A Pair of Community Health Maps Workshops at the ASTHO Climate and Health Summit

During the last week of May the Community Health Maps team (Janice Kelly, John Scott and Kurt Menke) traveled to Honolulu to participate in the Association of State and Territorial Health Officials (ASTHO) Insular Area Climate and Health Summit. There were representatives from:

• American Samoa
• Commonwealth of the Northern Mariana Islands
• Federated States of Micronesia
• Guam
• Palau
• Puerto Rico
• Marshall Islands
• U.S. Virgin Islands
• Hawaii Department of Health
• Pacific Island Health Officers Association (PIHOA)
• ASTHO
• CDC
• NOAA

The first afternoon was focused on the impacts of climate change, preparedness and building resilience. There were great presentations on climate change (Capt. Barry Choy - NOAA), an overview of the tools and programs available from the CDC (Paul Schramm), and issues with vector-borne diseases and mosquitoes (Janet McAllister).  The ASTHO grantees then gave some some sobering presentations on current issues people are dealing with in the Mariana Islands, Micronesia and the U.S. Virgin Islands.The second day focused more on tools and resources. There were more detailed talks given by the CDC on Technical Assistance for Vector Control and Tools and Resources for Climate and Water Safety. That afternoon we taught a 3.5 hour Community Health Maps Train-the-Trainers workshop to a group of health officials from each territory.  We went through the entire CHM workflow: A) how to design a data collection form, B) how to collect data, C) how to make a map in Carto and D) how to bring the data into QGIS.

The last morning we taught a second Community Health Maps workshop open to everyone. We had about 30 attendees and again went through the entire CHM workflow.Most of the trainees had little to no GIS training yet instantly knew how mapping could apply to their work and lives. They want to map everything related to hurricane relief, salt water resistant taro farms, infrastructure related to mosquito outbreaks etc. A benefit of having the community do this is that they can be in charge of their own data and it helps build community relationships.Over the three days I heard a lot of side discussions about the usefulness of the free/low cost/open source CHM approach. The cost of proprietary solutions is often a significant barrier to entry into the world of community data collection and mapping. We were gratified to hear some very positive feedback on the workshops and CHM overall during the closing session. There seems to be a lot of potential in CHM helping both U.S. Territories and ASTHO deal with the immediate and long-term health issues related to climate.

Fulcrum Community

Last year Fulcrum rolled out a new service named Community. They describe it as a, "no cost, short term crowdsourced data collection solution for qualified humanitarian projects." It works like Fulcrum, but you need to apply for a license. The application form is short and is right on the Community home page. In the application you need to describe your purpose and how long you will be collecting data. You also need to provide a project description. If approved you can invite any number of data collectors via email to share  your App (data collection form).  It is generally aimed at humanitarian agencies, non-profits, or government agencies. They restrict commercial use of this service.We used this last fall during King Tide data collection in Miami and it was a big success. In fact there are four main categories highlighted on the Fulcrum Community page: Hurricane, Tornado, Flood and Fire. If you click on Flood, the King Tide project is the first in the list. Clicking on it brings up a map with the data collected.One caveat is that the data collected falls into the public domain and can be downloaded freely by anyone. This is possible because the data are anonymized, meaning any private information is scrubbed. The data remain available for viewing and download after the event ends.It won't be appropriate unless there is some sort of disaster relief or environmental issue that demands it, but it is another tool to keep in your Community Health Maps toolkit!

