Nadine Schuurman

Trouble in the heartland: GIS and its critics in the 1990s:

GIS eased into geography without much discord until the 1990s, when a flurry of commentaries about the relative merits of GIS made their way into a number of geographic journals. The ensuing decade was marked by varying degrees of friction between GIS practitioners and their critics in human geography. Despite the methodological chasm between the two groups, little discussion of the implications of these differences has ensued. This article fills that gap with a historiographic examination of critiques of GIS. Critiques of GIS are organized into three waves or periods, each characterized by distinct arguments. The first wave, from 1990 to 1994, was marked by the intensity of debate as well as an emphasis on positivism. By 1995, the conversation waned as the number of critics grew, while GIS practitioners increasingly declined comment. This second wave marked the initiation of a greater degree of co-operation between GIS scholars and their critics, however. With the inception of the National Center for Geographic Information Analysis (NCGIA) Initiative 19, intended to study the social effects of GIS, many critics began to work closely with their peers in GIS. In the third wave, critiques of GIS expressed a greater commitment to the technology. Throughout the decade, debates about the technology shifted from simple attacks on positivism to incorporating more subtle analyses of the effects of the technology. These critiques have had considerable effect on the academic GIS community but are presently constrained by limited communication with GIS practitioners because of the absence of a common vocabulary. I argue that, if critiques of GIS are to be effective, they must find a way to address GIS researchers, using the language and conceptual framework of the discipline.

Defining rational hospital catchments for non-urban areas based on travel-time

BackgroundCost containment typically involves rationalizing healthcare service delivery through centralization of services to achieve economies of scale. Hospitals are frequently the chosen site of cost containment and rationalization especially in rural areas. Socio-demographic and geographic characteristics make hospital service allocation more difficult in rural and remote regions. This research presents a methodology to model rational catchments or service areas around rural hospitals – based on travel time.ResultsThis research employs a vector-based GIS network analysis to model catchments that better represent access to hospital-based healthcare services in British Columbias rural and remote areas. The tool permits modelling of alternate scenarios in which access to different baskets of services (e.g. rural maternity care or ICU) are assessed. In addition, estimates of the percentage of population that is served – or not served -within specified travel times are calculated.ConclusionThe modelling tool described is useful for defining true geographical catchments around rural hospitals as well as modelling the percentage of the population served within certain time guidelines (e.g. one hour) for specific health services. It is potentially valuable to policy makers and health services allocation specialists.

Deprivation Indices, Population Health and Geography: An Evaluation of the Spatial Effectiveness of Indices at Multiple Scales

Area-based deprivation indices (ABDIs) have become a common tool with which to investigate the patterns and magnitude of socioeconomic inequalities in health. ABDIs are also used as a proxy for individual socioeconomic status. Despite their widespread use, comparably less attention has been focused on their geographic variability and practical concerns surrounding the Modifiable Area Unit Problem (MAUP) than on the individual attributes that make up the indices. Although scale is increasingly recognized as an important factor in interpreting mapped results among population health researchers, less attention has been paid specifically to ABDI and scale. In this paper, we highlight the effect of scale on indices by mapping ABDIs at multiple census scales in an urban area. In addition, we compare self-rated health data from the Canadian Community Health Survey with ABDIs at two census scales. The results of our analysis confirm the influence of spatial extent and scale on mapping population health—with potential implications for health policy implementation and resource distribution.

Formalization Matters: Critical GIS and Ontology Research

Abstract There have been several obstacles to an embrace of critical theoretical work in GIScience; chief among them is the barrier between conceptualization and formalization. Early critics of the technology were not cognizant that technological change must be implemented within the language of code. While critics expressed their concerns in a theoretical and esoteric language, increasingly GIScientists are at pains to address the same issues so that solutions can be incorporated into software technologies. Indeed an implicit recognition of the important divide between informal and formal environments has aided GIScience researchers in developing strategies to represent multiple epistemologies in GIS. The article begins with a review of early critical GIScience, examines the degree of its acceptance in the light of a content analysis of GIS journals, and then illustrates that the issue of multiple representation of the same reality is being addressed under the rubric of ontologies. New research in this area has had significant impact on GIScience because it has been articulated and addressed at both the conceptual and formal stages—a criterion for real changes to both GISystems and GIScience. The article concludes with an examination of why critical GIS remains relevant to the discipline, in spite of efforts to address issues of representation within GIScience.

