIS systems since detailed maps can be revised many times with ease. Furthermore, the use of global positioning systems for well and septic-system analysis has been well documented (Vine, Degnan, & Hanchette, 1997).

The GIS layer designating the WCHD wellhead protection area has also been very useful for emergency processes. For example, during the fall of 2003 WCHD received a report of a fuel tanker rollover on Highway 9 just south of the town of Acme (see photo on page 38). Initial estimates were that approximately 3,000 gallons of fuel had spilled onto the ground surface. The author was able to highlight in GIS the spill location (at the intersection of two roads) and the wellhead protection areas for the public water system (Figure 4). The GIS showed that this event had occurred within the wellhead protection area of a Group A public water system. Having the GPS coordinates of the spill site and the public wellhead eased distance calculations. Relief and topographic maps in GIS showed potential gradient, along with water bodies and direction of flow. It was then possible to work with the Washington State Department of Ecology and local spill responders to quickly notify the public water system and local residents with private wells, map all local wells, begin background sampling procedures, and select locations for monitoring of wells.

During the fall of 2003, a private landowner reported a fuel odor in his well. The parcel was immediately highlighted in GIS, showing the site location in the one-year wellhead protection area of a Group A public water system (the Lynden Border Station). The author then worked with the Washington State Department of Health Drinking Water Program and the Washington State Department of Ecology Leaking Underground Storage Tank Program to design an initial sampling plan for surrounding wells. The cause of groundwater contamination here has not yet been determined.

Recommendations

Collaboration of Public Health Researchers and GIS Users

Many researchers feel that GIS is the most prominent contribution of geography to environmental health and other health-related fields (Parvis, 2002) and that GIS has become well accepted and widespread (Ricketts, 2003). "Indeed," write O'Dwyer and Burton, "there appears a good match between the capabilities of GIS and the facets of public health" (1998, p. 819). Melnick and Fleming argue that "like other new analytic tools, the greatest promise of GIS may lie in raising additional questions rather than in coming up with answers. The map should begin or advance, but not end, the investigative process" (Melnick & Fleming, 1999, p. ix).

If the full potential of GIS technology for environmental health is to be realized, communication and collaboration must occur among researchers from varying fields, including environmental sciences, biostatistics, epidemiology, and medical geography (Vine et al., 1997). As O'Dwyer and Burton point out, "Criticism is often evoked when GIS is used purely for mapping purposes without use of the spatial analysis 'toolbox'" (1998, p. 822). The medical geographer may be an expert in spatial-study analysis and design, whereas an epidemiologist can appropriately collect and analyze data on populations. Furthermore, an environmental scientist could determine the appropriate information to include in GIS exposure estimation models, while the biostatistician could develop, perform, and interpret sophisticated spatial statistical analyses (Vine, Degnan, & Hanchette, 1997).

Cromley and McLafferty note that new roles for GIS in public health may emerge as computer technology continues to transform the ability to gather, analyze, and map health data, eventually confronting the conceptual and methodological foundations of public health (2002). Vine and co-authors also find that "GIS technology is a tool of great potential for environmental health researchers. It can be used to support or suggest hypotheses regarding disease causation through the conduct of relatively quick and inexpensive ecologic studies using existing databases and easily computerized data" (Vine et al., 1997, pp. 604-605).

Present-day GIS researchers are finding that in the United States GIS is more likely to be first seen in the local and state agencies than at the national level (Rushton, 2003). Rogers points out that for a small health department to be successful with GIS, it needs to select realistic projects that are small and manageable (1999). The experience of Rogers' local health department in Georgia suggests that GIS is an important tool for community public health, cost effectively assisting officials to "organize the process of community health assessment, identify preventable health problems, and improve the delivery of essential public health services and prevention at the community level" (Rogers, 1999, p. 33).

Web-Enabled GIS Makes Collaboration Possible

Around 1996, Internet programmers were beginning to be able to enable their Web sites geographically via GIS. These GIS applications for local and state health practitioners are still in the early stages of development. Web-enabled GIS with community-wide access potentially provides many opportunities to improve essential public health services and prevention effectiveness at the community level: "In the 21st century, geography, geographic reasoning, and Web-enabled GIS will become an expected part of public health management, practice, and decision making" (Thrall, 1999, p. 82).

[ILLUSTRATION OMITTED]

Federal agencies like the Agency for Toxic Substances and Disease Registry (ATSDR) and university-based researchers have taken the lead in developing GIS training programs and conferences specifically for public health professionals. The Centers for Disease Control and Prevention, ATSDR, and the National Center for Health Statistics each support an online GIS lecture, a public health GIS newsletter, a GIS list server, and a GIS lecture series (Richards et al., 1999).

