Mapping Out Public Health Successes and Challenges With Esri’s Este Geraghty

June 07, 2018|9:53 a.m.| ASTHO Staff

stella (Este) Geraghty, MDAs a keynote speaker at ASTHO’s 2017 Annual Meeting, Estella (Este) Geraghty, MD, chief medical officer and health solutions director at Esri, discussed how public health leaders can use geospatial technologies to address issues, such as the opioid epidemic, natural disasters, vectorborne disease, and even hypertension.

Following the annual meeting, ASTHO collaborated with Esri on a GIS training for state health department staff as part of a project to increase the use of self-measured blood pressure monitoring. In March 2018, Esri facilitated the training with three state grantees (New York, Missouri, and Kentucky) to discuss ways to identify hypertension hotspots through GIS mapping and build blood pressure libraries in communities.   

With the 2018 ASTHO Annual Meeting around the corner, ASTHO caught up with Geraghty to learn more about Esri, GIS mapping, and why this powerful tool should a part of every public health tool set.

What is GIS mapping, and what role does it play in public health?

You may have noticed that words like location, place, and where come up with considerable frequency in everyday conversation. In fact, the word place is the 107th most commonly used word in the English language and where is 110. Location is part of everything we do and represented in nearly every dataset we collect and analyze. A geographic information system (GIS) helps turn location data into actionable intelligence and should be a key component in public health informatics toolsets.

The relationship between health and place is not new. Hippocrates, the father of medicine, wrote a treatise, “On Airs, Waters, and Places,” around 400 BCE expounding on the connection between location and health outcomes. In 1854, John Snow, the father of modern epidemiology, made health mapping famous by ending a London cholera outbreak through spatial analysis of cholera deaths and the built environment.

Nowadays, with modern GIS, public health departments can benefit across many program areas. The world of mapping and spatial analytics empowers a health department to make strategic resource allocation decisions and better understand the communities they serve. For example, geography can provide insights about a community’s social determinants of health, it can help predict the spread of infectious diseases, determine access to programs and services, and ensure health departments are prepared for emergencies. The possibilities are endless.

How can public health departments incorporate GIS mapping into the work they are already doing?

I’m a big fan of Dr. Stephen R. Covey’s teachings around effective productivity. I’m sure he would answer this question by saying that one should begin with the end in mind. When it comes to GIS, it means that the department’s strategic outcomes should be the starting point for a workflow review. Throughout the review, leaders should ask specific questions about the value of location intelligence at each step of the process.

To accomplish that, one needs to know a bit about the capabilities of GIS software (many, if not most, states already use some level of Esri’s ArcGIS product suite). Esri technology is generally deployed in ways that exhibit eight common patterns of use, which we see widely repeated in the public health community. These include:

  1. Mapping and Visualization.
  2. Data Management.
  3. Field Mobility.
  4. Monitoring.
  5. Analytics.
  6. Decision Support.
  7. Sharing and Collaboration.
  8. Stakeholder/Constituent Engagement. 

If you are trying to improve efficiency and transparency around inspections of food retailers, you might employ the field mobility pattern to create a mobile inspection solution. Real-time data would feed into your data management system with each completed inspection, where it can be immediately displayed with maps and charts in an interactive online dashboard. You might even make the results available to the public with an inspections results look-up application or an open data portal where users can connect directly with the data, plugging it into other websites and applications. This simple workflow would employ five of the common patterns (1, 2, 3, 4, and 7) and accomplish the goal of increased transparency, more efficient inspections, near real-time oversight, and more accurate data collection. Additionally, making data available in this manner can satisfy mandatory reporting requirements and Freedom of Information Act requests without requiring additional resources.

When you begin with the end in mind, you can develop a location strategy that makes sense and adds real value.

How is Esri working with state and territorial health departments?

Esri provides support to state health departments in several ways. We like to think of ourselves as problem solvers and trusted advisors that help state health departments meet their needs with modern, powerful solutions that bring a high return on investment. We do that by offering a number of products and services to fit every need.

As problem solvers, we are always looking at the health concerns of the day and creating configurable templates and apps that any user can freely download and deploy. Those templates focus on issues such as substance abuse and misuse, vector control, disease surveillance, public health preparedness, as well as social determinants of health such as homelessness, to name a few. As trusted advisors, we help state and territorial health departments create solutions in other areas, and even help them develop comprehensive location strategies.

Beyond our extensive software and data offerings, which can be deployed on premise or in the cloud (or a hybrid approach), we also have a great professional services department. They can assist with implementation or project needs and help determine correct deployment options. With professional services, you reach success faster.

We know that technology without training and capacity-building is just a waste of money. Esri has both onsite training as well as a number of free online training resources and complimentary massive open online courses.

What else should public health leadership know about GIS mapping?

I spent many years training to become a physician and then sought more training and experience in public health. I love working in public health. When I began to see how a geographic approach could transform an organization both operationally and in ways that improve key outcomes, I knew I had to be a part of that world.

With that said, I think there are three important things that state public health leaders should know. The first is that GIS is not just for GIS analysts. The need for location intelligence spans an organization in many ways, including field workers, epidemiologists, and leaders who need overall situational awareness. Secondly, it is important to know that ArcGIS enables configuration over coding. We believe that makes GIS tools more accessible, reducing complexity and cost due to less reliance on developers. It also reduces project completion time and increases sustainability in important ways. Finally, to be successful in deploying a transformative technology, leaders must focus on intentional change management.

As public health leaders applying GIS to your workflows, you need to act as strong champions for your staff. It is critical that you message frequently about the “why” component of the change. Explain the expected outcomes and how that is related to the department’s strategic plan.

In addition, it is equally important that your line-of-business leaders champion the change, though their message is different. These leaders are managing the individuals tasked with incorporating the change into their daily work lives. The message they need to hear is the WIIFM message—i.e., “what’s in it for me?” How does their personal effort make a difference? Everyone should celebrate the wins along the way to reinforce the change. Whether the innovation is GIS or some other technology, don’t underestimate the value of frequent communication for bringing great success. 

As for me, it would be my honor to serve you and the great work you do! You can reach me at