• Chapter 5: Mapping and Designing Healthy Communities

    • Chapter 5: Mapping and Designing Healthy Communities

    Section One: Geographic Information Systems (GIS) Maps


    Introduction 

    John Snow, often thought of as the father of modern epidemiology, was a London physician in 1854. He famously mapped the locations of cholera cases during a 19th century epidemic. From his map, Snow determined that a particular water pump, which brought polluted water from the Thames River, was part of the cause of the problem. When the pump handle was removed, the epidemic eased; Snow had found a pattern in the geographic data that made it possible to change conditions and save lives.

    Often, community problems require a geographic examination. Maps that contain detailed information about social, economic, and political trends can be a valuable resource in community problem solving. These maps can be constructed using GIS (Geographic Information Systems), a digital mapping system. This section describes GIS, how to use it, and when it could advance community projects and building.


    WHAT IS GIS?

    GIS is a method of digital mapping that links data to its geographic location.

    A GIS computer program creates maps from data that’s fed into it, displaying layers of geographic information for the geographic area you’re interested in. This can be done with all kinds of information, as long as it has a specific geographic reference. In order to function,GIS systems require the following:

    GIS is often useful in health and community services. It can track the spread or incidence of diseases or medical or social conditions. GIS maps can show where people live based on age, ethnicity, income level, illnesses, education, employment, and so on. They can also show where certain things happen, such as traffic accidents and crimes, and the location of health providers, restaurants, farms, water sources, and schools. Other data that GIS maps can reveal are where certain things are likely to happen. They show how pollution is spreading, the direction of development, and where consumers buy food. 

    GIS MAPPING



    An example of a map


    We all know what a map is. In its simplest form, a map is a picture of a place, usually seen from above. In newspapers and news magazines, on some TV shows, and especially in places like the National Geographic magazine and websites we may see maps that show more than just the normal physical and political information. (Perhaps the most familiar of these are the weather maps that TV weather broadcasters refer to.)

    Some of these maps may simply show more detailed spatial information. They point the way to particular kinds of places, or tell more about the landscape than an average map might. 

    Some examples of the physical information on such a map might include:    

    GIS maps show more information than you can see by just looking around. For example, by riding a bike through town, you can observe the intersections you pass through. GIS can tell you the location of the intersections and how many traffic accidents have occurred at each one. GIS maps are more than a picture of a landscape, they also tell you what happened there.

    In addition to showing you the location of where something happened, a map can tell you about the lives of the people who live there, the geology or soil chemistry of the area, the ranges of its endangered species, and the spread of disease in its human or animal populations. By using different colors or patterns, just as they often do to distinguish between states or countries, maps can show many kinds of differences:

    These are the kinds of maps that can be created using GIS software and proper data.

    Let’s say you’re concerned with the effects of spreading industrial development on the health of people in the area where it’s taking place.

     Some of the data that you might want to enter into a GIS system could include:

    Each of these pieces of information would be a GIS map layer. Whichever of the layers you chose, or all of them, can be laid one over another so that many different pieces of information could be viewed at the same time. In that way, you can examine just how certain factors overlap or interact. 


    COMPONENTS OF GIS

    There are, as we’ve mentioned, four requirements for using GIS effectively:


    WHY WOULD YOU USE GIS?

    The use of GIS requires some expense and preparation. Why would you go to the trouble? There are several good reasons. GIS is a powerful tool that can be used for analysis and assessment of the community or of an issue, and the planning, implementation, and evaluation of an intervention or initiative.

    SOME OF THE ADVANTAGES OF USING GIS:


    WHEN WOULD YOU USE GIS?

    In general terms, there are three times in the life of a project, intervention, or initiative when GIS can be most useful: before you begin, to help with community assessment and to understand the issues; during the planning phase; and while you’re evaluating and refining your work. 

    MORE SPECIFICALLY, GIS CAN BE USED:

    WHO SHOULD USE GIS?

    The list of those who might benefit from using GIS mapping is long. News organizations and think tanks, weather forecasters, space scientists, and the intelligence community use GIS maps. 

    A logical shortlist might be:


    Examples Using GIS

    Some of the most common types of data that might be used with GIS maps are demographics which identify people in an area by different categories or levels of categories.

    Typical examples include:

    Another common type of data concerns the location and frequency of particular events or conditions:

    GIS maps are not limited to this list of events. There are many possibilities for data that might be entered into a GIS system. Various groups use GIS data to study consumer buying patterns, the spread of weapons around the globe, oil exploration possibilities, or endangered species protection.


    IN SUMMARY

    GIS (Geographic Information System) capability can change how you and others look at your work and your community.  GIS is a method of digital mapping that allows you to add and subtract information from the maps you make to see spatial information more clearly and to compare various factors and understand relationships among them – can lead to new insights about an issue or place. It can be helpful in understanding causes, in detecting potential problems, and in predicting scenarios, among other uses.

    The effectiveness and power of a GIS system depends on the nature of the hardware and software being used, the reliability and scale of the data fed into it, and the expertise of the people who run it and interpret its results. The advent of GIS has made it possible to look at the community in a new way, and use that to guide your work.