Mapping Disasters

By Colette Hochstein (NLM)On October 12^th, 2017, the National Library of Medicine Disaster Information Management Research Center (DIMRC) collaborated with Community Health Maps (CHM) to host a webinar focused on using mapping tools during disasters. The meeting was attended by 128 professionals, including first responders and receivers, emergency planners, and public health librarians, many of whom are involved, directly and indirectly, with disaster relief efforts.DIMRC provides access to health information resources and technology for disaster preparedness, response, and recovery; CHM provides users with information and training on low-cost mapping tools that can be used to collect data related to health hazards in communities, including during disasters. Many community-based organizations can better serve their constituents when they are able to collect and maintain their own data; CHM seeks to provide them with the training and tools needed to carry out cost effective and scalable mapping.After the basic premise of CHM was explained to webinar attendees, several case studies illustrating the different applications of CHM were detailed. One took place in Seattle, Washington and centered on mapping noise pollution in different neighborhoods. The primary focus of this case study was to provide useful insight into the public health concern of noise pollution, which has been linked to various health conditions. Other goals included offering recommendations on the scalability of the Urban Indian Health Organization (UIHO) network and measuring and testing the usability of the CHM GPS/GIS workflow.Another study described how CHM was used to map “King Tides” in Miami, Florida, and was CHM’s first opportunity to work in the field with users of its workflow. The goal was to communicate health risks associated with the 2017 King Tides during their highest activity, and to demonstrate how the flooding affects local communities. It was also a good test case of successfully using the tools in challenging field conditions.Overall, the webinar provided the audience with information on the resources offered by CHM and demonstrated how different populations and communities, such as communities affected by disasters, can use CHM to collect and interpret their own data. You can watch the webinar by clicking on this link.

Mapping South Florida's King Tides

By John C. Scott - Center for Public Service Communications

Community Health Maps (CHM) recently joined forces with community based organizations and residents in North Miami, and Florida International University faculty to map health risks associated with the 2017 King Tides, September 19th and 20th and again on October 7th , the time of the highest of the inundations.

Several communities in Miami experienced predictable tidal flooding during the highest tides of the year. The Shorecrest community is among them. Sampling of the flood waters during previous King Tides has established that they contain elevated concentrations of bacteria. The aim of this project was to prepare residents of the community to record and map data that will help them plan their daily activities to protect their health, and give them tools to communicate with the city and county about their environmental health risks.

King Tides flood the streets of the Shorecrest neighborhood while community members collect data.

Complicating the task of collecting data in the community was Hurricane Irma which hit South Florida only a week before the September measurements, causing dislocation of residents, power outages and other disruptions that resulted in the decision not to tax neighborhood residents by expecting them to learn the CHM workflow and map hazards in the community.

For the CHM/King Tides mapping project, community members were trained on the CHM workflow before collecting and mapping environmental health data during the King Tides in the Shorecrest community of Miami. A physical tool box containing needed technology, sampling equipment, key contact information, and protocols for community engagement in data collection during King Tides was created by Jan Booher of Unitarian Universalist Justice Florida and Drs. Tiffany Troxler and Susan Jacobson of Florida International University Wetland Ecosystems Research Lab and School of Communications, respectively. Based on the initial data collection and mapping effort with the Fall 2017 tides, a community report will be generated in collaboration with community leaders to be shared with residents and decision-makers in the community and with appropriate members of City of Miami and Miami-Dade County staffs.

For those of you who are new to Community Health Maps, the initiative was founded on the premise that community-based organizations, environmental health advocacy groups, public health agencies are in a better position to serve their constituents when they can collect and maintain their own data, rather than relying solely on national, state or city agencies, or majority-institution partners to provide data to them.

The CHM approach involves using relatively low cost tablets and smartphone platforms, combined with a selection of low/no-cost applications that run on them, to collect data in order to better understand health status or health risks to the community and support decision-making leading to appropriate allocation of resources to improve health conditions and prevent or mitigate risk. Using the CHM workflow, those data can then be analyzed, shared and presented using low cost/open source software. These tools allow expert and novice users, with little budget resource, to implement mapping workflows.

A common way in which prospective users have learned the CHM workflow is through our CHM Training Workshops. The CHM workshop presents an opportunity to learn and discuss new ideas and methodologies, which will empower community organizations, teachers, and students serving vulnerable or underserved populations with low cost, intuitive mapping technology. During the workshops, we also share experiences where the CHM workflow has helped MPH programs and other academic health centers and community-focused organizations visualize their data and better understand and portray their significance to the community.

The Florida King Tides was a more ambitious project than usual for CHM. While most of the work of the CHM team consists of training and building capacity of communities to map and better-understand their health risk to environmental factors, this was our first opportunity to work in the field with users of the workflow. Together with the core CHM team of NLM, Center for Public Service Communications and Bird’s Eye View, CHM teamed with Unitarian Universalist Justice Florida (UUJF) and it’s The Rising Together project, which works residents in vulnerable communities in coastal Florida about how to prepare for and react to the public health effects of climate change. Through its association with UUJF, the Community Health Maps team also trained and worked with Quaker Earthcare Witness, New Florida Majority, and Florida International University’s Wetland Ecosystems Research Lab and School of Communication and Journalism.

