Big ‘E’ ℠ GDM – Geospatial Decision Making for Public Health

Over 30% of the world's data is generated by the healthcare industry. [1] Open Data initiatives have made health data extremely accessible, and mapping applications like CDC PLACES, the FCC's Connect2Health, and The National Environmental Public Health Tracking Network make it easy to understand and interact with U.S. health data in geospatial contexts.

The problem is that, while place-based health data is abundant and accessible, drawing practical and actionable insights from it is not. The gap between insight and action can be overwhelming when dealing with complex issues like public health. For health organizations that don’t have in-house analytic capabilities, this gap can be insurmountable.

Translating maps into action is not hard because geospatial analysis is hard or because action is easier said than done. Using maps to inform decisions is hard because making decisions about complex issues is incredibly difficult. [2] The factors that must be considered in a complex decision-making process can be many and varied. There could be a number of health-related maps relevant to a public health decision, and these would need to be considered alongside medical science, program capacity, equity assessments, community input, strategic factors, program data, cultural contexts, and more.

How do decision makers process all of these factors and consolidate them into equity-driven decisions? How would they weigh a map displaying health data against grant conditions? How is equity being measured? What likely happens in many public health decision processes is that maps are relegated to a referential role. This may be especially true in problems where a majority of the factors under consideration have no evident spatial dimensions.

But public health is inherently spatial, so any public health initiative in which place-based factors are not integral to understanding the problem is unlikely to produce solutions that are truly targeted or equitable.

We have the data to make place-based analysis the standard for health equity. The problem now is making it feasible for health organizations of all sizes everywhere to translate it into action.

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Figure 1 presents a specific but hypothetical problem that could be solved using S.C. Equity's Big 'E' GDM analysis.

Source: www.policymap.com.

S.C. Equity’s Big ‘E’ ℠ Geospatial Decision-Making (GDM) tool makes place-based analysis accessible to health organizations of all sizes across the continental U.S. 

The SCE Big 'E' multi-objective analysis enables health leaders to conduct in-depth equity assessments alongside strategic analyses, program assessments, community engagement, and more and combine them into a single decision-making process. The results of the decision process are then translated into maps that are able to pinpoint the neighborhoods experiencing the greatest inequity while also reflecting the decision maker’s priorities and project objectives. 

When SCE maps are incorporated into dashboards, the result is a powerful, interactive tool that public health leaders can use to chart their health equity initiatives. Decision makers can use the tool to determine which gaps affect which communities and how severely, how communities with similar socioeconomic profiles may differ across measures, where program outputs overlap with measured gaps, or where there may be opportunities to increase the efficacy and impact of existing projects, for example.

The GDM tool is powered by GIS while the GDM process relies, in part, on techniques from the fields of operations and poverty research, in particular: multiple-criteria decision making (MCDM), multi-objective decision analysis (MODA), structured decision making (SDM), and multidimensional poverty research. 

S.C. Equity’s Big ‘E’ equity assessment, however, is a completely new approach created by Founder SC Reed. It assesses over 100 equity-related indicators in effort to identify groups experiencing the deepest and broadest equity gaps across a wide range of topics relative to the neighborhoods they live in. As a convenience, S.C. Equity offers its Big ‘E’ index to clients, which can they can customize and incorporate into their public health projects. Clients can also build their own Big ‘E’ indices, which are custom-formulated via an exploratory process that is designed to capture decision makers' understandings of the problems and solutions as subject-matter experts. 

Once an organization has their unique Big ‘E’ index map, whether fully custom-built or built on top of the SCE Big 'E' map, it can serve as a basis for all subsequent projects and decision processes. This ensures that every S.C. Equity collaboration has equity as its foundation.

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Figure 2 shows a prototype of S.C. Equity's Big E Index for Philadelphia, PA, as of April 2024 and presents an S.C. Equity solution from the problem outlined in Figure 1.

Source (Figures 2.1 and 2.2): www.scequity.com.
Source (Figure 2.3): www.policymap.com.

Medically underserved communities. Low-access neighborhoods. At-risk populations. 

These are just a few phrases used to describe groups experiencing gaps in healthcare access and health outcomes. We generally understand them to mean: individuals who experience barriers to comprehensive healthcare due to socioeconomic and identity-based marginalization—but do we know who they mean, specifically?

Do we know which road will take an individual to the nearest hospital in the event of a medical emergency? Do we know how many community members require translation services? Can we point out these communities on a map? Can our maps point them out to us?

If our answer to these questions is "no," then we are probably dealing with the concept of health inequity and not with actual health inequities.

When we talk about health inequity, we are, in theory, referring to real communities of real people who have specific healthcare needs that are being unmet due to specific gaps in healthcare access. Two communities considered to have comparable levels of health inequity could have entirely different experiences of healthcare (in)access.

Thus, if we generalize the problems, we can't target solutions. S.C. Equity's Big 'E' ℠ equity assessment is able to build detailed neighborhood equity atlases. When customized and incorporated into public health initiatives, Big ‘E’ GDM enables health leaders to identify and target specific resource gaps that may be creating barriers to comprehensive healthcare for residents in the neighborhoods they serve. Hopefully, this will lead to better health outcomes for impacted populations.