    Section Two: Health Impact Assessments

    WHAT IS A HEALTH IMPACT ASSESSMENT?

    The Health Impact Assessment (HIA) is a tool that helps community leaders, legislators, and changemakers find out what health and safety impacts their proposed projects may have on area residents and community members. 

    The HIA can be a valuable resource in anticipating the health effects of a project, a long-term plan, policies, or a new party. In simpler language, it’s a way of finding out whether and how a proposed action or policy will affect the health of people who are in some way exposed to it.

    An HIA is intended not to determine, but to support decision-making. It helps decision-makers choose among options by predicting the health consequences of each option. The recommendations of an HIA can impact a pending proposal, program, or policy. 

    HIAs have been used to determine projects such as proposed highways, housing policies, subdivision regulations, environmental issues, location of landfills, safe routes to schools, public buildings, zoning decisions, agriculture policies, transit projects, airport expansions, and safe routes to schools. 

    HIA looks at health from a community perspective. It considers the social, economic, and political, as well as the physical determinants of health when examining the potential health effects of a proposal.

    The WHO includes in these:

    The attention paid to social determinants greatly increases what we might consider health impacts. While impacts on health are often seen in direct, medical terms – for example, chemicals from an industrial plant can poison water supplies, causing specific types of cancer – impacts on health can also be indirect and far less visible.

    An indirect health impact might be noise from increased traffic from a commercial development. It might disturb residents’ sleep and affect their immune systems even though the development itself has no direct impact on their lives. Currency fluctuations on another continent might cause loss of income and severe stress to workers in a North American factory town, leading to substance abuse.

    That’s why an HIA can be so important. In the best case, it can directly prevent negative health consequences. Even where it can’t, predicting them can perhaps prevent their worst effects. At the very least, it can make policymakers and others in authority aware of the issue and motivate them to consider ways to address it.

    These factors may act alone, act in combination, or interact to determine the overall health and well-being of individuals, communities, and even whole nations.


    HOW TO CONDUCT A HEALTH IMPACT ASSESSMENT 

    An HIA has political and practical aspects, and they can’t be separated. The political aspects have to do with the motivation and support for conducting an HIA and its financing. The practical has to do with the mechanics and logistics of gathering the appropriate participants, putting together and implementing a plan, and coming up with information and potential courses of action.

    There is no prescribed way to conduct an HIA. By definition, each is adapted to its context – the proposed policy’s location, sectors, and character, the controversy it generates, the levels of government involved, etc. There is, however, a general, five-stage form to any HIA, and a set of logical, if not set-in-stone, guidelines that go with the stages that can help you conduct an HIA effectively. 


    HIAs are generally conducted in one of three ways, depending on the time, resources, and personnel available.


    HIAs are guided by basic values or principles. These are:

    WHEN SHOULD YOU CONDUCT A HEALTH IMPACT ASSESSMENT?

    The best time to initiate an HIA is during the planning process, well before activity is scheduled to begin or policy put in place. A later HIA, whether concurrent or retrospective, can be useful and can lead to correcting mistakes that are being or were made during the activity. It’s much harder, however, to change a project or revamp a policy once it’s underway or – worse – completed than it would be to change plans beforehand. Furthermore, when a concurrent or retrospective HIA identifies a potential negative health impact, there’s a good chance that there will already be community or other groups calling attention to and perhaps protesting it. Considering impacts before the fact not only makes addressing them easier, but also avoids unnecessary conflict and distrust.

    WHO SHOULD BE INVOLVED IN CONDUCTING A HEALTH IMPACT ASSESSMENT?

    The ideal HIA is planned through a collaborative process involving all stakeholders and is carried out with the help of all parties involved. Increased stakeholder participation can increase understanding the policy, project, or program development process. In practice, that can mean encouraging various government agencies to work together and share information. It can also mean changing the culture of professionals to accept and welcome community participation.

    Stakeholders include:


    IN SUMMARY

    Health Impact Assessment (HIA) is a process that attempts to understand and make recommendations about the possible health impacts of local, regional, national, and international projects, plans, and policies. It involves all the players—government agencies in several sectors, contractors and developers, local officials, civic institutions, people affected by the proposed action or policy, and so on.—to at least some extent in the planning and carrying out of the HIA and is meant to inform them of its results as well.

    An HIA is not meant as a directive for what decision-makers should do, but rather as a tool to give them the best and most accurate information possible to work with. They aren’t bound to its recommendations, but can use the recommendations to weigh competing interests and goals, and to make decisions that seem to carry the most overall public benefit, and the least potential for conflict.

    HIAs are guided by the values of democracy, equity, sustainability, and the ethical use of evidence. If these values are practiced, a well-conducted HIA that is carefully considered by decision-makers can result in not only a well-planned and well-executed project or effective and equitable policy, but in community buy-in and support, and in a project or policy that truly protects and enhances public health and contributes to the creation of a healthy society.


