Medical GIS Guide
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Medical GIS Guide
Recommended tools , resources, and methods. Examples of what can be done, what should be done, and what has been done.
Curated by Brian Altonen
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Historical medicine photographs: Important insights with applications to contemporary medicine and public health programs

Historical medicine photographs: Important insights with applications to contemporary medicine and public health programs | Medical GIS Guide |

Top left:  A Native American program for inoculating children, ca. 1950.  Top right:  An epidemiological map of the mid-1950s, for documenting childhood and school related outbreaks of measles.  Bottom two pictures: Collection of serum from pock-infected cattle (genetically "hairless" or shaved), for the production of Small Pox vaccines, ca. 1955-1960. 

Brian Altonens insight:

Now more than 3 years in the making, this Pinterest site has more than 8000 photographs depicting some of the most unusual aspects of medicine, complementary-alternative medicine, integrative medicine, cultural medicine, and dozens more cultural, historical, medical and public health themes.


This is perhaps one of the few sites where special topics pertaining to the history of medicine and war are reviewed, including an extensive review of the history of terrorism and bioterrorism.  GIS and disease mapping are reviewed in several locations. 


For those into the history of medicine and public health, the following are most important to note:

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Health Coverage and Care in the South: A Chartbook

Health Coverage and Care in the South: A Chartbook | Medical GIS Guide |

The research areas defined for these studies.  This Kaiser project webpage focuses on the Southeast.  For the most part few, if any, maps are provided for these comparisons, although some helpful tables are provided.   

Brian Altonens insight:

The description for this site begins with - - - "The South has faced longstanding disparities in health and health care, although significant variation exists between southern states.  Compared with other regions, Southerners are more likely to be uninsured, less likely to have access to needed health services, and more likely to experience a number of chronic health conditions. This chartbook provides key data on the demographic and economic characteristics of the southern population as well as their health status, health insurance coverage, and access to care today. Together, these data offer a snapshot of health care in the South, highlighting both opportunities for advancement and challenges relating to improving health care and health equity in the future."


"Regionalizing" public and population health studies has been the standard for health insurance programs.  


This report uses a map to makes its point about where the focus of this study lies, but fails to demonstrate much to us about the detailed insights that health mapping or medical GIS can provide to us.


The standard in public health research has been to produce outcomes that utilize complex lists, tables and graphs to depict the findings of these studies.  Such reporting however can marginalizes the already underrepresented parts of the population.  


To make better use of your healthcare data, there has to be a way to report on those population not represented in most population health and insurance agency annual performance reports.   We can accomplish this by transitioning from tables and charts to real maps with real data.  Imagine if in just an instant, you could see the overall performance of you company and know where the differences exist between you and your partners, of the different parts of you total healthcare population using this process.  


Mapping population health is the only way to truly understand the health of your region or members in relation to the health of the nation.

I review each of these more extensively as an important part of the managed care program review process at


For examples of how this process can be put to use, see my special review of Pacific Northwest population health created several years ago, utilizing numerous maps and videos, beginning at



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Darwinianism and Neodarwinianism sometime go hand-in-hand when it comes to Behavioral Health Theories

Darwinianism and Neodarwinianism sometime go hand-in-hand when it comes to Behavioral Health Theories | Medical GIS Guide |

Social Hate Maps.  An excellent portrayal of regionalism, secularism, and culturally defined segregation behaviors, combined.  Posted by the Southern Poverty Center.   

Brian Altonens insight:

A neo-darwinian look at this spatial distribution utilizes non-parametric stats to define the regionalism that exists.  

We begin with the standard diversity, richness metrics used for speciation analytics (i.e. phytogeography), and then practice the same philosophy on racial "diversity" the amounts of each, as numbers, percents, fractions) and "richness" (the various kinds of each as counts in whole numbers).  

Population density does not define the diversity index.  Cultural variety alone also does not define the diversity index.   If this were the case, we'd expect some resemblance between racism contours or isolines and the US population density isolines.  

But California definitely prevails as the leader in social organizations, at least according to this evaluation by the legal group.  Likewise Texas outshines New York and New Jersey in its diversity and perhaps richness or racism, obviously a result of regional history and long held cultural beliefs.  In contrast, New York (New Jersey too?) certainly outshines much of the rest of the country when it comes to population density and population-cultural diversity and richness in general.  

Satellite communities and Hinterland/Borderland theories have been used in geography to define these cultural differences in the "back woods" parts of the country.  When income is added to this social interpretation, reversed hierarchical modeling can be used to define where the niduses often exist for these social group problems.  Reversed hierarchical modeling states that the satellites (suburban settings) of urban centers, the further they are from the core as large communities, the more likely they are with developing their own cultural system.  Thus the racism of the south is different from the racism of the Far West in California, versus the Northwest in Washington-Oregon, versus New England, New York, or Pennsylvania, versus the montane settings in the Rockies, etc. etc.

