The Added Value of Geographical Information Systems in Public and Environmental Health The GeoJournai Library Volume 24 Series Editor: Wolf Tietze, Helmstedt, Germany Editorial Board: Paul Claval, France R. G. Crane, U.S.A. Yehuda Gradus, Israel Risto Laulajainen, Sweden Gerd Luttig, Germany Walther Manshard, Germany Osamu Nishikawa, Japan Peter Tyson, South Africa The titles published in this series are listed at the end of this volume. The Added Value of Geographical Information Systems in Public and Environmental Health edited by MARION J.C. DE LEPPER National Institute for Public Health and Environmental Protection, Bilthoven, The Netherlands HENKJ. SCHOLTEN Department of Regional Economics, Free University & GEODAN bv, Amsterdam, The Netherlands and RICHARD M. STERN World Health Organization, European Centre for Environment and Health, Bilthoven, The Netherlands KLUWER ACADEMIC PUBLISHERS DORDRECHT / BOSTON / LONDON Published on behalf of the World Health Organization Regional Office for Europe Library of Congress Cataloging-in-Publication Data The Added value of geographical information systems in public and environmental health / edited by Marion J.C. de Lepper and Henk J. Scholten and Richard M. Stern. p. cm. — (GeoJournal library ; v. 24) Includes bibliographical references and index. ISBN 0-7923-1887-0 (hb. : acid free paper) 1. Environmental health—Data processing. 2. Public health—Data processing. 3. Geographic information systems—Economic aspects. I. Lepper, Marion J. C. de. II. Scholten, H. J. (Henk J.) III. Stern, Richard M. IV. Series. RA566.A33 1994 614.4'2'0285—dc20 93-39559 ISBN 0-7923-1887-0 Published by Kluwer Academic Publishers, P.O. Box 17, 3300 AA Dordrecht, The Netherlands. Kluwer Academic Publishers incorporates the publishing programmes of D. Reidel, Martinus Nijhoff, Dr W. Junk and MTP Press. Sold and distributed in the U.S.A. and Canada by Kluwer Academic Publishers, 101 Philip Drive, NonA^ell, MA 02061, U.S.A. In all other countries, sold and distributed by Kluwer Academic Publishers Group, P.O. Box 322, 3300 AH Dordrecht, The Netherlands. The views expressed in the publication are those of the contributors and do not necessarily represent the decisions or the stated policy of the World Health Organization or of Kluwer Academic Publishers B.V. Printed on acid-free paper All Rights Reserved © 1995 Kluwer Academic Publishers No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. Printed in the Netherlands Foreword Health for all by the year 2000 is the blueprint for change agreed to by the Member States of the World Health Organization. In Europe, this blueprint is built on 38 regional targets, many of which have the underlying aim of uncovering new knowledge and of using existing knowledge more effectively. The targets related to a healthy environment have the ultimate goals of safeguarding human health against environmental hazards, and of enhancing the quality of life by providing clean and safe water, air, food, and working and living conditions. Allied to these goals is the need to reduce the sense of jeopardy that many people feel about what they perceive as 'the risks of everyday life'. These goals are an integral part of the European Charter on Environment and Health, adopted by 29 European Member States and the Commission of the European Communities in December 1989. The Charter stresses the shared responsibility of everyone to protect the environment, to be given adequate and accurate information, and to be involved in decision-making. It outUnes the principles for public policy as well as what needs to be done to transform them into action. In this, strong information systems have a vital role to play by helping to monitor the effectiveness of measures taken, of trends analysed, of priorities set and of decisions made. In keeping with the letter and spirit of the Charter, Member States need to develop multisectoral policies that effectively protect the environment from health hazards, assure community awareness and involvement, and support international efforts to curtail hazards affecting more than one country. Similarly, the machinery for implementing such policies must be developed, especially through the monitoring, assessment and control of a wide range of potential environmental hazards. To do this, specific agents and their potential effects must be studied to provide information on new risks and to better quantify old ones, thus providing the necessary input for priority setting and risk management, and for the development of integrated monitoring systems for priority substances. Studies of the health of populations often reveal great unevenness in disease rates in time and place, which occasionally reach statistical significance. In addition to temporal peaks that may be related to epidemics, local variations are observed, frequently in the form of clusters of rare events, or of elevated or depressed rates of incidence (or mortality) in geographically restricted regions. Such results are often displayed as maps of health status, which greatly influence public opinion. This book has been developed to stimulate research and training in this area. In particular, it is directed towards developing the study of disease or adverse health outcome in individuals and populations based on the availability of geographic linkage between medical information in the health records, usually collected in routine surveys and compilations of public health statistics, and the