By Jesus Carroll,2014-12-03 16:53
10 views 0




    Examining lead risk factors by geographic location allows for the identification of local variations in lead risk factors and provides an effective vehicle for communicating the presence of risk factors specific to a certain area. Geographic Information Systems (GIS), computer software capable of spatial analysis, permits powerful consolidation and analysis of multiple risk factors. GIS can be used to analyze address-specific data from various sources, including, but not limited to, Census data, local tax assessor and other housing data, blood lead surveillance data, and code violation data. With the encouragement and support of CDC, a number of CLPPP programs and researchers have employed GIS technologies to analyze lead risk data, present information powerfully, and develop more precise targeting strategies. GIS can also assist health departments, housing agencies, and others to focus lead hazard control and lead screening planning and can help such programs in allocating resources.


    Immediate/Direct Results: Use of GIS software allows spatial analysis of address-specific data, identifying high-risk geographic areas that may be difficult to discern by scanning lists or data sets. The software automates the labor-intensive process of manually mapping information, accommodates updates and additions to the data, and permits customization of analysis.

    Public Health Benefits: Well-done analyses can yield more sophisticated and efficient targeting strategies for both primary and secondary prevention activities. They can also effectively illustrate situations where a single property is associated with repeated EBL cases and track properties that have been evaluated, renovated, or abated over time. Sometimes such analysis yields unexpected information such as clustering of cases, shedding light on previously unrecognized point sources or risk factors.

    Other Indirect/Collateral Benefits: GIS analysis can yield data-driven findings that provide the scientific basis for motivating action by public officials. Indeed, computerized analysis of address-based data can counteract perceptions of bias about expected outcomes.


    Statewide Regional (e.g. multi-county)

    City- or County-Wide Neighborhood/Community


    Health Department Housing Agency

     Property Taxation Agency

     Human Services Agency


    Staff requirements: Varies according to scope of project and existing capacity.

    Other resource requirements: The quality of the existing databases is crucial: information must be complete and accurate. Correctly spelled addresses must be expressed in the same formatting conventions and terms that geo-coding programs recognize. Also, access to information technology expertise, software, and technical support.

    Institutional capacity required: Securing access to the desired data may require programs to negotiate new data-handling agreements or take special programming steps to comply with privacy policies, especially with respect to the identity of children in lead surveillance databases, and in some circumstances, address information.

    Centers for Disease Control and Prevention 1

    Building Blocks for Primary Prevention: Protecting Children from Lead-Based Paint Hazards

    Targeting High-Risk Housing


    Cost considerations: There are out-of-pocket costs associated with programming, acquiring data, cleaning databases (if necessary), and licensing software; however, specific costs will vary depending on a number of factors. Purchase of GIS software is now an authorized expenditure for CDC CLPP grant funds.

Timing issues: Can be implemented at any time.

Feasibility of Implementation: Moderate. A number of programs have already deployed GIS technology

    successfully to analyze data related to lead poisoning prevention, providing useful models and resources for support, advice, and practical tools.


    Although “mapping” feels approachable, the concept of Geographic Information Systems (GIS) can be intimidating for those unfamiliar with the software. Programs need to set clear goals for their analyses and decide if simple and focused will accomplish their goals (e.g., Wisconsin illustration), or if something more complex and comprehensive is appropriate (e.g., NCHH illustration).

    A potential barrier that can require considerable staff time to remedy is the quality of the databases. Generally speaking, tax assessor databases are relatively clean, due to their importance to local government finances, while lead surveillance data tends to require cleaning to render it intelligible for GIS programs.

    It is also possible that very small scale mapping (e.g., at the block level) of EBL data could trigger privacy concerns, so agencies must have clear policies in place in comply with prevailing privacy requirements.


    1. Kim D, Forrest S, Curtis GB, Buchanan S. Relation Between Housing Age, Housing Value, and Childhood

    Blood Lead Levels in Children in Jefferson County, Kentucky, Using Geographic Information System

    Technology. American Journal of Public Health, June 2002, 92(5):769-70.