In medical geography, reversed hierarchical diffusion processes also define how diseases find the chance to strike and urban setting.  You have those outliers that are poor, underfed, etc., with a poor immunological defense, catching a disease, and making it more likely to strike to richer urban community settings.  Transportation of physical illness may follow hierarchical routes (to big cities followed by smaller ones), but the place where it initiates in these settings is defined by the location of the poor (i.e. Asiatic cholera routes), and thus engages in a reversed hierarchical diffusion process  at the local level.  

At the managed care/healthcare level, this suggests that priorities should be placed on the poorest of the poor when dealing with disease diffusion patterns.  Even behavioral and emotional health related behaviors and practices such as racism follow this theoretical pattern.   Be a disease physical and Darwinian, or emotional and behavioral and therefore neo-Darwinian, some rules tend to remain unchanged in medical GIS and the spatial behaviors of certain disease patterns.  Even if we resolve the core urban region problems through gentrification, improved life styles and living environments, we still are at risk if we leave the rural or borderland-hinterland settings to fend for themselves.  



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Pneumoconiosis - YouTube Pneumoconiosis.   Some of my earliest educational work.  This was a test of using three dimensional imagery to depict epidemiological data.


This is one of hundreds of videos I downloaded onto Youtube and other sites over the years, depicting how to visualize national and local disease patterns, in 3D, using a rotating 3D algorithm I wrote combined with standard animation techniques.  There are no limits as to how you can pan, tilt, and otherwise visualize your research areas.  


This technique was actually first employed in medicine for surgery of the brain (esp. cortex) back in the 1980s, and entailed the use of some early GIS-like software during my medical school years.   My technique does not require a GIS, and I have made it work in several standard statistical software packages out there, but prefer one of the most standard statistical software packages due to its speed.  

I can easily produce 12-15k images per day using this technique.  In theory, that's a quarter million maps per year, but editing and production of videos cuts that productivity in half when just one person is employed.  

Brian Altonens insight:

Teachings examples with links:


Pneumoconiosis, in its various forms (expanding upon the three dimensionality of area-point mapping) -


Occupational Lung Diseases (surveillance tactics)- -


Multi-tiered mapping (multiple levels, depicting different features for comparison over time and space) -- 


Rhinosporidiosis (national, columnar instead of areal points, for comparison with subsequent regions video) --


Rhinosporidioisis (with specific regions scanned) -


Bioterrorism (demonstrated regional subpopulation terrorist behavioral differences) --


Chicago Disease (A true diagnosis, demonstrates regionalism, and differences between N, N-sq and N-cubed 3D projections) --


Crimean Congo Fever (diffusion pathway analysis and demonstration) --


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Bullying Statistics 2014

Bullying Statistics 2014 | Medical GIS Guide |
Finally, presents Bullying Statistics 2014 for researchers, students, parents and teachers. Explore our essential Bullying Statistics 2014!
Brian Altonens insight:

Mapping childhood aggressive behavior will probably not resolve the problem or help define its exact cause(s).  

But it may provide us with insights into the social situations or environments that help lead to this growing problem, and/or provide us with the knowledge needed to better understand these events as possible personal behavior induced events.

The relationships between grade level and age, gender, ethnicity, family poverty history, school-derived cultural definitions about certain people, and the nature of ongoing staff-student relationships help shed some light into the social aspects of this problem.

We once believed that the causes for this behavior were very much related to mostly poverty, and crime and gang-related activities.  More recent cases suggest that these social behaviors can occur independent of such causes, tending to be individually derived rather than socially derived.  

 Bullies themselves can be broken down into different groups ( ;).


Chances are, many GIS interpretations of bullying and other activities related to violence (spouse or child abuse, drug activity, certain crime events) may in fact show it is not as predictable through spatial analyses as we would like.  However, with spatial analyses we can still see certain large area features being shared by these cases (i.e. mostly within urban settings, or certain SES  and poverty settings). 


For more on this topic . . . . see


Bullying Statistics:

Signs of bullying at school:

National Association of Nursing opinion on this subject:

American Psychological Association stance:

Graphic depiction, caught on tape:

Who is in fact liable?



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In Memoriam: Harm de Blij

Harm de Blij describes his book, "Why Geography Matters."
Brian Altonens insight:

As United States schools struggled to remain focused on the potential values of geography and GIS in education programs, de Blij was just plowing along making new pathways in this field.  

One of the most important qualities of a geographer is he/she traditionally thinks about other things that most traditional scholars never conceptualize.  

The notion of space and time as features that bear specific rules and associations with disease, disease order, the tendency for one disease to follow another but not vice versa in the evolution of populations, are features that medicine failed to get a complete grasp of throughout the late 19th and early 20th centuries.  

We ignored the gestault of health and disease patterns, by focusing too much on the minutia, the microcosm and its bacteria or viruses and how human cells and tissues react to these when they become pathogens.

