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The California Air Toxics"Hot Spots" Information and Assessment Act of 1987 (Assembly Bill 2588) requires statewide implementation of a programme to identify carcinogenic and noncarcinogenic health risks associated with air toxics emitted by industry. Some of the programme's immediate objectives are to assess the health risks associated with the total emissions from each regulated facility, to identify the degree of public exposure and to notify any public potentially exposed to significant risk levels. The extent of the database will also allow regulatory agencies to eventually develop and evaluate risk management strategies. This chapter discusses the application of a geographic information system (GIS) during the preparation of an Assembly Bill 2588 multipathway air toxics health risk assessment. A case study provides insight on the development of a health risk assessment database and system integration with dispersion and risk assessment modelling elements. The value and potential of a GIS in the data analysis and management throughout the risk assessment process are emphasized. Finally, the potential use of a GIS to communicate risk and assess cumulative (regional) impacts for risk management decision-making is addressed. [ABSTRACT FROM AUTHOR]

A geographical information system combining data on both health and the environment would facilitate policy development, implementation and management, as well as research, in the fields of public health and environmental quality in Europe. A World Health Organization consultation therefore met to verify the usefulness and technical feasibility of creating such a permanent information management system. The issues discussed were its areas of application in the health and environment field, the administrative infrastructure required at both national and international levels, the usefulness of pilot studies, the data sources and requirements, the choice of indicators, the software and hardware specifications and the training of appropriate personnel. It was recommended that the European Centre for Environment and Health, Bilthoven, be considered as the coordinating point for launching the initial programme, to be based on pilot studies chosen according to well defined criteria, and that the Centre should seek the help of qualified technical collaborating centres and other national and international organizations engaged in the use of geographical information systems for environment and health management. [ABSTRACT FROM AUTHOR]

Air pollution has become an increasing threat to environmental quality over the past decades in all parts of the world. An example of this is known as acid rain: deposition of acidifying compounds, i.e., sulfur and nitrogen, which are emitted in the atmosphere by fuel combustion. The transboundary atmospheric transport of these acidifying compounds covers large areas, resulting in environmental effects, e.g., forest dieback in regions that may be distant from the sources. Recently, other environmental effects, e.g., climatic change, damage to the ozone layer and eutrophication of soils and waters are seen having global consequences. The assessment of the regional distribution of environmental effects has become an important issue for scientists and relevant input for policy-makers. One of the tools in evaluating abatement strategies is to compare regional acidifying deposition with regional patterns of acceptable acidification, so-called critical loads. In 1989 a Coordination Centre for Effects (CCE) has been established in the framework of the United Nations Economic Commission for Europe at the National Institute of Public Health and Environment Protection (RIVM) in the Netherlands in order to produce maps of critical loads and maps displaying the excess of critical loads by current acidification. The method used by the CCE consists of the application of a mathematical model to compute critical loads and the use of geographical information systems (GIS). In 1992 a project group financed by the World Bank, in which RIVM participated, has started the mapping of critical loads in Asia. In this chapter, the potential of using an environmental model in combination with GIS is presented based on the experience of air pollution research in Europe and China. It is shown that this combined method enables the computation of environmental quality indicators and the identification of regions where environmental quality is most at risk. [ABSTRACT FROM AUTHOR]

The CORINE Programme of the European Community represents one of the most ambitious and extensive attempts to establish a geographical information system for policy applications that has yet been undertaken in Europe. As such, it has much useful experience to offer the various new international systems that are now being developed or are planned. This chapter outlines the experience of establishing the CORINE information system and shows some of the conceptual, technical and administrative problems involved. [ABSTRACT FROM AUTHOR]

Any commitment to the development of environmental monitoring and risk management information systems must be long term in nature given the complexity of the issues that are involved. This has massive organizational and interorganizational implications that need to be taken fully into account before a commitment is made to implement such a system. In the process, it is necessary to recognize that many things that may be technically feasible may not automatically be worth the organizational and interorganizational effort that will be required to implement and maintain them. With these considerations in mind the chapter sets out three conditions for the effective utilization of geographic information systems in organizations of the kind encountered in the health and environmental fields. [ABSTRACT FROM AUTHOR]