Map made in QGIS of the September King tide data collection showing flood water salinity levels.

It is our vision that data collected by neighborhood residents about conditions affecting environmental health can be visualized via CHM, together with databases available from city, county, state and federal governments to, as one example, identify potential predictable impact of future king tides so that public transportation and school walking routes can be modified to avoid health risks.

Map showing water depth in comparison to elevation above sea level

While collecting data for risk maps a Miami Herald reporter stopped by the Shorecrest neighborhood where we were working. Here's his story about our initiative.

Q & A with Kurt Menke, CHM Moderator

By Jenny RewolinskiThe following is a question and answer interview with the moderator of the with Community Health Maps (CHM) blog, Kurt Menke, GISP (Certified geographic information systems (GIS) professional). Kurt has worked with CHM since its inception in 2014 and is a valuable resource for users of CHM.What is your background? Kurt: I started out as an archaeologist. I spent 8 years in the desert southwest working on Anasazi pueblo archaeology. I went on to receive a Masters in Geography from the University of New Mexico in 2000. While in graduate school I began working at the UNM’s Earth Data Analysis Center (EDAC). That's where I really learned about GIS. I worked there for 11 years as a GIS Analyst/Programmer.When did you being using open source GIS?It was at EDAC, about 15 years ago, when I was first exposed to open source mapping software. We began using Mapserver for web mapping applications, because it was faster and more stable than the Esri alternative. I realized there was a whole ecosystem of open source tools out there.How did you first come to work with NLM?Kurt: John Scott, President of the Center for Public Service Communications and I have collaborated on health related projects with NLM for over 10 years. We first met while I was working at EDAC on a project with the National Indian Council on Aging (NICOA). I had developed an app named the Interactive Health Atlas. That project eventually ended and I left the university to create my business Bird’s Eye View. John thought we should take the best parts of the NICOA project to the National Library of Medicine (NLM). It evolved into what we called the Health Equity Atlas. This was custom software we developed, which was really time consuming. It worked great, but wasn’t widely adopted. We learned a valuable lesson, for something like this to be successful, it needs to be something organizations are asking for. No matter how useful it may be, if people don't have time for it, it will just sit on the shelf.How did CHM begin?Kurt: In 2012, John asked me to look at existing smart phone apps. His idea was, rather than developing a completely new application, we could use existing low cost software. Plus we would work with organizations who had mapping as a defined need. I ended up completing a thorough survey of smartphone data collection tools and some of them were perfect. I identified what I thought were the two or three best. We realized we could stitch together a series of low cost intuitive tools that collectively address everyone’s mapping needs.We settled on Fulcrum, QGIS, and Carto as our core CHM workflow tools. We started with pilot projects at the University of Hawaii and the Urban Indian Health Institute in Seattle. Showing people how to use these tools via a train-the-trainer approach ended up working really well.You are a QGIS expert. When did you first begin using QGIS?Kurt: QGIS was started in 2002 and I began playing with it in 2005. I just discovered it from a listserv. At first it was very limited, being little more than a data viewer. But I was really curious to see how it might evolve, so I started following it. It really started becoming a useful alternative in 2010. I gradually migrated to it with my business. I also started teaching GIS classes with it. I used to keep a list of things you could do with ArcGIS that you couldn't in QGIS. Now it's come so far that I have a list of things you can do in QGIS that you can't in ArcGIS!How has CHM evolved?Kurt:  Once we realized we had something that would be useful to people, we began looking for partner organizations. These are organizations who work with data and can benefit from mapping, but lack the resources to get started. We conduct workshops and webinars to get people started down the mapping path.Along the way I thought a blog would be a really helpful tool to keep people up to date with new technology. These tools are constantly improving and I thought this would be a way to share these enhancements with everyone. Later we realized we needed additional resources for people to continue to build their skills after the initial workshops. I developed a series of six labs covering the mapping tools in more detail. These labs were inspired from a separate project I worked on called the GeoAcademy. This is a complete college curriculum for teaching GIS using open source tools. It even won an award!Our primary goal for CHM has always been to provide tools that are helpful to users. After years of trying to build something from scratch, we are now finally gaining some traction with CHM. It feels like a snowball, rolling downhill and gaining speed. I believe it is both because the tools are powerful and intuitive, plus we are getting better at identifying potential users.Would you recount one experience with CHM that felt especially influential for CHM’s progress so far? Kurt: Yes the first thing that comes to mind is the work with the Medical University ofSouth Carolina (MUSC). In early 2015 I taught a CHM workshop to 8 people. The training went well. No one in attendance had ever worked with any type of mapping software before. Yet I was able to show them how to make a data collection form, collect points, and map the data in Carto. The next day I went to a high school on John’s Island and taught several students over their lunch break how to collect data. They picked up on it immediately and spent the semester mapping food and water locations on the island.Months later, the MUSC participants were so excited by the possibilities that they asked me to come back. This second training had 25 people. Later that year we came back for a third workshop, and 80 people from across MUSC attended! That I could show such a large group, how to work with these tools in a half day was a real proof of concept!Several projects were inspired these MUSC workshops. Of particular note is Dr. Bryan Heckman’s smoking cessation research project. I must point out that Dr. Deb Williamson and Dana Burshell worked to organize and plan the MUSC trainings and deserve most of the credit for the turnout.Our successful trainings with MUSC have served as a model for teaching bigger groups such as those at the CHM Symposium at the National Library of Medicine in June, 2016 and recent trainings in Seattle.The most gratifying aspect of these workshops was seeing people shed their technological insecurities. It’s common for people to show up and admit they’re scared of the technology. To then see in a few short hours, they are getting it all to work, and actually getting excited about the possibilities, is a beautiful thing. What are your plans for the future of CHM? Kurt: The work that people are doing right now with CHM barely scratches the surface in terms of the potential. I would like to get more community members involved. I envision a scenario where there is an organization can really engage with citizens to map the community. The data could be managed by a central data manager in the organization. It would be such a great way to involve the community in a project directly related to their healthcare.I’d also like to see someone get past the initial data gathering and map making phase. QGIS has a lot of spatial analysis capabilities. I’d like to see someone push beyond the CHM labs and do some interesting analyses in QGIS or use some of the cool data visualization techniques in Carto.What advice you would give to new CHM users?Kurt: Don’t be afraid to dive in and use the tools. Be adventurous and creative with your projects. Don’t be afraid to mess up. That’s how you learn. There is no limit to the kinds of things you can accomplish with mapping and spatial analysis tools. If you can imagine it, it can be done.