The international relationships that exist, which de Blij emphasized in many of his textbooks, are core features today as we try to better understand health as a global issue.  The isolationism initiated in the 1930s, and the notion that our understanding of science is better, no longer guides those who take the most important pathways to discovery in academia.  

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Human Development Index variation

Human Development Index variation | Medical GIS Guide |

"Here's how the United States looks when it is measured on the county level by the same standards used to rank countries by the UN, the Human Development Index.  Five variables are taken into account: life expectancy, income per capita, school enrollment, percentage of high school graduates, and percentage of college graduates." 

Brian Altonens insight:

A WHO map of what life in the U.S. is like demonstrates the role of urbanization and heavily population regions for defining where U.N.'s Human Development Index scores are highest.

Three of the metrics pertain primarily to education.  The fourth is a measure of financial success for a region.  The fifth is most likely a consequence of scoring well for these first four measures.

An obvious next step in making additional use of this map is to compare its findings with the distributions of various language, culture and ethnic groups in this country, according to most recent US Census patterns.  



Lara N. Madden's curator insight, March 26, 2014 1:10 PM

My thought when I see this map is if Alaska was to scale the low indicator is of off the charts. Also note the dark areas are on the main road systems and include 2 large military bases. The author is focused on the south, but does not say anything about the north. Interesting.

s smith's curator insight, March 26, 2014 3:53 PM

A fantastic resource for development studies.

Ms. Harrington's curator insight, March 26, 2014 6:57 PM

Regional patterns?

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The Animation of Medical GIS

The Animation of Medical GIS | Medical GIS Guide |

National and regional NPHG Video mapping.  NPHG depictions of everything from people to cost and utilization in managed care may be presented as national, regional or close up images.  The uses for these techniques are diverse and are applicable to the insurance, healthcare, health economics, and PBM industries.

Brian Altonens insight:

During the late 1990s (ca. 1997), a number of west coast reviews of GIS  included research teams devoted to animated mapping.  Within a year, a leader in this field was Sonoma College in California, where GIS was successfully used to map out crime in an animated fashion (Lodha and Verma 1999).   The same year, a University of Georgia student completed his assessment of the same for evaluating densely populated urban settings (Beavers 1999).  In 2003, Bidoshi (2003) completed his dissertation on the virtual visualization of mapped data at Ohio State University.  By 2009, Yale University students at G-Econ created a 3D global mapping program based on spherical geometric formulas.


The use of three-dimensional GIS for tracking population features is now more than 15 years of age.  Its most common uses have been mapping crime and demographic features.  Recent works by Alfarhan (2010), Kim (2012), and Zhang (2012) suggest that new cloud and EMR technology might pave the way for the development of more successful use of this Medical GIS technology.  


This is the purpose of the NationalPopulationHealthGrid (NPHG) program I developed.  NPHG algorithms produce maps on population health that are much faster to run than the traditional methods already in place for developing these maps. NPHG is designed for use in weekly and daily reporting on hundreds to thousands of population health metrics.




Alfarhan, M. S. (2010). Geosciences information system (GeoIS): A geospatial paradigm for real and virtual three-dimensional worlds. (Order No. 3414888, The University of Texas at Dallas). ProQuest Dissertations and Theses, , 135. Retrieved from (734622078).

Beavers, R. M. (1999). An evaluation of cartographic visualization's utility in the spatial analysis of urban social dynamics. (Order No. 3022089, University of Georgia). ProQuest Dissertations and Theses, , 164-164 p. Retrieved from (304516996).

Bidoshi, K. (2003). Virtual reality visualization for maps of the future. (Order No. 3088842, The Ohio State University). ProQuest Dissertations and Theses, , 186-186 p. Retrieved from (305319198).

Kim, I. H. (2012). Developing high performance GIS simulation models on geospatial cyberinfrastructure: a case study of population change models with grid computing and cloud computing technologies. (Order No. 3545065, University of California, Santa Barbara). ProQuest Dissertations and Theses, 250. Retrieved from (1237250056).

Lodha, Suresh K. and Verma, Arvind . 1999. "Animations of Crime Maps Using Virtual Reality Modeling Language." Western Criminology Review 1 (2). [Online]. Available:

Nordhaus W.  (2009).  Geographically based Economic data (G-Econ), Yale University.  Accessed at

Nordhaus W.  (2009).  G-Econ Project, Yale University, September 2009. ;

Zhang, C. (2012). Interfaces and visual analytics for visualizing spatio-temporal data with micromaps. (Order No. 3504130, George Mason University). ProQuest Dissertations and Theses, , 156. Retrieved from (1011001290). 

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Suicide | Medical GIS Guide |

 Work in Progress. SUICIDE -- The spatial distribution of suicides is not equal across all age groups.  

Brian Altonens insight:



Knowing that the Pacific Northwest has its own unique patterns involving runaways, children no longer attending school, and teenagers living on streets, my focus was on young parented children teens still living at home, and then teens who were older but were living on the streets.