Care of the Subject: Feminism and Critiques of GIS

Critique is a fundamental part of academic discourse. It is a means for researchers to critically examine assumptions, ideas, statements and theories. While there may be general agreement about the integral value of critique to scienti!c and intellectual enterprises, less attention has been paid to the form and delivery of critique. This article argues that ‘how’ critique is expressed, as well as what its objectives are, is critical to achieving changes in any research area. We start from the position that many of the critiques of geographic information systems (GIS) have aimed to demonstrate what is ‘wrong’ with this subdiscipline of geography rather than engaging critically with the technology. Critics have judged the processes and outcomes of GIS as problematic without grounding their criticism in the practices of the technology. This follows a pattern of external critique in which the investigator has little at stake in the outcome. External critiques from human geographers tend to be concerned with epistemological assumptions and social repercussions, while internal critiques have focused on the technical. But there is a further difference. Internal critiques have a stake in the future of the technology while external ones tend not to (Pratt, 1996). While dividing critiques of GIS into ‘external’ and ‘internal’ oversimpli!es the !eld, we use it as a heuristic to delineate broad differences in approach. By drawing on feminist analyses of critique, we argue for a form of critique that transcends this binary by tackling enframing assumptions while remaining invested in the subject. To be constructive, critique must care for the subject. A feminist critique of GIS engages more directly with GIS practices, and need not reproduce the antagonistic dualisms that have characterised debates about GIS and technology to date. Over the past decade, there have been a number of critiques of GIS in geographic journals. Many of these were written by critics concerned with the effects of widely disseminated GIS technology, but expressed in a manner consistent with external critique. Critics expressed concerned about the promulgation of positivism, repercussions of enshrining quantitative techniques in software, as well as social effects of GIS (Smith, 1992; Lake, 1993; Sheppard, 1993, 1995; Pickles, 1993, 1995, 1997). Accounts of GIS from the early 1990s were polemical and often negative, while those published later in the decade, when GIS was better ensconced, tended to be more conciliatory (Schuur-

Ontology‐Based Metadata

Metadata are an extant mechanism for conveying ontological information about semantic data. Metadata have the advantage of being institutionally and structurally ensconced in GIS. At present, however, they lack fields to express information beyond the technical and geometric domain. This paper describes a framework for the creation of extended metadata for non-spatial attributes, with the goal of incorporating ontological context. We use an informatics interpretation of ontology which refers to the total universe of discourse associated with a given attribute (database field). In other words, an ontology is the possible range of meaning offered by an encoded field. Current ontology research in GIScience has focused on data structuring and modelling. Implementation of these schemes demands restructuring of existing relational database models. An alternative is to extend current metadata schemes (e.g. ISO 19115) to include context-based and tacit information about semantic attributes. Such ontology-based extended metadata permits data selection and interoperability decisions that are ultimately more defensible. We have developed eight preliminary fields to add to existing metadata frameworks that will enable ontological context to travel with the data. This paper illustrates a preliminary implementation based on the integration of non-commensurate cadastral data. The results illustrate the value of ontology-based metadata in highlighting descriptive and substantive differences between similar classification systems. Recognition of semantic heterogeneity is the basis for creating defensible data linkages between multiple datasets. The development of ontology-based metadata is profoundly

Using GIS-based methods of multicriteria analysis to construct socio-economic deprivation indices

BackgroundOver the past several decades researchers have produced substantial evidence of a social gradient in a variety of health outcomes, rising from systematic differences in income, education, employment conditions, and family dynamics within the population. Social gradients in health are measured using deprivation indices, which are typically constructed from aggregated socio-economic data taken from the national census – a technique which dates back at least until the early 1970s. The primary method of index construction over the last decade has been a Principal Component Analysis. Seldom are the indices constructed from survey-based data sources due to the inherent difficulty in validating the subjectivity of the response scores. We argue that this very subjectivity can uncover spatial distributions of local health outcomes. Moreover, indication of neighbourhood socio-economic status may go underrepresented when weighted without expert opinion. In this paper we propose the use of geographic information science (GIS) for constructing the index. We employ a GIS-based Order Weighted Average (OWA) Multicriteria Analysis (MCA) as a technique to validate deprivation indices that are constructed using more qualitative data sources. Both OWA and traditional MCA are well known and used methodologies in spatial analysis but have had little application in social epidemiology.ResultsA survey of British Columbias Medical Health Officers (MHOs) was used to populate the MCA-based index. Seven variables were selected and weighted based on the survey results. OWA variable weights assign both local and global weights to the index variables using a sliding scale, producing a range of variable scenarios. The local weights also provide leverage for controlling the level of uncertainty in the MHO response scores. This is distinct from traditional deprivation indices in that the weighting is simultaneously dictated by the original respondent scores and the value of the variables in the dataset.ConclusionOWA-based MCA is a sensitive instrument that permits incorporation of expert opinion in quantifying socio-economic gradients in health status. OWA applies both subjective and objective weights to the index variables, thus providing a more rational means of incorporating survey results into spatial analysis.