CHM Conducts Three Workshops in Maryland

Last week Kurt Menke traveled to Maryland. Two workshops were held at the Prince Georges County Department of Social Services for people working on homeless issues. All attendees were novices to mapping technology. However, in the first hour they all built a data collection form in Fulcrum and went outside to collect some data around the building.The attendees represented a variety of organizations including many working with YouthREACH Maryland. REACH is an acronym standing for Reach out, Engage, Assist, & Count to end Homelessness. It is an effort to obtain accurate, detailed information on the number, characteristics, and needs of unaccompanied homeless youth in Maryland. Other organizations represented at these workshops included:

• Maryland's Commitment to Veterans
• Maryland Department of Planning
• Prince Georges Community College
• St Ann's Center for Children, Youth, and Familes
• Maryland Multicultural Youth Center
• So Others Can Keep Striving (S.O.C.K.S)
• Sasha Bruce Youthwork
• Lifestyles of Maryland.

In the final two hours of the workshops attendees learned how to map the data they collected in both Carto and QGIS. We also had time for a brief discussion about how CHM could be used in their projects. There were a lot of ideas shared about how the technology could help community engagement.After the two PG County workshops, CHM traveled across the Chesapeake Bay bridge to Salisbury University on the eastern shore.The following morning we held a workshop geared towards social work students at Salisbury University. Attendees went through the CHM workflow and were introduced to Fulcrum, Carto and QGIS. Below is a map of data collected around the student center in Carto.Salisbury University Data Collection in CartoThe workshop concluded with a short introduction to working with data in QGIS.The next scheduled workshop for the Community Health Maps team will be at the Teaching Prevention 2017 Conference in Savannah, Georgia. That conference takes place from April 5-7th. If you are interested in learning this technology this workshop will be a great opportunity!