Next, I experimented with this data modeling technique for young, middle age, older adults, people of retirement age, and those well into their retirement and/or assisted living years.


Finally, I focused on the questions,


1--where in the country do teens, and older and younger kids try to commit suicide--was it in fact the Pacific Northwest due to its unusually high number of street kids support services?


2--which age group does Niagara Falls fit into this scenario, commonly referred to as Lovers' Leap?


These and other questions were reviewed as part of my first attempts to apply 3D rotating imagery math to some spatial mapping algorithms I developed, thanks to some support from faculty at the Geography and Community Health Departments at Portland State University, Portland, OR, about 10 years ago.  

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Are There Geographic "Hotspots" for Shaking Babies? Shaken Baby Syndrome.

Are There Geographic "Hotspots" for Shaking Babies?  Shaken Baby Syndrome. | Medical GIS Guide |

The Medill Justice Project, in its now year-long effort to build a database of SBS cases, has published a portion of that data relating to the geographic occurrence of SBS . . . .

Brian Altonens insight:

Comparing the highly detailed spatial results (above figure) to other undergoing programs (below figure), demonstrates two different applications for Medical GIS.  


Regional programs provide the impetus needed for better preventive care practices and the development of effective surveillance and health education programs.  Programs that monitor small service areas are capable of finding the exact cause for a health problem and define the barriers  that may exist.  


The best programs  utilize both of these research, intervention and public health education methods.  

Brian Altonen's curator insight, February 20, 2014 9:35 PM

Phil Locke's article "Are there geographic "hotspots" for shaking babies?" ( provides us with important insight into this growing national public health problem. 


The above map in this figure is the nationalpopulationhealthgrid (NPHG) mapping technique developed for mapping any medical statistic or number down to the small area level.  Beneath the NPHG map is the US map by states produced by Lauryn Schroeder of The Medill Justice Project at Northwestern University (


NPHG allows us to identify small areas of high incidence for any medical diagnoses, episode or event.   Exact locations within each of the states noted as high risk were reassessed down to the town/city level using this innovative mapping technique. 


Important to note here is that NPHG displays its results in 3D, and can also be used to generate rotating videos of your results, impressive for any public speaking or upper level management presentation.


Minus the videos, NPHG can produce hundreds to thousands of maps per day, depending upon your study.  The rotational 3D images used to make the videos could be produced at a rate of 15,000 to 20,000 (15-20 videos) per day.   At this speed, we can now report on dozens to hundreds of metrics per week spatially, either locally or at the national level, and at any pre-determined subpopulation level (age, gender, SES, etc.).  

There are no limits to the use for this spatial modeling tool.

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Spatial Health

Spatial Health | Medical GIS Guide |

July 1973. From page 72 of “The Future Society: Aspects of America in the years 2000″ American Academy of Political and Social Science annual meeting. “Health Challenges of the Future” lecture by George E. Ehrlich.

Brian Altonens insight:

eCloud, Big Data and EMR come to life!  More than 40 years ago a professor in New York predicted that computers would take the place of workers in many clinical settings, and standardize the way in which we manage tertiary and the most high specialized forms of quaternary care.  His primary concern was the depersonalization of medicine these changes would result in.  In many ways he was right.


The NPHG technique I developed  ( provides a cost-effective means to make complete use of our eCloud, Big Cloud and EMR/EHR data.   It specializes in the analysis of Big Data at the small area spatial level. (No limits to unit area size.).  


The products of the NPHG mapping technique are highly effective outcomes that can be used to demonstrate the unique success of a program driven by community needs, instead of just system needs.   NPHG maps enable highly targeted intervention programs to be developed.  They provide a more effective demonstration of the failure or success of your program.  The enable you to identify the places where the best outcomes were generated, for more insights into how to improve the different parts of your program.    


This method of analysis and review is capable of producing hundreds of maps  per day, automatically, enabling detailed, comprehensive programs to be developed.  


Imagine, for example, being able to routinely analyze 150 to 200 diseases weekly, for a special topic like Hispanic, Asian or African American population health, infectious disease migration patterns, rare or genetic disease distributions, or culturally related ICDs.  In addition, cost and utilization patterns can be evaluated at the areal or neighborhood level.  For conditions ignored in most annual reporting processes like HEDIS ot the Annual QI (PIP) reviews, programs unique to your population profile can be developed for routine use.

In essence, there are no limits to the applications of this tool, at the R&D, Business, or Quality Improvement level.

Brian Altonen's curator insight, December 2, 2013 9:20 AM

A little more than 40 years ago, George E. Ehrlich gave a lecture at Temple University on July  of 1973 entitled “Health Challenges of the Future".   This lecture was part of the annual meeting of the American Academy of Political and Social Science devoted to "The Future Society: Aspects of America in the years 2000."