    Section Three: Designing Healthy Communities

    HEALTHY COMMUNITIES 

    One of the important objectives of public health is to create healthy, safe communities where people can live, go to school, and work. As discussed earlier in this chapter, scientists, government employees, and health professionals have used tools like Geographic Information Systems (GIS) maps and Health Impact Assessments to assess and evaluate the health of communities worldwide.

    Despite each community being unique and having different health issues, one shared global trend among communities is the increasing number of deaths and injuries involving motor-vehicle accidents. In fact, road traffic injuries are the leading killer of children and young adults, and the eighth leading cause of death for people of all ages. More than half of global road traffic deaths are amongst pedestrians, cyclists, and motorcyclists, who are still too often neglected in road traffic system design in many countries.  

    Progress in reducing traffic deaths over the last few years has been made in many countries but is not uniform across regions and income levels. There continues to be a strong association between the risk of road traffic death and the income level of countries. The risk is three times higher in low-income countries than in high-income countries. Africa and South-East Asia regions have the highest rates of road traffic deaths. Only in the Americas, Europe, and Western Pacific regions have the rates of death decreased since 2013. Low-income countries are less likely to have sidewalks, marked crosswalks, bike lanes, and street designs to support safer, slower speeds that protect pedestrians and cyclists.

    Despite these disturbing facts, some countries have significantly improved where concerned parties, public health, and government officials have worked together to create positive solutions.


    Example of a Healthy Community: Vision Zero, Bogotá Colombia

    One example is Bogotá Colombia, which used an approach known as Vision Zero to tackle road safety. By implementing an integrated approach to road safety and urban mobility, the city reduced the number of traffic deaths by 50% between 1996 and 2006 (World Health Organization, 2018). 

    Factors leading to the success of the project:

    (World Health Organization, 2018)

    IN SUMMARY

    Making a difference in communities requires the aid of various organizations, professionals, volunteers, government officials, assessments, and technologies. The New Vision road safety project in Columbia is one example of how one community improved the health and safety of its citizens. The project implemented many tools and strategies presented earlier in this text, like advocacy, lobbying, collaboration, facilitation, focus groups, leadership, GIS mapping, and Health Impact Assessments. Many people, organizations, public health professionals, volunteers, and government officials worked together to create a much safer road system in Bogotá. The same strategies and cooperation can be used to create healthier communities worldwide.  



    References


    World Health Organization. (2018). Global status report on road safety 2018. World Health Organization. https://apps.who.int/iris/handle/10665/276462


    Case Study: Effectiveness of road safety policy in Ethiopia

    Case Study Background

    As mentioned earlier in the chapter, lack of road safety is a growing public health threat. The CDC reports that every year, 1.35 million people are killed on roadways around the world. That means almost 3,700 people are killed daily in crashes involving cars, buses, motorcycles, bicycles, trucks, or pedestrians. Crash injuries are estimated to be the eighth leading cause of death globally for all age groups and the leading cause of death for children and young people 5-29 years of age. More people now die in crashes than from HIV/AIDS. 1

    Accidents have been reduced in industrialized countries over the past four decades, but in mid to low-income countries, the rates have actually increased. There were no reductions in the number of crash death in any low-income countries from 2013 to 2016. 1 

    High-income countries have experienced a decline in the number and seriousness of those accidents because of well-designed road safety policies. If those policies are enforced, there could be an even greater decline. According to the European Transport Safety Council estimation, if all existing road safety laws in European Union are enforced, up to 50% of death and injuries could be averted. 2

     

    Case Study Description

    In September 2007, the government in the Oromia Regional in Ethiopia revised the road safety policy to include new laws which banned cell phone conversation while driving, unbelted driving, and not using motorcycle helmets. They also amended existing road safety laws to increase punishment for excessive speeding, impaired driving with alcohol, and unsafe loading. The increased punishment was a higher penalty rate and possible driver's license suspension.

    The government worked with the media at the regional and national levels to send out a mass media campaign to educate the citizens about the new policies before they went into effect. They coordinated with the administrative level of the transport sector with the increased regulations. They also collaborated with the police by recruiting and training officers in accident documentation and adding two senior officers and an investigator to collect accident data. Officers also regularly checked up on drivers at random checkpoints throughout the region.

    After this program's implementation, Adama Hawassa, the region's main road, experienced a decrease in the crash fatalities rate by 12.4 percent. The non-fatal injury crash rate was also reduced by 19 percent compared to the 2002 accident statistics.

    Although this is a good start in improving road safety, much can still be done. Some improvements can be made by adding radar detectors for speeding and breath analyzers for detecting alcohol in drivers. 3

    References:

    1. https://www.cdc.gov/injury/features/global-road-safety/index.html#:~:text=Whether%20you're%20on%20the,protect%20your%20health%20and%20safety.&text=Each%20year%2C%201.35%20million%20people,on%20roadways%20around%20the%20world.&text=Every%20day%2C%20almost%203%2C700%20people,bicycles%2C%20trucks%2C%20or%20pedestrians.

    2. https://research.rug.nl/en/publications/police-enforcement-strategies-to-reduce-traffic-casualties-in-eur

    3. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-539

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