Potential GIS Pitfalls for Small Local Health Departments

Underestimating Project Size

Rogers argues that "for LHDs [local health departments] getting started with GIS, one of the keys to success is that initial projects need to be small and selected carefully" (1999, p. 30). He identifies several examples of initial projects that might be good starting points for local health departments. These include "building a library of local geographic files related to public health practice; projects to map births, deaths, and cases of reportable diseases; and childhood lead poisoning projects" (pp. 30-31).

Bouton and Fraser provide an example from a local health department that had success applying GIS in environmental pollution prevention (1999). The health department in Needham, Massachusetts, used GIS to map households with septic-systems, identifying environmentally sensitive areas such as surface water and wellheads, and to prioritize these areas for pollution prevention outreach and loans to owners of failing septic systems. This small local health department learned three main lessons:

1. Staff will need training on how to use GIS software.

2. Students are a useful resource for GIS projects.

3. A relatively small local health department may be able to apply GIS successfully (Needham, Massachusetts, is a jurisdiction with only about 28,000 people).

More current local public health department GIS research (Miranda et al., 2005) also found it important to

1. focus GIS training on real-life situations,

2. develop timelines for GIS projects,

3. provide ongoing technical GIS support,

4. provide ongoing GIS hardware and software funding,

5. develop a network of GIS relationships through varying agencies, and

6. have senior management at the local health department committed to GIS.

WCHD has been able to incorporate GIS layers into various local-land-use-planning processes (Miller et al., 2003; Miller, 2005). Updating and maintaining these layers has been difficult since WCHD has switched its database systems on several occasions, while varying layers (wellhead protection areas, service areas, private wells, etc.) are being referenced in an increasing number of ordinances.

Keeping Completed Maps and Data Sets Updated

[FIGURE 4 OMITTED]

Before beginning any GIS project, the user must also consider a clear plan to budget resources for updating and maintaining the new data and GIS maps. WCHD's initial GIS projects were started with direct funding for projects (i.e., mapping of EDB & 1,2 DCP with respect to private wells and mapping of public wellhead and wellhead protection areas), but once these projects and funding ended, no clear path was discussed for keeping the GIS data sets updated. When the maintenance of existing GIS data is not taken into consideration, it becomes difficult to take on new projects.

GIS Workspace

Environmental health department offices are busy places. The typical environmental health specialist is coming and going from the field, dealing with the public either in the front of the office or at the desk, making calls, taking calls, speaking regularly with cohorts, and so on. Basic users of GIS (i.e., ArcExplorer) need a relatively quiet workspace. GIS users who are using GIS with higher analytical capabilities (ArcView, ArcGIS, ArcInfo) need a very quiet workspace. Users of regular GIS who work with confidential GIS data (such as patient records) need even more privacy. WCHD's Environmental Health Program has four separate offices with two, three, or four employees crowded into each space. At certain times of the year temporary staff arrive, pushing these numbers even higher. This situation lowers productivity and quality, and ultimately less GIS work is accomplished.

Funding

Funding for new hardware can sometimes lag, depending on the budget cycle and what equipment is needed for various programs. This situation can create problems in the sharing of data with other GIS users. WCHD recently upgraded again, from ArcView 3.2 GIS, a GeoExplorer II Global Positioning System (GPS), and Pathfinder Office 2.1 GPS software to ArcMap 9 GIS, a GeoXT GPS, and ArcPAD 6 GIS/GPS software. It took several years to acquire the GPS hardware upgrades.

Lag in Training

It is necessary to allow time for training in and maintenance of a current GIS package. In the beginning, the learning curve is steep for new users. Afterwards GIS users need to maintain their skills while learning new ones. GIS is now only a small portion of the WCHD drinking-water staff responsibilities, but the need for GIS has been growing since the geographic data are being used by WCHD and other agencies on a regular basis. WCHD has several basic ArcExplorer GIS users who have had no formal training.

Interdepartmental Data Sharing

Whatcom County recently hired a GIS administrator to oversee countywide GIS applications. This hire has been a huge step forward for the local GIS community. Large holes in local GIS that were never resolved (e.g., updated parcels) have recently been overcome. Having a local GIS user on hand to answer questions is critical for beginners and intermediate-level users trying to move through GIS projects. On the other hand, WCHD still has a long way to go until the average environmental health specialist is using GIS on a regular basis. Multiple databases, varying opinions, and lack of communication and understanding still plague the agency. Nevertheless, in time, the need for and usefulness of spatial data will override these obstacles and the real power of GIS will become apparent, making it a necessity.

In a recent issue of the Wall Street Journal, Gomes explained that towards the end of the 20th century, some cartography students began to look at map history through the lens of postmodern criticism: "Instead of seeing the usual chronicles of stouthearted explorers, they began viewing maps as ruling-class tools designed for reifying power, reinforcing the status quo, and freezing social interaction within charted lines" (2003, p. B1). Those critics would have less to complain about today, since the new breed of GIS maps is, according to Gomes "turning those old cartographic power dynamics upside-down. Rather than celebrating colonialism, maps today are often created to stir up social change" (p. B1). With these new maps, present-day GIS users in local health departments are asking questions, looking for answers, and, in doing so, stirring up important changes.