Then Professor of Medicine at the Temple University School of Medicine, Ehrlich predicted the depersonalization of medicine which the computer might result in. 


Also evident is the possibility that we are falling short of one of his visions about the direction in which the field of medicine was heading due to the invention of the computer.  


Ehrlich thought that by 2000 we would be fully engaged in making the best use of the computer and the storage of patient records, thereby create tremendous improvements in people and population health.  He speculated that with the computer, diagnoses could be made more rapidly, lab orders and clinical testing could be automated, with the results generated and then posted in a timely manner, and that we could therefore understand the best options for care we had available to us, all in very short time.  


Ehrlich's major concern with these technological advancements was the further reduction of the human contribution that could ensue--a reduction of interactions that normally occurred between patients and care givers.


Unfortunately, many of today's practitioners, allied healthcare givers, and patients agree with Ehrlich's last statement.


Even more unfortunate however, the failure of the system to more quickly and more effectively make the best use of its technology to provide patients with more health care value for their money.


This latter failure has nothing to do with the technology itself, only with those responsible for the best use of that technology--those responsible for employing it within the health care system with the best long term interests in mind.      


George Ehrlich could not foresee the increasing split that ihas occurred between the rich and poor since the 1970s.   But he would probably aggree and be incredibly surprised to see how that, in spite of technological achievements and advancements, the human side of providing care and making care accessible has not changed in more than forty years.  


The recent resistance to change and improvements in healthcare, are a repeat of these same events unforeseen by Ehrlich.  The ongoing resistance to change due to financial managers and CFOs of these systems offers little explanation for the tremendous acceptance these companies have for their lack of progress during the past 40 years.  


The failure of insurance companies to implement EFFECTIVE, cost savings population health analytics programs into their systems is an example of what Ehrlich refers to with his criticisms.  


Conformity is not always to our benefit when it comes to  healthcare.  The attached quality of life and financial benefits of receiving more effective care are opportunities missed due to poor management and the corporations' resitance to change.   


Ref:  George E. Ehrlich, (Publ. in The Annals of the American Academy of Political and Social Sciences, Vol. 408, July 1973, pp. 70-82.) 

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- CartoDB | Blog

- CartoDB | Blog | Medical GIS Guide |
We love Open Data. CartoDB is a geospatial database on the cloud to allow development of location...
Brian Altonens insight:

Examples of how to apply Theissen's mid-19th century polygon mapping routine  to your work, and more.

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Rectangular and hexagonal grids used for observation, experiment and simulation in ecology

Rectangular and hexagonal grids used for observation, experiment and simulation in ecology | Medical GIS Guide |
Brian Altonens insight:

The clarity of hexagonal grid mapping results is partly a result of how we perceive the grid mapped results, but also a consequence of the greater accuracy this technique provides.


Thirty years ago we utilized square grid techniques due to ease of production.  With GIS, it is now just as easy to program and implement the production of hexagonal grids as it is toproduce old fashioned square grid models.  The difference is, hexagonal grids are more accurate.


This article reviews the differences in the various grid methods and demonstrates their value ecologically, in terms of plant distributions.  


It is accessible at two sites:

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Big Data and the changing definition of "Rare" patients or diseases

Big Data and the changing definition of "Rare" patients or diseases | Medical GIS Guide |

Ralphie Aversa.   New Documentary From Woman With Rare Syndrome Aims To Curb Online Bullying.  Trending Now.


Recently, work and a presentation done by Lizzie Velasquez of Austin, Texas changed the meaning of "rare" for us when referring to medical conditions.  Her condition, which currently bears no name, is experienced by just 2 other people in the world.    


By studying the rarest of conditions with Big Data and GIS, many of the new studies being generated and published will be first time events for their fields.  Such is the advantage of initiating GIS in healthcare programs earlier than planned.

Brian Altonens insight:

The impact of Big Data on the study of rare medical conditions will no doubt enable researchers to study a number of conditions or diagnoses in a variety of new ways for the first time.  In the past we relied heavily upon special programs and databases to obtain the basic data needed to study extremely rare conditions.   Big Data enables studies of large populations, large numbers, for long periods of time to be developed based on previously unused or underutilized medical records data.  


Healthcare research for the most part has focused on major population health problems, with rare diseases left for highly specialized, tertiary and quaternary care health science centers to engage in.  With Big Data, and a working knowledge on how to research rare medical conditions, most institutions can perfect their care management skillsets in this area and be able to develop better programs for those with these conditions, diagnoses or care events. 


Implementing Medical GIS into a managed care program will improve the intervention responsibilities of these programs and result in more effective long term healthcare activities and outcomes.


Rare health conditions and diagnoses are no longer rare anymore due to EHR, EMR and Big Data advances.  The "Rare" seem numerous,  and the "Very Rare", more like what we want to call "Rare" in this research community.  


Post-script ....