This chapter makes a brief assessment of the possible use of geographical information systems (GIS) in answering questions of health and the environment from the point of view of epidemiology. Health service planning is not dealt with, except as a baseline against which the needs of epidemiologists using GIS are compared. The initial discussion is about the contribution that spatial epidemiology itself can make, as a subject, irrespective of what actual tools are used. GIS is proposed as the most appropriate way of providing a tool-kit with the necessary features. The chapter goes on to suggest four key requirements of a GIS for epidemiologists, and looks at how well current GIS meet the needs as well as how easily the gap between the ideal and the (currently) feasible can be closed by judicious use of the existing features of GIS. Finally, the chapter outlines the necessary changes and developments in GIS technology that are needed to enable GIS to live up to their long-term potential. [ABSTRACT FROM AUTHOR]

This chapter addresses the problem of diffusing geographic information system (GIS) technology to policy-makers, planners and managers. Although GIS holds enormous potential for improving the public's health, its use still is limited. This is in part due to the sociopsychological differences between information producers (technicians) and the consumers of GIS products (public health policy-makers and managers). The design and implementation of GIS applications must be guided by the principle of user orientation. The elaboration of information products, the major outputs of these systems, must be carefully tailored to provide decision support to intended clients. Mechanisms also must be elaborated that assure close interaction between decision-makers and GIS technicians. Included among these are staffing of projects, information audits and client-technician forums. These approaches are elaborated and illustrated based on the authors' experience with such projects. [ABSTRACT FROM AUTHOR]

We consider some of the spatial statistical and epidemiological literature on tests for the clustering of disease events. We then turn to a consideration of the possible health effects resulting from exposure to the products of waste incineration, since proximity to such incinerators may give rise to a locally elevatied incidence of disease. One possibility raised is incidence of cancer of the larynx. After reviewing the epidemiology of this disease, especially its possible links to environmental contamination, we look at the relation between laryngeal carcinoma and proximity to both hospital and industrial waste incinerators. Particular interest centres on analysing these data using methods from the theory of spatial point processes. We suggest how to embed such methods into a conventional geographical information system environment. [ABSTRACT FROM AUTHOR]

Schistosomiasis is a group of parasitic diseases caused by Schistosoma parasites associated with bodies of fresh water affecting more than 200 million people in 76 countries. The disease is present on many continents, including Africa, Asia and Latin America. Like many other parasitic diseases, schistosomiasis has adapted itself to the particular ecology of the habitat: the presence of fresh water is necessary for transmission. The control measures for schistosomiasis include chemotherapy, health education and molluscacide use (snail control). In order to actively identify and control the disease, it is vital that up-to-date information on the epidemiology of the disease be available to the control programme manager. The Schistosomiasis Unit of the Division of Control of Tropical Diseases of the World Health Organization has been exploring the use of geographic information system (GIS) for monitoring the epidemiology of schistosomiasis. Initial studies suggest that GIS can be useful in monitoring schistosomiasis epidemiology and assisting programme managers in their control efforts. However, in order to fully realize the usefulness of GIS, the quality of epidemiological data has to improve and additional information has to be incorporated into GIS to examine the relationship between various ecological and disease-related variables. [ABSTRACT FROM AUTHOR]

The use of geographical techniques in the health sector has been an issue of increasing interest. Along with facilities in graphic presentations rendered easy by new software techniques in computers, mapping and related interpretations of numerical data has captured the attention of health care specialists as an useful tool. The stumbling block, however, has been the potential for analysis and the concrete uses that such a marriage would bring. The resolution and the accuracy of the data used in the health sector is generally far below the standards required for the proper application of geographical tools. Terminologies and underlying concepts also differ sufficiently to make interdisciplinary initiatives difficult. Despite these hurdles, in 1987, within a study financed by the World Health Organization (WHO) on information systems for famine management in Africa, the WHO Collaborating Centre for Research on Disaster Epidemiology (Brussels, Belgium) experimented with a specific application of geographical techniques for health sector planning. Although applications of geographical techniques were not the principle objective of the study, the potential for geographical information systems for health priority-setting and optimal planning, especially in situations where a rapid response is required, was considered worth a certain investment in research and development for appropriate applications. [ABSTRACT FROM AUTHOR]

Road traffic accidents are a very serious cause of morbidity (and mortality) among children. The data are therefore worthy of examination, and in addition the nature of the data lends itself to geographical information system (GIS) analysis. The data for north-east England are analysed in this chapter, using very simple GIS techniques. Some interesting results are presented, which are used to illustrate the utility of GIS analysis of data in the field of health and environment, even when using the most basic of techniques. The caveats of the work and the data are also discussed. [ABSTRACT FROM AUTHOR]

