Geography Matters: Methodological Issues in Spatial Presentation of Healthy People Data

Healthy People (HP) provides a framework for improving the health of all Americans and provides a blueprint for the nation's public health agenda. Although national in scope, HP is extensively utilized (79%) at the state and local level in community health assessments. Methodological issues in spatial presentation of HP data are of two immediate types: 1) when the national data source differs from the state or local data source; and 2) when the same data source is used for both national and state/local data, but estimates and interpretations vary based on the geographic unit used to analyze or display the data. Type 1 Example: For HP2010 objectives 3-11b (Pap tests) and 3-13 (Mammograms), the national data source is the National Health Interview Survey (NHIS) and the state data source is the Behavioral Risk Factor Surveillance System (BRFSS). For objective 3-11b, BRFSS estimates are comparable to the NHIS estimate (75.6%) and comparisons to the national target (90%) are reasonable. However, for objective 3-13, most of the BRFSS estimates exceed the NHIS estimate (67.1%) and comparisons to the national target (70%) are not reasonable. Type 2 Example: Illustrations of scale and zone effects will be discussed using HP2010 objectives 16-10a (low birth weight <2,500g) and 16-11a (preterm births <37 weeks).