Jalisco is one of the 32 states (departments) of Mexico. It is located in the Central Western area of the country and it is the 7th biggest state in Mexico with an area of 78,588 km². Jalisco has 125 municipalities (counties), a population of more than 7.3 million people distributed in urban (87%) and rural (13%) areas, and ranks as the 4th most populated state in the country (6.5%). There are 3,750,041 women (51%) and 3,600,641 men (49%) in Jalisco, with a mean age of 25 years. In 2013, the gross domestic product of the state represented 6.4% of the country’s total.

While the main scope of the atlas is the state of Jalisco, its analysis units are the municipalities. There are 125 municipalities in the state with a mean distribution of 93.5 inhabitants per km². The municipality with the largest population is Guadalajara with 1,495,189 inhabitants on a surface of 187.91 km², only 0.23% of the state’s surface. The least populated municipality is Ejutla with only 2082 inhabitants on a territory of 472.21 km², representing 0.60% of the state’s surface. Ejutla has three times more surface than Guadalajara and a population density of 4.42 inhabitants per km², while Guadalajara´s density is of 7957 inhabitants per km². Thus, a great disparity in population distribution exists in Jalisco [20]. More than 50% of the population lives in only five municipalities: Guadalajara, Zapopan, Tlaquepaque, Tonalá (central region), and Puerto Vallarta (north coast region), with 1.49 million inhabitants in Tonalá and only 250,000 in Puerto Vallarta.

The atlas is divided into seven broad, health-related themes, where three of them (mortality, morbidity, and health infrastructure) are direct health indicators and four of them (demography, socio-economy, education, and living condition) are general health-related indicators. Each of the seven themes are composed of different health indicators (referred to as variables in the atlas) and broken down as follows: (1) demography (36 variables), (2) socio-economy (18 variables), (3) mortality (43 variables), (4) morbidity (59 variables), (5) health infrastructure (3 variables), (6) education (18 variables), and (7) living conditions (79 variables). Each variable generates a thematic map resulting in seven thematic maps and a total of 256 variables.

Most of the variables are represented in absolute numbers while some are shown as percentages, and a few as rates. The variables are not all represented in the same format because they were received them from the HMJ and the NISGI, and because we did not want to change the data so it reflected the real situation of the state according to those institutions.

There are two major regional divisions in the HAJ: the 12 sanitary regions made by the HMJ, and the 13 planning regions made by the Jalisco´s State Planning Office (JSPO, COPLADE in Spanish). The difference is because the HMJ divided the state more than twenty years ago for health service delivery purposes, whereas the Government of Jalisco, through the JSPO, divided the state about fifteen years ago for planning purposes. The regions of both divisions have different municipalities; therefore the results given by the atlas are different too. Given that, the user needs to verify which major division to select in order to receive the adequate information.

The information regarding health indicators was provided by the HMJ, who provided databases in datasheet format corresponding to mortality, morbidity, and health infrastructure of the state, divided by municipalities for the year 2013. In addition, information was extracted by mining the NISGI website [20], and demographic, socio-economic, education, and housing information corresponding to the 125 municipalities for the year 2013 was obtained. The information from both sources was retrieved in datasheet format and then manipulated to feed the GIS used in this project.

The HAJ is a Web-based service that provides a friendly environment for users to interact with health and general data, regions, and categories according to their information needs; the atlas generates thematic maps about the situation of the state for each health indicator and category requested (ie, the total population of the state or of a single municipality, grouped by age or sex). It is capable of generating and displaying more than 32,000 different maps by combining categories, indicators, municipalities, and regions, so users can select the entire province, one or several municipalities, and the indicator that they require. Then, the atlas generates and displays the requested map. Users can then print it or save it in PDF, spreadsheet, PNG or html formats. This represents a very large amount of information for the health ministry and the community of the state. Access to the atlas can be found on its website [21].

The main page of the HAJ (Figure 2) shows an introductory video that explains why the atlas was made and what it can be used for. The video plays automatically when the webpage is opened, but it can be paused or stopped at any time, shown in full screen or in the default small-frame setting. The logos of the institutions involved in the project and the grant credits are shown at the top of the page. The main menu is displayed under the logos. The five main menu options are Homepage (Inicio), Theme Selection (Atlas), Downloads (Descargas), Contact (Contacto), and More Info (Más). Each link takes the user to a different area.

To see the thematic maps users must get to the mapping tool. This can be done by following two paths. The first is selecting the Atlas option on the main menu that opens the Theme Selection page, which shows the previously mentioned categories and a general explanation of each. If a category is selected, the mapping tool on that category is displayed. The second is selecting a category from the submenu in the Atlas option on the main menu, which links directly to the mapping tool to choose data from the category selected.

The site includes a tutorial on how to use the mapping tool; users must select the "More Info" option of the main menu and select the "Extras" option from the submenu. There, the "Video Tutorial" link opens an 8-minute video clip that explains how to use the mapping tool.

