UC Santa Barbara

The last two decades have seen a broadening of the scope of public health that has resulted in a ``spatial turn" in a field that is inherently spatial. The increased role for Geography is particularly clear when considering local public health practice. Several factors have contributed to this including increased interest in the Social Determinants of Health which are sometimes characterized as attributes of place. This has resulted in a focus on neighborhood or ``context" effects on health including attributes of the built environment, demographic characteristics, and environmental measures. Simultaneously, there has been rapid acceleration in the availability and timeliness of data at fine geographic, demographic, and temporal resolution, and an emphasis on open data and inter-sectoral collaboration. This has enabled the timely, systematic characterization of communities or neighborhoods.

This dissertation presents three projects demonstrating the value of geography in public health surveillance in New York City. Surveillance is one of the core functions of public health and has been called the ``essential feature of epidemiologic practice.'' Traditionally, surveillance has been used for communicable disease outbreak detection and emergency response. However, in the current data context, the systematic, timely, and detailed characterization of populations and communities including health behaviors, outcomes including chronic disease, and social determinants of health is possible and facilitates all aspects of public health practice and policy making. The projects presented here further that goal by developing methods for the detailed characterization of spatial and demographic patterns.

First, the construction of area-based poverty measures (ABPMs) for surveillance is presented. ABPMs can be used to measure and monitor disparities and track progress towards published goals. Second, a system for the timely characterization of child mental health outcomes is developed. The system can be used to target mental health services and evaluate the impact of ThriveNYC, an extensive preventive mental health program. Finally, a quantile regression framework for child BMI is presented. This has the potential to greatly increase the amount of information used in characterizing childhood obesity including spatial and demographic patterns. Together these projects provide actual use cases for the central role of geography in local government.