    2. Miranda, ML, Dolinoy, DC, and MA Overstreet. Mapping for Prevention: GIS Models for Directing

    Childhood Lead Poisoning Prevention Programs. Environmental Health Perspectives, Volume 110,

    Number 9, September 2002.

    3. Reissman DB, Staley F, Curtis GB, Kaufmann RB. Use of Geographic Information System Technology To

    Facilitate Health Department Decision-Making Regarding Childhood Lead Poisoning Prevention Activities.

    Environmental Health Perspectives, Volume 109, Number 1, January 2001.

    4. Roberts JR, Curtis GB, Hulsey T, Reigart JR. Using Geographic Information Systems to Assess Risk for

    Elevated Blood Lead Levels in Children. Public Health Rep 2003 118:221-229.

    5. CDC staff have developed a white paper providing guidance on potential issues associated with the

    use of surveillance system address data. The paper, called Preparing Surveillance Data for GIS Use

    (January 2004), is available upon request to CDC’s Childhood Lead Poisoning Prevention branch.

    6. The Foundations of Better Lead Screening for Children in Medicaid: Data Systems and Collaboration, Alliance

    For Healthy Homes (formerly The Alliance To End Childhood Lead Poisoning), (April 2001). This

    report contains a case study describing Oregon’s experience with GIS analysis of Medicaid-related



    WI CLPPP used GIS software to produce maps demonstrating visually the association between childhood lead poisoning and age of housing. Specifically, Wisconsin developed a series of maps showing both the geographic location of residences of children with elevated blood lead levels (data from the state’s blood lead surveillance system) and age of housing (data from US Census).

Centers for Disease Control and Prevention 2

    Building Blocks for Primary Prevention: Protecting Children from Lead-Based Paint Hazards

    Targeting High-Risk Housing


    Jurisdiction or Target Area: Wisconsin

    Primary Actor: WI Department of Health and Family Services, Childhood Lead Poisoning Prevention Program

Secondary Actor(s): N/A

Staffing utilized: Producing the maps required about 1 month of 1 FTE’s time from the CLPPP. The

    CLPPP was able to tap into the State’s Business Information Systems office to secure the expertise needed to create the data source files and deploy the GIS software (ArcView); this support required one month of 1 FTE in-kind.

Other resources utilized: N/A

Factors essential to implementation: The program partially credits the success of the maps to careful

    planning and testing to ensure that the messages were clear for the desired audiences. To this end, WI CLPPP pilot-tested the materials with nurses, health educators, and sanitarians from local health departments’ lead program staff. The state is currently exploring the feasibility of offering online access to GIS mapping, through which the public would be able to customize maps of lead data in combination with various other types of data.

Limitations/challenges/problems encountered: None mentioned.

Magnitude of Impact/Potential Impact: Wisconsin created maps with 3 views for all of its 72 counties

    and the larger cities, enabling them to show separately the areas with low (0 30 percent pre-1950 housing),

    medium (30 60 percent), and high (60 100 percent) densities of older housing. The resulting maps were

    powerful communication tools showing strongly that those with lead poisoning are predominately found in the areas with the highest proportion of pre-1950 housing.

    Although the maps were relatively straightforward in the sense that they only mapped one familiar risk factor (age of housing), feedback on the maps has been universally positive, with continuing requests for customization. At least one jurisdiction used them to target properties for HUD lead hazard control funding, and the city-level maps positioned cities for collaboration and communication about the use of Community Development Block Grant (CDBG) funds for prevention. Even private managed care organizations have requested detailed maps for their service areas, as they reportedly do not have GIS capability themselves. An unsolicited feedback letter from an insurance company requesting additional maps commented that they “were

    a real visual learning experience for our head Pediatrician and, interestingly, … his nurse [said] they are now doing lead testing

    at 12 and 24 month [well child] visits. So the visual is a real WOW to nonbelievers.”

