Application of GIS technology in public health: successes and challenges STEPHANIE M. FLETCHER-LARTEY 1 * and GRAZIELLA CAPRARELLI 2 1 South Western Sydney Local Health District, Public Health Unit, PO Box 38, Liverpool, NSW 1871, Australia 2 Division of IT, Engineering and the Environment, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia (Received 1 July 2015; revised 29 November 2015; accepted 14 December 2015; first published online 2 February 2016) SUMMARY The uptake and acceptance of Geographic Information Systems (GIS) technology has increased since the early 1990s and public health applications are rapidly expanding. In this paper, we summarize the common uses of GIS technology in the public health sector, emphasizing applications related to mapping and understanding of parasitic diseases. We also present some of the success stories, and discuss the challenges that still prevent a full scope application of GIS technology in the public health context. Geographical analysis has allowed researchers to interlink health, population and environmental data, thus enabling them to evaluate and quantify relationships between health-related variables and environmental risk factors at different geographical scales. The ability to access, share and utilize satellite and remote-sensing data has made possible even wider understanding of disease processes and of their links to the environment, an important consid- eration in the study of parasitic diseases. For example, disease prevention and control strategies resulting from investiga- tions conducted in a GIS environment have been applied in many areas, particularly in Africa. However, there remain several challenges to a more widespread use of GIS technology, such as: limited access to GIS infrastructure, inadequate technical and analytical skills, and uneven data availability. Opportunities exist for international collaboration to address these limitations through knowledge sharing and governance. Key words: Geographic information systems, infectious diseases, public health, parasitology, spatial analysis. INTRODUCTION Geographic Information Systems (GIS) play a major role in health care, surveillance of infectious diseases, and mapping and monitoring of the spatial and temporal distributions of vectors of infec- tion (Shaw, 2012). GIS combine sophisticated algorithms, spatial analysis, geo-statistics and mod- elling, making GIS technology a powerful tool for the prediction of disease patterns and parasite ecology associations (Higgs, 2004; Guo et al. 2005; García-Rangel and Pettorelli, 2013). Given the variety of tools, concepts and applications of GIS in public health, a brief synthesis of the state of the field is due. In this paper, we review examples of successful applications of GIS in public health, with emphasis on parasitic diseases. Some useful definitions and concepts of GIS discussed in this paper are briefly introduced here, but we refer the readers to Caprarelli and Fletcher (2014 and references therein) for a comprehensive review of GIS architecture, availability, analytical tools, and for a synthesis of relevant principles of spatial analysis and modelling (Caprarelli and Fletcher, 2014). Every GIS is structured around five fundamental components (Fig. 1): (i) spatially referenced data, collected and stored in a relational geodatabase, i.e. an information system from which data can be retrieved by formulation of sequences of logical queries; (ii) the hardware physically storing data and processing tools; (iii) the software assembling the user-interface algorithms by which users access the database, query and analyse the data; (iv) the algorithms and data management procedures; and (v) the people, both producers and consumers of spatial data. Each of these components incorporates varying levels of complexity, depending on the scope and scale for which GIS is used. Regardless of the differences, all systems provide basic mapping and spatial analysis tools, which can be mastered in relatively short time even by users with no programming skills. The most basic opera- tions involve creating maps by overlaying data stored as tables comprising details of geographic fea- tures symbolized by points, lines or polygons, or raster datasets (e.g., photographs), and their geo- graphic coordinates (an example is shown in Fig. 2). Once the features are mapped, geo-statistical analysis, such as cluster analysis and network ana- lysis, important for disease monitoring and investi- gation (Bergquist and Rinaldi, 2010), can be carried out using the analysis tools included in the GIS software package. This basic approach may be followed by more complex modelling to understand * Corresponding author. South Western Sydney Local Health District, Public Health Unit, PO Box 38, Liverpool, NSW 1871, Australia. E-mail: stephanie. fletcher@sswahs.nsw.gov.au 401 Parasitology (2016), 143, 401–415. © Cambridge University Press 2016 doi:10.1017/S0031182015001869 https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0031182015001869 Downloaded from https://www.cambridge.org/core. University of Connecticut, on 29 May 2019 at 15:00:38, subject to the Cambridge Core terms of use, available at