Large-scale geographical patterns of diseases can be seen in most atlases of mortality or morbidity. These patterns reflect ill-defined regional differences of environments composed of intermingled and complex socioeconomic factors. Analysis of these broad patterns, however, may show individual communities that stand out as exceptions. These exceptions provide opportunities for more focused epidemiological and environmental studies to explore the possible environmental causes of these epidemiological abnormalities. In Atlas of mortality in Scotland from 1987, exceptional rates of various diseases were found in several towns. For the investigation of the high rate of lung cancer in one town and for the replication studies of other towns, the communities were subdivided into small areas for the combined epidemiological and environmental investigations and the results were subjected to geographical analysis. The detailed scale of these geographical frameworks suggests some possible mechanisms of environmental toxicity. These studies also demonstrated that two types of data resource might have substantial value for environmental epidemiology when geographical analysis by small area is required. Firstly, to interpret epidemiological studies related to environmental air quality in a community, detailed patterns of airborne pollution should be known. These patterns should be based on measurements of pollutants in samples collected simultaneously at many sampling sites; e.g., low-technology samplers, such as mosses, lichens and soils, collect metallic pollutants in the ambient air. Secondly, for demonstrating the effects of some toxic environments with minimal delay, obstetric data might perform a useful screening function, a view supported by some of our investigations in Scotland. [ABSTRACT FROM AUTHOR]

This chapter examines some of the methodological issues encountered when attempting to interpret patterns in data recording the occurrence of relatively rare events or conditions. Such issues are of particular concern to those working in the field of spatial epidemiology, where understanding the significance of patterns in the incidence of individual morbidity and mortality conditions can contribute to reducing the risk of exposure to these conditions and to the alleviation of suffering. This chapter outlines some of the advantages and disadvantages of alternative ways of representing aspects of the occurrence of relatively rare conditions in graphic form. Discussion focuses on the benefits and limitations of using a Poisson chi-square procedure in the production of choropleth maps. Consideration is also given to ways in which geographical information system features can be exploited in an effort to improve the representation of rare condition information in areas of relatively low population density. Use of the methods discussed is illustrated by drawing upon examples from applications that have been undertaken in a series of health-related projects carried out by the Urban Research and Policy Evaluation Regional Research Laboratory in the north-west of England. [ABSTRACT FROM AUTHOR]

The health of populations is affected by a variety of lifestyle and environmental factors, including where people live. Characteristics of locations (including sociodemographic factors and environmental exposure) offer additional information for studies about health. Spatial methods and other geographical procedures can be useful tools in epidemiological investigations, but must serve the analysis and not drive it. Even where accurate environmental data of appropriate resolution are available, our approach should not be "how can we make use of this data?", but rather "what health problems are we trying to solve, and what are the appropriate data and methods to help us find solutions?". This chapter addresses some of the issues in using geography, relating these to the various stages of an investigation. [ABSTRACT FROM AUTHOR]

The geographical approach towards the examination of diseases, or spatial health research, primarily focuses on the mapping of diseases and the correlation of spatial distributions by comparing two or more variables. The purpose is to disclose possible spatially determined aspects of disease etiology or even to help in defining hypotheses to be tested in comprehensive epidemiological research. In particular, exploratory spatial analysis could provide valuable instruments for spatial health research, given the fact that disease data are available but that models representing the real world are largely absent. These tools can help solving health research questions from a geographical perspective such as: "What is the spatial distribution of the disease under consideration?", "Can we detect patterns?" and "What are the possible coincidences with disease-causing factors?". In this chapter an attempt will be made to provide an overview of some useful analytical techniques in the context of health research. [ABSTRACT FROM AUTHOR]

Geographic information systems (GIS) are major tools for data management and information provision in the European Community CORINE Programme and for the European Environment Agency Task Force. Data are a key element in the implementation and development of GIS, acting both as a challenge and major opportunity. The key issue about data relates to their availability, quality, usefulness, accessibility and the cost for updating and conversion into digital form. On the other hand, GIS acts as an integrator and translator of data, giving an enormous opportunity for adding value to data. The capacity of GIS to bring together data from diverse sources results in a synergic stimulus where the whole is much more than some of the individual parts. [ABSTRACT FROM AUTHOR]