Founder SC Reed grew up in Southwest Philadelphia. Her high school senior project, a data-driven analysis, was on the penetrating effects of race and low income on academic achievement in contexts of improved educational opportunity. She graduated from Stanford University with a Bachelor of Arts in African and African American Studies after nine years of discontinuous and reduced enrollment. After college, Reed worked on lead poisoning with the City of Philadelphia and, later, on coal pollution in the nonprofit sector. 

S.C. Equity was carved out of Reed’s own experiences traversing inequities in education, opportunity, and comprehensive healthcare access as well as her commitment to reducing the same for others. In other words: Reed has been both a problem-solver and a target of equity initiatives, and she is sensitive to the implications of being in each of these roles. 

One way this sensitivity has manifested in the GDM tool is through its scope of analysis. S.C. Equity project maps display data at the neighborhood level (i.e., the Census block group and tract levels) and are limited in the number of places (i.e., cities, counties, states) that may be included in a single project. This choice was made to ensure that the tool would appeal especially to organizations working in closer proximity to their intended beneficiaries.

Reed also makes a point to differentiate between “communities,” “neighborhoods,” and “populations” in her analyses. In doing so, her projects can better accommodate the unique relationships that these groups may have to space and place, to each other, to the issues under consideration, and to the interventions proposed as solutions to their purported problems, including to the problem-solvers themselves.

Feasibility

S.C. Equity has an initial working version of the SCE Big ‘E’ Index (SCEI) of 100+ equity-related indicators (see Figure 2.1). Because SCEI maps can be uploaded to existing dashboard and mapping applications like Tableau, Felt, and Esri, GDM as a strategic tool is already a minimum viable product which has been successfully tested internally.

S.C. Equity secured a data vendor in early 2024, and this rapidly increased the speed of development of the Big 'E' index. Prior to this, development of the GDM tool was limited by the impracticality of researching, locating, cleaning, and managing the large amount of data required to carry out this analysis, which includes over 200,000 Census block groups and 70,000 Census tracts. S.C. Equity is now progressing at a pace it has never seen before and will be able to launch its GDM services in the very near future.

Figure 2.2 demonstrates the utility of SCE’s multi-objective, geospatial decision-making tool for equity-driven projects, but it has not yet been tested by market users.

Viability

Reed researched market interest in Big ‘E’ GDM at nonprofit conferences during the Spring and Fall of 2023, and there was significant interest from nonprofit staff and executives in Big ‘E’ as concept, particularly in the context of Diversity, Equity, & Inclusion (DEI). However, there were notable gaps in readiness to incorporate geospatial analysis into certain types of nonprofit work. GDM appealed in particular to organizations in the social services field, including youth welfare and transportation equity.

Reed herself has first-hand experience working in the public and environmental sectors on place-based issues, and there was expressed need for and interest in maps as part of the strategic planning process in both fields. In her last position, Reed led a large-scale, data-driven strategic planning process which analyzed over six years of program data relating to environmental issues. With the help of her team of support, associate, and managing staff, she built an interactive dashboard designed for frequent, practical, and general use amongst staff. The tool was launched at the annual planning retreat, and there was consensus that the incorporation of maps would have elevated the tool’s already substantial utility. At the time, the program did not have in-house GIS capabilities. S.C. Equity was founded in 2021 to fill need gaps Reed observed throughout her academic and professional careers.

Scalability

Though S.C. Equity frequently uses Philadelphia as a case study, the Big ‘E’ assessment can be readily applied anywhere in the continental U.S. However, S.C. Equity is currently able to offer only a small subset of its planned GDM services due to labor limitations. 

Reed is applying to Solve in order to initiate the journey of growing S.C. Equity to its global potential. 

The primary innovation around Big ‘E’ ℠ GDM is a technique. Therefore, S.C. Equity isn’t tied to any one place, and given the necessary tools and the availability of relevant data, Big ‘E’ GDM could be incorporated into any equity-driven project anywhere in the world.

As the sole member of S.C. Equity, Reed has been limited in her ability to scale S.C. Equity to even its full starting potential. This has been discouraging at times, but with Solve's support, Reed can turn this limitation into an opportunity. Because S.C. Equity is still in the very early stages of its launch, change is easy, new ideas are exciting, and new ways of doing things are just ways of doing things. S.C. Equity is ripe for the valuable learning and capacity-building opportunities that Solve offers.

Within her current vision for S.C. Equity's short- and medium-term growth, Reed is particularly interested in: mentorship; collaborating with bold innovators eager to create a more equitable world; guidance on growing the S.C. Equity team; technical partnerships; and partnerships with experts in local and regional human geography and sociology (e.g., Appalachia, The Black Belt, U.S. Southwest), policy research institutions, and climate equity experts.

1 full-time staff member

Founder SC Reed has been working on this solution since April 2021 (3 years).