Potential for replication: Moderate

Contact for Specific Information

    Reghan Walsh

    Health Education Specialist

    WI Childhood Lead Poisoning Prevention Program


References for additional information

    WI CLPPP has various program documents available in either hard copy or electronic form upon request, including project descriptions and sample maps.

Centers for Disease Control and Prevention 3

    Building Blocks for Primary Prevention: Protecting Children from Lead-Based Paint Hazards

    Targeting High-Risk Housing



    In March 2002, the U.S. Department of Housing and Urban Development (HUD) contracted with the National Center for Healthy Housing (NCHH) to develop an interactive, web-based lead database that utilizes “real time” information and mapping capabilities to display housing and blood lead information

    related to lead hazards. NCHH has partnered with Abt Associates in Cambridge, Massachusetts to do the technical development of the database system and website. As part of HUD’s strategy to eliminate childhood

    lead poisoning by 2010, this system is a demonstration project for other jurisdictions interested in using their local data in a similar way.

    The website provides visitors with a number of choices of data sources and presentation modes. For example, visitors can view maps of EBL data by neighborhood, or lead or code violation data for a specific address, and plot lead risk factors by zip code, census tract, or other geographic areas. The system is designed to allow user to interface seamlessly with multiple local databases to target at-risk properties for services and education as well as enforcement activities. The system could also assist individual renters and buyers in identifying lead-safe or at-risk housing.

Jurisdiction or Target Area: Nationwide; pilot tested in Baltimore, Boston, and Chicago

Primary Actor: National Center for Healthy Housing, with Abt Associates

Secondary Actor(s): N/A

    Staffing utilized: The pilot project has required an average of 1 FTE at each site, plus 4 FTEs at the national level, to develop the prototypes for these unique systems.

Other resources utilized: The pilot project was funded through a $3.5 million grant from HUD. Current

    funding will support the site through 2004. The project partners are currently seeking federal, state, and private funds for ongoing support of the system. Estimates for the development costs for local jurisdictions to replicate and maintain the approach are expected to be well below the costs of initial development. Costs to replicate the system will be affected by local characteristics, including: quality and “cleanliness” of the existing blood lead surveillance, housing, and other relevant data sets willingness and ability of local governments to share property-level information, and technical capacity of the jurisdiction with respect to GIS readiness (e.g., availability of “shape” files).

Factors essential to implementation: NCHH and Abt Associates consulted with stakeholders in each of

    the three cities to determine what data should be included in the database; how that data will be collected, cleaned, and incorporated in the database system; and how it will be maintained over time. Stakeholders included local and state health and housing agencies, community groups and advocates, health care providers, nonprofit housing organizations, and others. As a result, six key features were selected: “real time” health and housing data; one location for health and housing data; housing data at the address level; health data at a higher level of aggregation; mapping capabilities; and links to other websites containing useful information.

Limitations/problems/challenges: Overcoming concerns of property owners, the local real estate industry,

    and the health department over privacy issues required problem solving. As a consequence, all blood lead data is aggregated at the block group level and is not viewable for specific addresses. And, if fewer than 25 children are included, then the blood lead data is not displayed at all.

Magnitude of Impact/Potential Impact: The project has been piloted in Baltimore, Boston, and Chicago.

    Comprehensive, “real time,” address-specific data is a distinguishing feature. Address-level information will help localities focus their efforts and target resources toward the areas of greatest need.

Centers for Disease Control and Prevention 4

    Building Blocks for Primary Prevention: Protecting Children from Lead-Based Paint Hazards

    Targeting High-Risk Housing


    Potential for Replication: Moderate. The conceptual and technical development supported by HUD’s pilot project can greatly facilitate local replication if the resources to sustain and accurately update the information

    systems are in place at the local level. Cost estimates for replicating the approach are forthcoming.

Contacts for Specific Information

    Rebecca Morley Pat McLaine

    Executive Director Assistant Director for Program Management

    National Center for Healthy Housing National Center for Healthy Housing 410-992-0712 410-992-0712

References for additional information


    Centers for Disease Control and Prevention 5

Report this document

For any questions or suggestions please email