Lizzie Velasquez also reviews another important part of her social  dilemma.  Bullying, "making fun of" and related social activities are common to people with rare and/or misunderstood medical conditions.  As healthcare givers, by focusing on the needs of these groups more aggressively, we have a better understanding of what interventions are needed to prevent these social behaviors.  This not only applies to very rare conditions, but also to infrequent or commonly misunderstood conditions such as epilepsy, MS and others impacting the kids at school.   


NB:  In the yahoo Trending Now page linked to the photo above ( ;), as she tells us her story about her self, Lizzie Velasquez actions imply :   Verba movent, exempla trahunt --  Words move people, examples compel them.

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A Map of Baseball Nation

A Map of Baseball Nation | Medical GIS Guide |

"Fans may not list which team they favor on the census, but millions of them do make their preferences public on Facebook. Using aggregated data provided by the company, we were able to create an unprecedented look at the geography of baseball fandom, going down not only to the county level, as Facebook did in a nationwide map it released a few weeks ago, but also to ZIP codes."

Brian Altonens insight:

Anything can be mapped.  


This mapping did not fully account for hybridization--for example when a friend in Texas is a Boston Red Sox fan.

Courtney Barrowman's curator insight, April 28, 2014 10:43 AM

unit 1 & 3

Greg Russak's curator insight, April 29, 2014 12:53 PM

Maps and baseball - a good combination!

Wyatt Wolf's curator insight, October 30, 2014 7:46 PM

My favorite baseball team is the Philadelphia Phillies, here's everyone else's.

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This Map Shows There Are 10 KKK Organizations In My State. How Many Are In Yours?

This Map Shows There Are 10 KKK Organizations In My State. How Many Are In Yours? | Medical GIS Guide |
Take a look at your state here and then add your name to stand strong against hate.
Brian Altonens insight:

NY=42 . . . . and counting.

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A new purpose for re-investigating past epidemic histories.

A new purpose for re-investigating past epidemic histories. | Medical GIS Guide |

Reviewing historical epidemics as a part of the growing medical GIS profession serves a purpose. It provides insights into how we can better map out diseases in relation to population and human behavioral patterns. Many of the behaviors of the past still exist today. To better understand the public health problems of growing social inequality and poverty today, we need only search the past journals for the same mistakes being made back then.


Brian Altonens insight:

The first polio vaccine was invented in 1952 by Jonas Salk. It consisted of an injection of the dead polio virus. In 1957 Albert Sabin created the oral polio vaccine using attenuated virus. Allowed for regular use in 1962, the two polio viruses have since help to nearly eradicate polio from most of the countries of the world.
In 1916, there was no vaccine for polio. The first case of polio that struck the New York City area in 1916 took place in an Italian neighborhood in Brooklyn. This disease quickly spread into nearby communities, and was in just a few months considered to be one of the most deadly acute forms of this disease to strike the region.

Dr. Simon Flexner of the Rockefeller Institute put together an expert team of epidemiologists to investigate this epidemic and to engage in the appropriate public health actions.
To begin with, playgrounds and schools were closed, along theaters and libraries and any other place where kids might hang out together, in school or out.
Those children already infected with the disease or suspected were quarantined; usually removed from their parents, their home, their neighborhood, and most importantly, New York City.
By July 12, 1916, a report was published claiming the total number of cases for the year to be 1,278.  A total of 270 of these cases ended up fatal (about 20%). This was more than twenty times the rate noted for polio the two years before, and it was found that the children most susceptible to disease and most likely to die were those under the age of five.
Due to prior experiences with epidemics, especially "typhoid", sanitation was by then a main concern.  To reduce the likelihood for spread, the SPCA killed hundreds of animals, including stray pets, to prevent them any spread of disease into new neighborhoods.  

A law was also passed by the House of Representatives in Washington DC.  It turned Ellis Island Immigration Station into a quarantine facility.  Police then set up a Home Defense League, the goal of which was to inspect and clean up neighborhoods.  Their tasks included inspecting all streets and alleys, tenement houses rich in unhealthy interiors and exteriors, and a review of drinking water sources and supplies (reliance on wells in the city proper was recently reduced, but not completely eliminated).   
By July, the report of this epidemic was put together and the above map for this disease published in the local "urban development" journal for the time, "Municipal Journal.".
Reviewing historical epidemics as a part of the growing medical GIS profession serves a purpose. It provides insights into how we can better map out diseases in relation to population and human behavioral patterns. Many of the behaviors of the past still exist today. To better understand the public health problems of growing social inequality and poverty today, we need only search the past journals for the same mistakes being made back then.

References: “The Infantile Paralysis Epidemic.” Municipal Journal v. 41, no. 2, July 13, 1916, pp. 40-41. ; This is also the source for the base map on the left.

Google maps was used to produce to map on the right for comparison.

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Why Don't Homeless People Just Get Jobs? Hint: not all homeless are an employable age!

