Media Reviews and Reports
GIS Tutorial for Health
(Updated for ArcGIS 9.3),
Third Edition
Kristen S. Kurland, Wilpen L. Gorr. Redlands CA, ESRI
Press, 2009. 384 pp. $79.95, ISBN: 978-1-58948-224-1.
U
sing this as a textbook, I have assigned earlier
editions of GIS Tutorial for Health (hereafter Tu-
torial) in a graduate seminar in demography, and
I will similarly use this edition. The primary reason for
assigning this text is that it provides an effective introduc-
tion to the basics of the ArcGIS software: an introduction
grounded in real-world—in this case health-related—
applications. Goals in my course are for students to be up
to speed on the basics of ArcGIS, to feel comfortable using
the program, and to understand how to create, manipu-
late, and combine geospatial data appropriately . . . and
hopefully to achieve all this within the first 5 weeks of the
course. These goals are important, as the students need to
understand how to handle geospatial data before they can
launch into more sophisticated spatial analyses using
ArcGIS and other spatial statistical software. More ad-
vanced spatial analysis topics are not covered in the Tuto-
rial. Before I criticize the book for what it does not cover (or
perhaps more selfishly, what I hope the next edition might
include) and some of its weaknesses, I briefly describe the
Tutorial and discuss some of its many strengths.
As someone who has designed examples in demog-
raphy, social science, and health-related applications
using GIS and spatial analysis, I have a lasting respect
for the authors. This is a carefully crafted set of
health-related tutorials (11 in all), complete with a
well-designed data DVD as well as a set of PowerPoint
lectures accompanying each tutorial. The Tutorial also
includes a second DVD containing a time-limited, 180-
day single-use license to ArcGIS/ArcView 9.3.
In each tutorial, the user is introduced to a health
scenario and how GIS-related approaches can be har-
nessed to address it. Users then work through a series of
tasks that lead to the desired end product (e.g., a map, a
data set, a derived variable). Each tutorial includes “Your
Turn” tasks— usually repeating a mapping or data-
manipulation task on a different variable or data set—at
the end of which the user is encouraged to complete a
couple of self-directed exercises. These exercises are closely
related to the tasks and data sets used in the tutorial and
provide an excellent opportunity for applying the methods
learned without the support of detailed instructions.
The book closes with two tutorials presented in the
form of case studies that require independent thought.
All data required for the tutorials, case studies, and
574 Am J Prev Med 2009;37(6)
© 2009 American Journal of Preventive Medicine • Published by Elsevier Inc.
self-paced exercises are on the DVD, and/or the user is
directed to websites where similar data can be accessed,
cleaned, and analyzed. Moreover, the data DVD in-
cludes “solutions” and, most usefully, clean copies of all
the data to be derived by the user during a tutorial. The
tutorials start at a relatively gentle pace before the level
of complexity is ratcheted up. Tutorials tend to build
on each other with opportunities to recall tasks from
earlier work, reinforcing the learning-by-doing philos-
ophy. Most tutorials can be completed within 60 –90
minutes, although users will spend more time, depend-
ing on their motivation and interest, in completing
exercises and case studies tutorials.
Particularly impressive is the wide range of substantive
topics included in the Tutorial. These include but are not
limited to mapping cancer mortality, HIV/AIDS, unin-
sured populations, and child pedestrian injuries; decision
making regarding clinic locations and the distribution of
heart defibrillators; building databases for health service
areas; and measuring obesogenic environments (focusing
on access to parks and playgrounds) as well as techniques
for creating surfaces of poverty.
The case studies focus on foodborne disease out-
breaks and forming new service areas for American
College of Healthcare Executive chapters. The substan-
tive variety is matched by applications covering geo-
graphic scales ranging from detailed neighborhood
studies (within Pittsburgh), through county and state
levels in the U.S., up to the global map as well as GIS
applications drawing on both metropolitan and non-
metropolitan databases.
Similarly, the Tutorial includes careful attention to
common GIS tasks (mapping, integrating data, geocod-
ing, editing data) and basic spatial analysis (overlays
and buffering) as well as forays into data manipulation
involving methods used to apportion data from one
spatial unit to another and, in an added tutorial for the
third edition, a focus on the ArcGIS Spatial Analyst
extension. This is all impressive.
The tutorials provide examples of how the user can
visualize health data, although the chapters on building
geospatial data sets—and by extension adding value to
health research projects—are among the strongest. As
with similar workbooks, geocoding is covered quite well. I
tend to have two complaints about exercises on geocod-
ing. First, the examples nearly always use very clean
address data, which throws students through a loop when
they come to geocode address data in their own projects.
Geocoding is conceptually very simple but often trouble-
some and time-consuming for the conscientious. In fair-
ness, geocoding in the Tutorial is more realistic than
examples found in most other similar workbooks. My
second complaint relates to opportunities missed regard-
ing the discussion of the value added to geocoding in
0749-3797/09/$–see front matter
facilitating the construction of unique contextual data-
bases that can expand the range of variables incorporated
into multilevel studies—an application of GIS data manip-
ulation that has increasing importance across the health
and social sciences. This brings me to some of the
weaknesses of the Tutorial.