A method to determine spatial access to specialized palliative care services using GIS

BackgroundProviding palliative care is a growing priority for health service administrators worldwide as the populations of many nations continue to age rapidly. In many countries, palliative care services are presently inadequate and this problem will be exacerbated in the coming years. The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there is little distinction made at present between levels of service provision. There is a pressing need to determine which populations do not enjoy access to specialized palliative care services in particular.MethodsCatchments around existing specialized palliative care services in the Canadian province of British Columbia were calculated based on real road travel time. Census block face population counts were linked to postal codes associated with road segments in order to determine the percentage of the total population more than one hour road travel time from specialized palliative care.ResultsWhilst 81% of the provinces population resides within one hour from at least one specialized palliative care service, spatial access varies greatly by regional health authority. Based on the definition of specialized palliative care adopted for the study, the Northern Health Authority has, for instance, just two such service locations, and well over half of its population do not have reasonable spatial access to such care.ConclusionStrategic location analysis methods must be developed and used to accurately locate future palliative services in order to provide spatial access to the greatest number of people, and to ensure that limited health resources are allocated wisely. Improved spatial access has the potential to reduce travel-times for patients, for palliative care workers making home visits, and for travelling practitioners. These methods are particularly useful for health service planners – and provide a means to rationalize their decision-making. Moreover, they are extendable to a number of health service allocation problems.

Identifying targets for potential interventions to reduce rural trauma deaths: a population-based analysis.

BACKGROUND Rural environments have consistently been characterized by high injury mortality rates. Although injury prevention efforts might be directed to reduce the frequency or severity of injury in rural environments, it is plausible that interventions directed to improve injury care in the rural settings might also play a significant role in reducing mortality. To test this hypothesis, we set out to examine the relationship between rurality and the setting in which patient death was most likely to occur. METHODS This is a population-based retrospective cohort study evaluating all trauma deaths occurring in the province of Ontario, Canada, over the interval 2002 to 2003. Patient cohorts were defined by their potential to access trauma center care using two different approaches, rurality and timely access to trauma center care. RESULTS There were 3,486 deaths over the study interval, yielding an overall injury mortality rate of 14.6 per 100,000 person-years. Overall, more than half of deaths occurred before reaching an emergency department (ED). Prehospital deaths were twice as likely in the most rural locations and in those with limited access to timely trauma center care. However, among patients surviving long enough to reach hospital, there was a threefold increase in the risk of ED death among those injured in a region with limited access to trauma center care. CONCLUSIONS We demonstrate that a significant proportion of deaths occur in rural EDs. This study provides new insights into rural trauma deaths and suggests the potential value of targeted interventions at the policy and provider level to improve the delivery of preliminary trauma care in rural environments.

Are Obesity and Physical Activity Clustered? A Spatial Analysis Linked to Residential Density

The aim of this study was to examine spatial clustering of obesity and/or moderate physical activity and their relationship to a neighborhoods built environment. Data on levels of obesity and moderate physical activity were derived from the results of a telephone survey conducted in 2006, with 1,863 survey respondents in the study sample. This sample was spread across eight suburban neighborhoods in Metro Vancouver. These areas were selected to contrast residential density and income and do not constitute a random sample, but within each area, respondents were selected randomly. Obesity and moderate physical activity were mapped to determine levels of global and local spatial autocorrelation within the neighborhoods. Clustering was measured using Morans I at the global level, Anselins Local Morans I at the local level, and geographically weighted regression (GWR). The global‐level spatial analysis reveals no significant clustering for the attributes of obesity or moderate physical activity. Within individual neighborhoods, there is moderate clustering of obesity and/or physical activity but these clusters do not achieve statistical significance. In some neighborhoods, local clustering is restricted to a single pair of respondents with moderate physical activity. In other neighborhoods, any moderate local clustering is offset by negative local spatial autocorrelation. Importantly, there is no evidence of significant clustering for the attribute of obesity at either the global or local level of analysis. The GWR analysis fails to improve significantly upon the global model—thus reinforcing the negative results. Overall, the study indicates that the relationship between the urban environment and obesity is not direct.