address of the individual concerned, and information on spatial variations of potential exposures or environmental hazards. The study of such small area health statistics at large scale enables us to learn about variations in health status on a subregional, national or subnational level. It also indicates to governments the need for questioning, at the very least, the origin of such variations, especially when they imply a locally reduced standard of public health. As geographically coded information becomes available at a smaller and smaller scale, as is now the practice in many European countries, especially with the inclusion of local postal codes in addresses in hospital discharge records, local authorities, national governments, the public and the press are becoming aware of the degree of variation in health risk at small scale. When a high degree of risk is found among a population with close geographic association to what could be a potential source of environmental risk, public concern becomes acute. In response, public authorities turn to the scientific community for advice. In particular, the scientific community is asked for an estimate of the probability that a locally high health risk is not due to chance, but is the reflection of a local increase in risk. The methods necessary for such studies in analytical environmental epidemiology are complex; they also demand high standards of scientific rigour and are in a state of rapid development. This book is the first attempt to bring together the experience of environmental epidemiologists, statisticians and map-makers in a single volume. It is also one of the first outcomes of the WHO European programme on environment and health information systems. This programme, which has been generously supported by the German Ministry of Environment, Nature Conservation and Nuclear Safety, the Italian Ministry of Environment and the Department of Health in London will be carried out by a large number of participating institutions in Europe, assisted by several WHO collaborating centres and coordinated by the newly established European Centre for Environment and Health with offices in Copenhagen, Bilthoven, Rome and Nancy. The wide use of this book is expected to improve the ability of the European Region to identify areas of environmental concern and to help improve public and environmental health planning policy. Jo E. Asvall WHO Regional Director for Europe Acknowledgements This volume would not have been possible without the technical and adminstrative support of the National Institute of Public Health and Environmental Protection (RIVM), Bilthoven, the Netherlands. The editors are also indebted to colleagues from the RIVM and from Geodan BV in Amsterdam for their scientific contributions. We wish to thank Han van Veldhuizen and Andre van der Veen for their work in preparing camera-ready copy for the manuscript, and to express our gratitude to both Alice Uppelschoten and Carmen Molina for all their efforts in facilitating the production of the book. Marion J.C. de Lepper Henk J. Scholten Richard M. Stern September 1994 Contents Foreword v Acknowledgements vii List of figures xvii List of tables ixx List of maps xx Editorial introduction xxiii PART I: NEED OF INFORMATION IN PUBLIC AND ENVIRONMENTAL HEALTH 1 Environment and health data in Europe as a tool for risk management: needs, uses and strategies - Richard M. Stern 1.1 Introduction 3 1.2 Information needs 6 1.3 Studying risks to the environment and to health and their geographical variation 7 1.4 The need for high resolution and global environmental data: indicators 10 1.5 Strategies for identifying priority data 11 1.6 Conclusions 23 2 Indicators of public health and environmental quality - Erik Lebret 2.1 Introduction 25 2.2 Concepts of health and environment 25 2.3 Combining health and environmental quality indicators in a GIS 35 2.4 General considerations and criteria for health and environment data in a GIS 36 2.5 Indirect indicators for environmental health 37 2.6 Conclusions 37 3 Meta-information systems for environment and health - Jan A. Bakkes 3.1 What is a meta-information system? 41 3.2 The added value of meta-information systems 43 3.3 The CIMI formula 43 3.4 Recommendations 46 3.5 Conclusion 49 PART II: THE COMPONENTS OF GEOGRAPHICAL INFORMATION SYSTEMS 4 An introduction to geographical information systems - Henk J. Scholten, Marion J. C. de Lepper 4.1 Defining geographical information systems 53 4.2 Types of spatial information systems 55 4.3 The objectives of geographical information systems 56 4.4 Technical aspects of geographical information systems 58 4.5 Type of user and kind of need 62 4.6 Conclusions 66 5 The integration of information in geographical information systems - Arthur U.CJ. van Beurden, Marion J.C. de Lepper 5.1 Introduction 71 5.2 Spatial and descriptive information in GIS 72 5.3 Information integration 74 5.4 Conclusions 84 6 Organizational aspects of geographical information systems - David W. Heath 6.1 Data organization 87 6.2 GIS development and management 93 6.3 Direct user access 95 6.4 Dissemination 96 7 Data aspects of geographical information systems - J. Maes, M.H. Comaert 7.1 The CORINE Programme 99 7.2 The European Environment Agency and its information and observation network 100 7.3 The CORINE Information System 101 7.4 Some generic GIS lessons learned 105 7.5 Examples of GIS use in the framework of the CORINE Information System 107 7.6 Conclusions 109