Whether the user selects the first or second path, the site directs him/her to the mapping tool. The mapping tool with the Mortalidad (mortality) category in the upper left corner of the screen is shown in Figure 3. There are four frames in the center of the screen. The mapping tool will display information on any element within the frame simply by moving the mouse over that element. Clicking on any element, however, produces a change in the map in the middle, as explained in Textbox 1.

Here, we described how the HAJ was made and how it functions. The HAJ is a Web-based service that interactively allows users to review health indicators such as structure, supplies, processes and the impact on public health and related sectors, in order to request and identify opportunity areas and good practices in health services in Jalisco, Mexico. For example, users may use it to analyze the distribution of vaccines in the state and then make projections by age groups or life dimensions about the needs of the population for general care [23].

The atlas is intended to help the HMJ in (1) reducing the volume of information requests from the health sector of Jalisco; (2) maintaining available data from multiple sources with a different grouping or presentation; (3) presenting in map format a considerable volume of data for users with different interests; (4) unifying health data focalization criteria; (5) facilitating graphic and cartographic data representation; (6) integrating the new technologies for request consultation; and (7) supporting the consultation of data for health decision making.

One of the main interests of the HMJ is to reduce the number of information requests that the Ministry of Health receives every week from the general public, media reporters, and other government sectors. These requests are made through the transparency channels and the ministry is forced by law to answer fast and correctly. The atlas will support transparency, information diffusion, health decision-making, and the formulation of new public policies. Furthermore, the research team intends to promote research and education in public health.

Showing health information in map format helps us to analyze the spatial relations between health and geographic situations (eg, mountains, rivers, and water bodies) that can affect the area accessibility. This action cannot be easily done just by looking at a graphic chart or a table. These topographic elements can sometimes represent important barriers to the resources sent to an area and can represent a delay of hours or even days to reach some communities for the health personnel because they have to travel in small planes or helicopters, by walking or riding a horse.

In addition, displaying the health situation in a map can help the authorities to make decisions on a sanitary region or municipality that are more or less affected by a disease. This can be done, for example, by putting over a transparent layer with financial information or human resources that are closer to the areas in trouble. Finally, spatial-temporal analyses can show how conditions can change over time to find tendencies or future perspectives.

Although we tried to gather the main health indicators, it is very difficult to have all of them because of confidentiality issues. The HMJ is very careful about releasing health data, in order to protect its users and personnel from information misuse or abuse. We were very clear on this matter and we only published a data collection from official sources and after receiving the authorization from the Ministry of Health.

Moreover, the service is not yet finished because users cannot generate an output map in PDF or JPEG format directly from the mapping tool. Instead, we created the Download section to make some maps available, but they may not comply with user needs. We will continue to work on these issues.

Another limitation is the level of aggregation. Here, we worked at the municipality level but the basic geographical-statistical areas (AGEB) level or blocks would be better. However, we are not sure if the data records at the HMJ are complete at those levels. In a second version of the atlas we are planning to work at the AGEB level, but then we will work with NISGI´s records. They make a population census every five years that gathers information at the house level, and we will try to reach that level.

Different researchers have studied the use of GIS and/or Web-based maps and its usefulness has been proved as an accepted method to provide information to users and to support health decision makers in providing a better service [24]. As Wong and colleagues [25] have demonstrated, GIS have important implications for improving public health; they developed a system that keeps track of public water sources to make decisions on managing water systems. Though their system was not specifically an atlas, it provides geographic information through maps that show water system boundaries and support authorities in decision-making.

In Latin America and Spain, most of the atlases have been developed to analyze the mortality situation of the respective countries. Ocaña and colleagues [8], for example, developed the interactive Atlas of the Andalucía region in Spain. This atlas is very similar to the one we created in that it displays a series of maps focused on mortality rates from that region, and compares them to the rates of the entire country. It is available on the Web and intends to help evaluate interventions and identify territorial inequities in resource distribution. It was reported as the first interactive mortality atlas in Spain.

However, Colombia [12] and Bolivia [15] each developed health atlases that show not only mortality information, but also health indicators in general. They show health, social, and economic information in order to provide an integral perspective of the health situation in those countries as well as indicate the problems shared by several regions or municipalities. Brazil also published its atlas of human development; they published it online, and it shows health information on a municipal scale [26]. This atlas is based on the human development index of the UN and it is intended to evaluate the effect of public policies on the population due to the country’s international agreements and future perspectives. Of note, other atlases available on the Internet are also based in Instant Atlas software [19].

The HAJ was created to quickly review the profiles and tendencies in which health conditions, disease, and death indicators are distributed in the state as well as the services provided in different socio-economic contexts, geographical borders, and political and administrative limits.

These methods have been used recently to support health decision makers and inform the general public. Now, more institutions will be using maps to represent health situations because of its proximity to the analyzed areas [27], especially if researchers plan to use spatio-temporal, and cluster analyses [28].

As Iñiguez and Barcellos say [29], it is time for health geographers to start analyzing the health situation of population groups in a state or a region, which will help authorities to identify the distribution of problems according to environmental and life condition inequities [30]. Indeed, the next step of the research team is to address this.