Why Don't Homeless People Just Get Jobs?  Hint: not all homeless are an employable age! | Medical GIS Guide |

"There are many assumptions about homeless people. Perhaps the most common is that they are too lazy to work. Having been there myself and having worked with many others in the same situation, I have to say that for the vast majority of homeless people . . . "

Brian Altonens insight:

But what about kids?


Does the health of homeless people impact you?


At Catholic Online, the article 'Tuberculosis sweeping through Los Angeles's population' attempts to explain this (  The authors state:



"Tuberculosis is also common among the homeless as they live in overcrowded areas and are constantly moving among hospitals, shelters and the streets. In addition, many have substance abuse or mental health issues that can impede treatment.

"'They go from place to place and the likelihood of passing it along is much greater,' Paul Gregerson, chief medical officer of the JWCH Institute says. The organization runs a homeless healthcare program on skid row. 'It makes everybody more susceptible.'

"Tuberculosis is easily transmitted by inhaling droplets from infected patients when they sneeze, cough -- or even laugh. TB can be deadly if left untreated. The skid row strain can be treated with all anti-TB medications. Treatment lasts six to nine months.

Most of the TB patients are men. Twenty percent are also HIV-positive, according to the alert. Six of the eight patients who also had HIV have died.

The increase of TB among the homeless population is occurring even as the county is seeing a decline in overall cases."



The majority of homeless people with Tb are adults.  The majority of Congenital Tb cases in newborn children is coincidentally distributed around many of the same urban settings where homeless is more common.  Both are products of urban settings with dense populations and desirable living space (even on behalf of the homeless).


"One of the four goals of Opening Doors is to finish the job of ending chronic homelessness by 2015.  Working together to implement proven solutions, we can continue to make progress towards our goal."  (Source:

According to Opening Doors . . . 

As long as there are homeless populations, there will be pockets of families and individuals who never receive complete health care.  Typically we hear about Mental Health, HIV, poor nutrition, drug use, the poor management of chronic diseases such as diabetes or epilepsy as primary concerns of community health groups.    


But there is more to this public health issue than normally considered.


My page which includes a review of this topic for Portland, Oregon, is:



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In Amazing Feat of Science, Surgeons Save Child's Life by 3-D Printing a New Heart

In Amazing Feat of Science, Surgeons Save Child's Life by 3-D Printing a New Heart | Medical GIS Guide |
The future of medicine was just demonstrated at the University of Louisville. Here's how they did it.
Brian Altonens insight:

3D printing and how to model the heart for practicing delicate valvular surgery.  These are mock hearts made for surgeons who need to learn how the heart really feels when delicate surgery is being performed, manually, and by hand.

3D modeling has tremendous applications to medicine and public health, and is underutilized by most medical professions outside the research setting.

One of the first inventive uses of GIS in medicine back in the mid to late 1990s was 3D modeling of the brain by neurosurgeons.

Even before ArcView and ArcInfo products could be easily combined, ESRI's GIS was offering opportunities to specialists in other fields normally not considered to be traditional GIS venues. [see, "Your Brain on GIS", by Daniel Lewis, or the original 20-Jan-2010 press release Lewis reviews at .]  

This is an example of how to think "outside the box".  Applying such thinking to GIS, GIS has been used to effectively model evolutionary sequences, taxonomic trees, phytochemical pathways, and cytochemical/physiological pathways modeling for pharma research.  Because these theoretical paths of evolution (evolution trees) were researched in GIS, they could be directly linked to spatial models of ecology, environment, plant distribution, crops, pests, soil, water, terrain and climate analyses. 

Progress comes when new paths are taken.

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1874 - Sydney H. Carney and the first maps produced by an Insurance Company

1874 - Sydney H. Carney and the first maps produced by an Insurance Company | Medical GIS Guide |
  . Biography Born in Lowell, Massachusetts on August 24, 1837, Sydney Howard Carney grew up in a fishing town near the Merrimack River.  He attended the local North Grammer school and then to Lowe...
Brian Altonens insight:

Sydney H. Carney produced one base map and five topical maps detailing the disease of the United States--Phthisis, Malaria, Pneumonia, Rheumatism, and Typhoid Fever.  

These were produced to define the payments required of railroad companies insuring their business, property, workers, and other future claimants of losses incurred due to this industry.

The majority of claims for these workers were injuries due to accidents in the workplace, along with certain chronic disease related losses (esp. DT and alcoholics' liver), and onsets of new diseases (opportunistic non-amoebic dysentery, marsh and mountain fevers like typhoid and Rocky Mountain Spotted Fever).  The regional causes for diseases were still poorly understood.  

Carney produced these maps to assign risk to certain places.  Contemporary maps are mostly demographic in nature for predicting risk, although natural disaster mapping has come to play a role in some insurance mapping endeavors.  The use of environmental mapping of health for insurance related reasons has once again become a new tool for the health insurance profession to relearn and standardize with contemporary investors and insurance company needs.