Acknowledgements: The author thanks Peter D. Thornton, R.S., M.P.H., D.A.A.S., environmental administrator, Volusia County Health Department, Florida, for reviewing final drafts of this research.

Corresponding Author: Chris Miller, Environmental Health Specialist II, 75-6009 Alii Drive, UnitJ2, Kailua-Kona, HI 96740. E-mail: w32puffin@gmail.com.

REFERENCES

Bouton, P.B., & Fraser, M. (1999). Local health departments and GIS: The perspective of the National Association of County and City Health Officials. Journal of Public Health Management and Practice, 5(4), 33-41.

Cromley, E.K., & McLafferty, S.L. (2002). GIS & public health. New York: The Guilford Press.

Jacobson, R.A., & Morrice, J. (2002). Probabilistic capture zone delineation based on an analytic solution. Ground Water, 40(1), 85-95.

Johnson, K., VanEenwyk, J., Chudek, P., Davis, J., & Snyder, R. (1999). A survey related to childhood acute Lymphocytic Leukemia--Whatcom County, Washington. Olympia, WA: Washington State Department of Health Office of Epidemiology.

Gomes, L. (2003). PORTALS: The newest road to fame and fortune is mapping the road. Wall Street Journal (Eastern edition), p. B1.

Lang, L. (2000). GIS for health organizations. Redlands, CA: Environmental Systems Research Institute Press.

Melnick, A.L., & Fleming, D.W. (1999). Modern geographic information systems--Promises and pitfalls. Journal of Public Health Management and Practice, 5(2), viii-x.

Melnick, A.L., & Fleming, D.W. (2002). Introduction to geographic information systems in public health. Gaithersburg, MD: Aspen Publishers.

Miller, C. (2004). The use of a GIS to compare and recognize wellhead protection areas for public drinking water systems in Whatcom County, Washington. Paper presented at the 2004 National Environmental Health Association Annual Educational Conference & Exhibition, Anchorage, AK.

Miller, C. (2005). The use of a GIS to compare the land areas captured by very basic and complex wellhead protection area models. Journal of Environmental Health, 68(4), 21-26.

Miller, C., Chudek, P., & Babcock, S. (2003). A comparison of wellhead protection area delineation methods for public drinking water systems in Whatcom County, Washington. Journal of Environmental Health, 66(2), 17-24.

Miranda, M.L., Silva, J.M., Galeano, M.A.O., Brown, J.P., Campbell, D.S., Coley, E., Cowan, C.S., Harvell, D., Lassiter, J., Parks, J.L., & Sandele, W (2005). Building geographic information system capacity in local health departments: Lessons from a North Carolina Project. American Journal of Public Health, 95(12), 2180-2185.

Morgan, L. (1999). Pesticides and groundwater in the state of Washington. Environmental Management and Health, 10(1), 7-17.

O'Dwyer, L.A., & Burton, D.L. (1998). Potential meets reality: GIS and public health research in Australia. Australian and New Zealand Journal of Public Health, 22(7), 819-824.

Parvis, L.F. (2002). The significance of geography in environmental health, or what can geography do for the environmental health profession? Journal of Environmental Health, 64(6), 42-44.

Richards, T.B., Croner, C.M., Rushton, G., Brown, C.K., Fowler, L., & Al, E., (1999). Geographic information systems and public health: Mapping the future. Public Health Reports, 114(4), 359-373.

Ricketts, T.C. (2003, January). Geographic information systems and public health. Annual Review of Public Health, 24, 1-6.

Rogers, M.Y. (1999). Getting started with geographic information systems (GIS): A local health department perspective. Journal of Public Health Management and Practice, 5(4), 22.

Rushton, G. (2003, January). Public health, GIS, and spatial analytic tools. Annual Review of Public Health, 24, 43-56.

Thornton, D.P. (1997). Environmental health as a catalyst for health care and public health reform. Journal of Environmental Health, 59(6), 4-5.

Thrall, G.I. (1999). The future of GIS in public health management and practice. Journal of Public Health Management and Practice, 5(4), 75-82.

U.S. Environmental Protection Agency. (1987). Guidelines for delineation of wellhead protection areas. Washington, DC: U.S. Environmental Protection Agency, Office of Water, Office of Ground-Water Protection.

Vine, M.F., Degnan, D., & Hanchette, C. (1997). Geographic information systems: Their use in environmental epidemiologic research. Environmental Health Perspectives, 105(6), 598-605.

Yasnoff, W.A., & Sondik, E.J. (1999). Geographic information systems (GIS) in public health practice in the new millennium. Journal of Public Health Management and Practices, 5(4), ix-xii.

Chris Miller, M.S., R.E.H.S.
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Title Annotation:FEATURES
Author:Miller, Chris
Publication:Journal of Environmental Health
Geographic Code:1USA
Date:Jan 1, 2007
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