Visualizing an Intervention for Tobacco Control

Submitted by Jennifer Rewolinski

Dr. Heckman, an assistant professor of psychiatry and behavioral sciences at the Medical University of South Carolina (MUSC) in Charleston, used Community Health Maps (CHM) tools in his research on tobacco control. Smoking is the leading preventable cause of death worldwide and costs the US $130 billion in direct medical costs annually. Smoking is still a major public health issue that influences mortality, morbidity, healthcare costs, the environment, and quality of life.

Dr. Bryan Heckman

The outcome of Dr. Heckman’s precision medicine project will be a mobile app that aids smokers who recently quit by alerting them of proximity to stores which sell cigarettes or alternative nicotine products. Studies show that greater tobacco retailer density is associated with greater incidence of relapse; Dr. Heckman believes that mapping provides a new approach to visualizing environmental factors. A CHM training event at MUSC spurred his decision to integrate mapping into his own work using the CHM labs as a guide. These labs provide step-by-step instructions for implementing the CHM workflow. He used the data collection app Fulcrum on an iPhone to collect information on retailers: GPS coordinates, type, type of tobacco products sold, e-cigarette advertising, and photos. His team also used a high-powered Trimble GPS device to test accuracy of phone GPS, and the accuracy of phone GPS was adequate and more cost effective than more expensive GPS devices.

Figure 1. Dr. Heckman’s in progress map shows higher numbers of tobacco retailers are associated with  Census Tracts that have both higher poverty and a higher percentage of minority populations.

Dr. Heckman integrated his Fulcrum data into QGIS software. He added national datasets from the American Community Survey and Behavior Risk Factor Surveillance System for Census tract data, and Synar for retailer data to check the validity of the Fulcrum data; field data collection with Fulcrum revealed a more accurate list of current retailers than the national secondary datasets provided. Dr. Heckman believes QGIS is a powerful tool with many features; he was not only able to use QGIS to monitor and visualize his research questions but also to guide his project decisions and hypotheses. His results will guide policy recommendations, improve access to care, and deliver novel interventions.

Figure 2. Dr. Heckman’s in progress map shows higher numbers of tobacco retailers are associated with Census Tracts with higher percentages of minority populations

For those attempting to undertake a health GIS project on their own, Dr. Heckman emphasized that all the tools needed are provided on the CHM blog; only time and patience are required. He also recommends asking for help and reaching out to other CHM users who have experience. Dr. Heckman’s project has the potential to affect behavior change and reduce health disparities via a mobile intervention app which identifies nearby tobacco retailers and prompts and provides an intervention and awareness of a health issue. Dr. Heckman’s experience is an example of how the CHM blog and tools might be used.

Dr. Heckman would like to thank Kurt Menke and the CHM team, Dr. Williamson from MUSC, and his mentors for inspiration and growth. He would also like to acknowledge the Hollings Cancer Center and American Cancer Society Institutional Research Grant that helps support his work, and Alex Hirsch for his help coordinating the project.

The CHM team would like to extend their own gratitude to Dr. Heckman as they sincerely appreciate his time and his support of the CHM blog.

White House Announces the Opportunity Project

This week the White House announced the Opportunity Project. It is an open data initiative geared towards empowering communities with data and tools to improve economic mobility. Open data is the data equivalent of open source software. It is licensed so that it is freely available to use by anyone.The main page for the project can be found here: http://opportunity.census.gov/.It includes links to sources of open data and online tools built on open data, ,many of them map based. This looks to be a great resource for Community Health Mappers! 

Community Health Maps Survey

If you've followed this blog, you know that  the goal of the Community Health Maps initiative is to help community organizations identify and apply low-cost and easy-to-use online mapping tools (GIS). If you are a first time visitor to this site we encourage you to peruse the blog entries.The purpose of these tools is to improve understanding and visualization of health conditions in the community so that attention might be best directed to reduce health disparities. This site is a collaborative effort between the National Library of Medicine, the Center for Public Service Communications, and Bird’s Eye View.To help advance this mission we have developed a survey.  The goal of this survey is to assess community health organizations’ satisfaction with GIS / mapping resources currently available to them.  The information will be used to improve NLM’s Community Health Maps site and tailor it to specific user requirements.You are encouraged to click the link below and take this brief survey.https://www.surveymonkey.com/s/NLM_GIS