I welcomed the inclusion of the new tutorial on
ArcGIS’s Spatial Analyst extension but in general found
the promotion of spatial analysis relatively weak. In
particular, I find reference to “overlay and buffering as
sophisticated spatial analysis” quite misleading, for to
me they are nothing of the sort. Indeed, a related
problem, given the sophisticated quantitative skills of
the likely audience for this book, is the lack of attention
to, and reminders to the user about, other forms of data
analysis. In several tutorial maps, descriptive statistics
and correlations are presented but rarely is the user
encouraged to think about aspatial—let alone spatial—
multivariate relationships and why it is that spatial data
are special. Patterns are shown and basic data referred
to but the processes underlying the mapped results are
rarely explored in depth; this is the case in the discus-
sion of some maps of counts as well as rates.
More disappointing perhaps is that given the attention
to mapping in the Tutorial, several key concepts in map-
ping and the analysis of spatial distributions are either not
discussed or are alluded to only in passing. Among these
concepts I would include such fundamental issues as scale
and aggregation (the Modifiable Areal Unit Problem)
and spatial autocorrelation. References and links to web-
sites offering guidance on spatial concepts and their
application are sparse and quite uneven in the Tutorial.
Given the growth in this area in the past 15 years and the
abundance of material that could be referenced, I found
this disappointing. Indeed, for each health-related sce-
nario, one can find published studies that have used GIS
for tasks such as data construction, mapping, and spatial
and/or statistical analysis. The same observation holds
true for the techniques or tools being used (e.g., match-
ing data on incompatible areas and kernel density).
Given the emphasis on mapping in the Tutorial, there
are two issues that deserve more attention. First, al-
though the topic of map projections—not the most
popular topic among instructors or students—is cov-
ered, it is a brief treatment that is held back until
Tutorial 4. This is too late and undermines the empha-
sis on visualizing health data Tutorial 2. Ironically,
some of the poor projection choices used in later
tutorials are not identified or changed.
The second topic deserving of more attention relates
to cartographic practice. Users spend a lot of time—
perhaps too much time—manipulating the visual ap-
pearance or symbolization of data but rarely are they
provided with information on well-established carto-
graphic principles; for example, there are no refer-
ences in either Tutorial 2 (Visualizing Health Data) or
December 2009
Tutorial 3 (Designing Maps for a Health Study). Further,
I do not recollect justifications being offered for the
selection of classes or the choice of color, shade, pattern,
size, or thickness of the objects being mapped. In a
discussion on the use of color, users could easily have
been referred to online guides such as ColorBrewer or
provided with a list of cartographic texts, specifically on
thematic mapping. One benefit of the frequent manip-
ulation of symbolization options is that the user can
become familiar with how to move away from default
options of cartographic settings; this is a good thing.
As with any update edition there are some minor errors
that slip through. Among the most glaring is the refer-
ence to VBA code in the “Your Turn” on page 252 that
was used in an earlier edition, but there were some others.
In my opinion, some screen captures are unnecessary
(including the repeats), and some discrete numbered
tasks could easily be combined to save space for more
important content (i.e., justification for or more depth on
options vis-à-vis geocoding, projections, and cartographic
design). On occasion, the more complex the sequence of
tasks the user has to work through, the less likely it seemed
that a screen capture and/or detailed comments were
provided to show the way (e.g., in the editing section).
The small number of errors and inconsistencies in the
Tutorial is a minor irritant and should not distract from an
otherwise excellent set of tutorials and exercises.
Although I have my own complaints, the Tutorial is
several rungs higher on the instructional ladder than
other competing texts that I have seen and worked
through. The Tutorial does a great job establishing famil-
iarity with, and establishing a comfort zone for, using a
complex package like ArcGIS, and it does so very effec-
tively. All who embark on this journey will be rewarded for
their endeavors. The Tutorial can provide a firm founda-
tion on which to build for those wishing to develop their
skill set in ArcGIS and other spatial statistical packages. I
just wish the Tutorial offered the interested reader more
guidance to both current cartographic/spatial analytical
practice and next steps, and that it specifically offered a more
consistent set of resources on where to find references and
more information on GIS, geospatial data handling, spatial
analysis, and spatial statistical analysis in health and other
related social science applications. More training in the
sophisticated use of GIS and spatial analysis by students of
public health and healthcare professionals will improve
understanding of many important health-related questions.
No financial disclosures were reported by the author of this paper.
Reviewed by Stephen A. Matthews, Population Research Insti-
tute, The Pennsylvania State University, University Park,
Pennsylvania. E-mail: matthews@pop.psu.edu.
doi:10.1016/j.amepre.2009.08.020
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