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Open Collections Program: Contagion, Tuberculosis in Europe and North America, 1800–1922

Open Collections Program: Contagion, Tuberculosis in Europe and North America, 1800–1922 | Medical GIS Guide |

A highly informative site on the history of medical geography and the mapping of contagion.

Brian Altonens insight:

Tuberculosis was one of the first endemic disease patterns mapped, which unlike the epidemic diseases like malaria, yellow fever and "typhus", did not have as much of a relationship to the warm climates like most fevers did.  First referred to as "consumption", this disease is seen in the cold temperate to warm arctic regions on early to mid 19th century global medical geography maps.  By the third quarter of the 19th century, many physicians and scientists were relating tuberculosis to temperament and hygienic practices at home and within the community.  


During the first period of medical cartography history, the map was used to related the disease to its environment in order to better understand its natural causes, aside from heredity and temperament.  During the early to late sanitative period in medical cartography, the map served to document where people lived and the relationship of their hygienic practices and the cleanliness of their food, water and living habits in relation to disease.  During this period small water and soil-borne "animalcules" were often defined as causes for disease.  


The documentation of relationships between bacteria  and illness beginning in the late 19th century, ca. 1884-1890 in the form of "Koch's Postulates",  drew medical cartographers away from environmental and ecological causes, and more towards the biology of organismal diseases, the impact of the environment on their survival, and the nature of human behavior and disease.  

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19th Century Ship Routes

19th Century Ship Routes | Medical GIS Guide |

"Ben Schmidt, assistant professor of history at Northeastern University, has visualized the routes of 19th Century ships using publicly available data set from NOAA (National Oceanic and Atmospheric Administration). The resulting image is a hauntingly beautiful image that outlines the continents and highlights the trade winds. It shows major ports, and even makes a strong visual case for the need for the Panama and Suez Canals."

Brian Altonens insight:

Lessons in GIS and Medical GIS - Examples of applications. Various Resources at hand.

Tracey M Benson's curator insight, March 10, 2014 4:29 PM

Beautiful data visualisation of 19th century ships using publicly available data set from NOAA (National Oceanic and Atmospheric Administration).

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Chicago Illness, Dispersal Patterns - YouTube -- 3D mapping rotational imagery mapping of theoretical 'Chicago Illness' Dispersal Patterns

Brian Altonens insight:

Chicago Illness -  A Lesson in Rotational 3D Epidemiological Mapping and Public Health Surveillance.


Why and how do diseases spread and migrate?

Now you can monitor this process, and determine if particular diagnoses, human behaviors, or other public health concerns diffuse or travel in all directions, or are hierarchical in nature, meaning they tend to travel the way people travel and strike heavily populated regions first and then the suburbs.  Some diseases and behaviors such a poverty, abuse, poor nutrition, child care related issues, follow a reversed hierarchical pattern, impacting poorer households first and if and when infectious, later impacting the middle class and upper class communities.

Ideally, we can monitor population in this way with little effort using the highly effective NPHG methodology.  This way of analyzing and visualizing population health has the potential of preventing disease, designing better intervention programs, and determining your highest risk communities for any intervention programs you might have in mind.  

This is what the NPHG method for disease mapping was written for.  It's advantage is it is less expensive than buying into a GIS or new HIT system of any kind.

Whatever system you utilize for developing your EMR/HER data and HIT monitoring programs, this method can probably be used to perform the tasks at hand.  If not, Open Source methods makes reaching this goal possible, in less than a year, at little or no cost.

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Hereditary Choroid Dystrophy (Children) - YouTube

Hereditary Choroid Dystrophy - and a comparison with several other seemingly random genetic or development disease distributions.

Brian Altonens insight:

The Big Data world is currently being underutilized by the health care field.  

We have the data and detail needed to map disease down to the small area.  That is to say we can determine when and where specific services are needed due to detection of clustering, outbreaks, and social behavioral patterns depicted using small area 3D mapping techniques.  

Most of the current data mapping systems take days if not weeks to produce a regional health report. consisting of several hundred specific areas of focus, reported on a monthly basis.  Such a standardized reporting system for use in monitoring health and preventing outbreaks is not possible using the current systems.

The NationalPopulationHealthGrid method enables these kinds of analyses to be generated, regularly, at rates that surpass those assocaited with the current standard GIS approaches.  The NPHG approach can be programmed to produce thousands of maps per day, depicting any kind of quantitative or qualitative data to your liking.   

Once spatial analysts are able to fully understand and apply the methods used to produce 3D spatial models to their work, better intervention and cost savings programs can be developed.  Population health improvements will for the first time be directly targeted.  Until then, we are looking at at the large area maps, not knowing where to begin our next public health programs at the local level.

For more on this technique, see


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Mapping Health

Mapping Health | Medical GIS Guide |
Brian Altonens insight:

Impressive uses for Medical GIS, with a touch of novelty in presentation.  

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