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Health department staffs are keenly aware of the importance of local-level data to effectively and efficiently reduce the burden of chronic disease (1). These local data — including data on disease burden, demographic factors, socio-environmental conditions, risk factors, and health care facilities — may be generated, analyzed, and mapped using geographic information systems (GIS), providing health department leadership and staff members with valuable information. This application of GIS (and the underlying capacity of health departments to perform GIS work) allows health departments to better incorporate chronic disease prevention activities into the places where people live, work, and play (1–3).  Given the value of applied GIS, we invited staff members from 1 local and 3 state health departments to describe their use of GIS to address chronic disease priorities. These health departments previously participated in the Building GIS Capacity for Chronic Disease Surveillance training, which is provided through a collaboration of the Centers for Disease Control and Prevention (CDC), the National Association of Chronic Disease Directors, and the Children’s Environmental Health Initiative (CEHI) (currently at Rice University) (2). The prompts given to the health departments were:   Please provide a brief description of how your health department currently uses GIS to address chronic disease priorities.   Please describe the benefits and challenges of using GIS to address the chronic disease priorities in your health department.   Please discuss how the use of GIS has enhanced your health department’s ability to perform one or more of the Public Health Foundation’s Core Competencies for Public Health Professionals (4) or the CDC/Council of State and Territorial Epidemiologists Applied Epidemiology Competencies (5). These competencies provide health departments with a definition of applied epidemiology and provide a framework within which to develop a public health workforce and to enhance the health of their communities.    The health departments’ answers to these prompts reveal the extent to which “Where” has become a key component in their chronic disease work. These health departments have extended basic GIS skills and maps into a more robust GIS infrastructure that supports the integration of GIS into many facets of their chronic disease programs. Critically, these health departments describe the value of using maps and spatial analyses to communicate the burden of disease; to inform decisions about resource allocation and policy, and to determine priority communities for intervention efforts; to develop culturally competent programs; and to assist with program planning, monitoring, and evaluation. Furthermore, health departments have experienced the benefits of using maps to communicate with diverse audiences, both within the health department and to partners, policy makers, and the public. Communicating disparities in the geographic patterns of chronic disease to the public enhances and improves community engagement. Finally, the health departments’ responses reveal that GIS is an important tool to support internal cross-disciplinary workgroups within an agency, to create a stronger workforce for public health programming, and to further each agency’s core mission for chronic disease prevention and management. As demonstrated in the following examples, GIS facilitates additional intersections across many of the public health and applied epidemiology core competencies, multiplying the benefits to the health departments and the communities they serve.  Cuyahoga County, Ohio, Board of Health   Question 1: How is your health department using GIS to address chronic disease priorities? The Cuyahoga County Board of Health (CCBH) participated in CDC’s Building GIS Capacity for Chronic Disease Surveillance training in 2014. Since that time, CCBH continues to expand and improve its GIS capacity (6). Our agency works in collaboration with the Cuyahoga County Planning Commission on a CDC-funded grant called Creating Healthy Communities (CHC) (7), administered by the Ohio Department of Health. CHC aims to reduce leading causes of death by increasing access to healthy foods, active living, and healthy eating; reducing smoking; and reducing childhood obesity. One outcome of this partnership was the creation of a map depicting both supermarket access and chronic disease health indicators, which was used to highlight food deserts and to examine the potential impact of future stores on neighborhood health.  CCBH uses GIS in grant applications and reporting. CCBH has been funded for CDC’s Racial and Ethnic Approaches to Community Health program (REACH) (8). In response to the project’s focus on enhancing access to healthy foods, physical activity, and chronic disease management in communities with the greatest need, we produced a map showing locations of community facilities with shared-use agreements for chronic disease self-management workshops and active living activities (Figure 1). The maps also indicated populations living near those facilities, defined by using half-mile buffer rings around those facilities. This map then allowed us to identify nearby populations that could potentially gain access to these facilities and programs. Agreements with these facilities increased access to resources for an estimated 140,838 people who previously did not have access.     Open in a separate window   Figure 1   GIS map generated by Cuyahoga County Health Department to map locations of community facilities with shared-use agreements for chronic disease self-management workshops and active living activities and populations within a half mile of those facilities.

Application of Geographic Information Systems to Address Chronic Disease Priorities: Experiences in State and Local Health Departments