This chapter addresses some of the important organizational issues which a geographical information system (GIS) in support of public and environmental health, especially at a Europe-wide level, will have to address. It looks at various issues of acquisition, sources, integration, project development and management, use and dissemination of data, as experienced by Eurostat, the Statistical Office of the European Communities. Eurostat receives data mainly from the official statistical services of the 12 Community Member States and makes this data widely available, e.g., to policy services of the Commission of the European Communities. It is currently engaged in developing a GIS for its own use and for the services of the Commission: the GISCO project. The remarks made herein, however, mainly reflect experience in developing and managing harmonized data from the different Member States and in using very large databases for their processing, storage and dissemination. In particular, a search for fully appropriate, completely accurate data, to be made available in a form that is optimized to well-defined known problems, would be an illusory target for large multi-purpose international data collection. [ABSTRACT FROM AUTHOR]

The integration of different types of information in a consistent manner is one of the most important issues for all disciplines attempting the same sort of operation: processing spatial information. The possibilities for data integration have grown dramatically with the emergence of geographical information systems (GIS). The key question addressed in this chapter is whether managers, planners and scientists in a wide range of applications actually need GIS and their sophisticated capabilities for successful information integration in order to achieve sensitive and intelligent decision-making. [ABSTRACT FROM AUTHOR]

This chapter introduces geographical information systems (GIS) by describing some fundamental concepts important to them in more detail. It aims to help the newcomer to GIS and to provide some understanding of what GIS are and what they can be used for. The concept of GIS will be described in a number of ways: formal definition, examination of distinguishing features in regard to other information systems, the type of questions it can help answer, its ability to carry out certain specific operations and, listing the components a GIS comprises. In addition, the subject matters of this chapter are both the latest developments in the fields of hardware and software in a GIS environment and future directions and trends in these fields. As the concept of GIS not only includes hardware and software, this chapter will, in addition, briefly consider types of data and data storage and the different types of user groups and their differentiated GIS needs. [ABSTRACT FROM AUTHOR]

Drawing upon national experiences regarding environmental meta-information and a WHO consultation on a European Metadatabase on Environmental and Health Information Sources (Munich, 8-10 May 1989), the role and elements of a meta-information system in relation to an envisaged European health and environment geographical information system are described. Three essential elements are identified: (i) absolute restriction to meta-information, that is: referral service only; (ii) a human interface; computers are not essential; (iii) a good thesaurus. In addition, the potential for completing national meta-information systems through the forming of an international network is briefly discussed. [ABSTRACT FROM AUTHOR]

This chapter gives a short outline of the relationship between exposure to environmental contaminants and the risk to public health involved. First, the concepts of health and environment will be introduced to provide a common frame of reference. Then, the relationship between environment and environmental contaminants with health will be described in broad terms. General indicators dealing with the different dimensions of public health and of environmental quality are presented. Some general considerations and criteria are suggested and the suitability of potential indicators for use in geographical information systems is discussed. It is concluded that, at present, many indicators lack one or more of the desired properties of indicators for environmental health. Therefore a set of indirect indicators is proposed. [ABSTRACT FROM AUTHOR]

Accurate, adequate and accessible data are a necessary tool for reducing existing environment and health risks and preventing the introduction of new and uncontrolled risks accompanying industrial development and societal growth. Without such data, environmental management in the WHO European Region will proceed based on risk perception alone and will be unduly sensitive to public pressure for priority setting. The systematic and unified collection of geographically localized environment and health data is a necessary activity which must be developed within the Region, perhaps based on subregional programmes in geographically or socially coherent areas. A concerted effort must be made to catalogue current data holdings and their method of access so that public data are made available to the entire Region for use in environmental and health management of common problems and local and regional priority-setting. Epidemiological studies using geographically linked exposure and health data are the method of choice for hypothesis testing with respect to the effects of past exposures and emissions on human health and predictions of the effect of the current state of the environment on the future state of public health. Studies of unevenness of health outcome will indicate where major research into the causes of existing inequalities in public health status and the presence of "hot spots" of disease or functional impairment is necessary. The unified monitoring of the environment at an appropriate scale is necessary to aid in the development of a regional programme to study the potential relationships between spatial variations in risk factors and in disease rates. [ABSTRACT FROM AUTHOR]