Mapping DiseaseUsing Info-graphics to Chart the Spread of Disease

Max Matthäus

Special thanks to my parents Elke and Jürgen Matthäus

As travel becomes easier humans can

move from one side of the globe to the

other in a matter of hours. This has helped

connect countries and create a diverse

global community; it has, however, also

allowed for diseases to spread at an

alarming rate. In September 2012 a man

from London was diagnosed with a case

of a SARS-like virus, contracted in Saudi

Arabia. (“New SARS-like coronavirus

identified”) “High and rapid mobility of

people is one factor. Airlines now carry

more than 2 billion passengers a year, en-

abling people and diseases that travel with

them, to pass from one country to another

in a matter of hours. The potential health

and economic impact was seen in 2003

with SARS, which cost Asian countries an

estimated US$ 60 billion of gross expendi-

tures and business losses” (“International

spread of diseases”).

And so it begins...

In September 2012 a

man from London was

diagnosed with a case

of a SARS-like virus,

contracted in Saudi Arabia.

You cannot open a

book without learning

something.

Confucius

The spread of disease from influenza to

Ebola may be tracked on info-graphics. By

analyzing the audience, medium, type,

color and image, information can be

effectively communicated to a specific

viewer. Though one must keep in mind that

when designing info graphics: “Confucius

famously wrote, ‘You cannot open a book

without learning something’… Confucius

may have offered us some theoretically sage

advice, but in this case he was wrong. De-

spite his wisdom, he ignored two diamet-

rically opposed facts of human nature: 1.

People like knowing things. 2. People hate

learning things” (Casey 9).

Different readers or viewers expect different information

when looking at an info graphic. The average newspaper

reader wants a basic overview of the disease and its effects.

A scientist will need more information. The newspaper

reader wants to know where the disease originated; a

scientist will want to know the cause and spread of the in-

fection. “The conventional sentence is a poor way to show

more than two numbers, because it prevents comparisons

within the data. The linearly organized flow of words,

folded over at arbitrary points (decided not by content but

the happenstance of column width), offers less than one

effective dimension for organizing the data” (Tufte,

Quantitative Information 178). This makes it less than

ideal for the average viewer to figure out what the author

means when presenting data. Someone in a less developed

country will want to know how to prevent infection or

Audience

The conventional

sentence is a poor way

to show more than two

numbers

what to do in the case of infection. A designer would need

to consider lower literacy rates and a population that does

not speak a common tongue, or differing dialects of the

same language.

The methods can also differ, choosing between print and

digital deliveries. For audiences in third-world countries

digital presentations are out of the question due to the lack

of technology and electrical power. For other

audiences digital may be ideal as one can fit a lot of infor-

mation onto a website or an app. It can be kinetic, swapping

out data sets over a map, or comparing two kinds of graphs

to see the differences in spreads in different countries.

However, print can reach a fairly wide audience, while

containing all the necessary information; posters can be

posted at the local shop to warn about not walking in

ponds barefoot to stop ringworm infections. Textbooks

are useful in schools that have a limited budget. Textbooks

can provide maps and graphs, as well as background

information on what these maps mean.

Fig.1Contagion — Haisam Husseian

A map without adequate information is use-

less. (Just seeing an arrow point from Tunisia

to Italy could mean any number of things,

Hannibal’s invasion of the Roman Empire

to the influx of illegal immigrants in recent

years crossing the Mediterranean Sea.)

Maps can hold a relatively large amount of information

and different sets of information regarding the topic of the

map. “When components are numerous, we will speak of

a ‘set of information’. It is useful to analyze it as a whole

and to consider the finite set of components in order to

determine the most efficient and economical processing

system”(Bertin 32). Meaning that the amount of data on

a map varies and that we need to change the way we take

in information depending on how the information is

arranged on the page.

The main strength of maps is that they give the viewer a

visual aid and a sense of the scale. The map by Haisam

Hussein (Fig.1) is called Contagion. The map shows how

smallpox and leprosy spread across the globe from Africa.

It also shows areas that are effected by malaria. The main

focus of the viewer is on the red and blue arrows that show

the spread of the disease. As Edward Tufte, a statistician

and retired professor who has written multiple books on

data visualization, said: “When nouns are linked together

by arrows or lines, a change in the level of analysis often

takes place. Sameness of a visual element implies sameness

of what the visual element represents, as if the identi-

cal process operated between every pair of connected

nouns”(Tufte, Beautiful Evidence 70). The red and blue

arrows connect the white dots of information that give

historical data. The arrows seem to creep across the map

spreading their veins into the different areas that they

reach.

Maps

The arrows also grow thinner the further away they get from their source,

though it is no indication as to the actual strength or speed of the spread.

The use of red and blue can be seen as veins in the human body,

especially when they spread into little tendrils near the end of the spread.

It is odd though as the little tendrils seem somewhat arbitrary as they

start to spread while the arrows are in the middle of the ocean, and in

areas where there are no islands to host them. It may be showing that the

ships spread the diseases across the eastern coast of the

Americas, but the tendrils end shortly after they began.

Each of the arrows also has dots in them that signify cer-

tain important events that happened in history. However

the way that this is indicated is done rather sloppily, as

the distance to the starting point is not necessarily an

indication as to the time, rather the times are mixed in

between distances. The way that the historical facts are linked to the dots

is somewhat unclear, as the lines go both above the arrows and below

them at differing heights and using only very thin lines to connect them.

It may have been better for leprosy information to be at the top of the

page, and the smallpox information under the arrows, or vice versa, just

“Sameness of a visual

element implies same-

ness of what the visual

element represents.”

`

to have some consistency when looking at

specific areas. The different diseases can

also be identified by the symbols that are

used to represent them; there is a hand that

is losing fingers to show leprosy, a body

covered in spots to represent smallpox, and

a mosquito to portray malaria.

“The first problem is that of the design of

the symbol so that it is instantly recogniz-

able. Will a symbol locating something be

the same as the symbol making a quantita-

tive statement? For example, a shaft locates

the coal mine. To show production does

one repeat numerous mine shafts or use a

symbol of a lump of coal?” (Lockwood 70).

The symbols are showing what the disease

does effectively and it assumes knowledge

about the disease. The use of a hand losing

fingers is using a common misconception

of the disease to represent it, as leprosy

does not cause limbs to fall off, rather it

causes numbing of appendages and some

tissue loss. This is acceptable however, as

people often understand this misrepresenta-

tion better than the actual facts, as the facts

may be harder to represent so that one can

understand the meaning.

The area representing malaria is a pale

yellow that is cross hatched over equatorial

areas. One barely notices these areas with

all the saturated red and blue lines running

across the map. The type in the image is too

small to serve its purpose effectively. It is

a serif typeface that gives it a more official

connotation, but also makes it harder to

read at such a small size. Often it is con-

densed into small areas with a very busy

background, such as the information on

Alexander the Great bringing leprosy from

India to the Middle East.

As Tufte states: “Good design… can dispose of clutter and

show all the data points and their names” (Tufte, Beau-

tiful Evidence, 119). This would remove the information

out of the way of all the arrows making all of the text and

graphics easier to read. The small type over the Saudi

Arabian peninsula and malaria area in the Middle East, as

well as red and blue arrows circling the text with tendrils

stretching into the type area makes it very difficult to focus

on reading what the text says.

Fig.2World Health OrganizationPublic Health Information and Geographic Information Systems

The Contagion map is in contrast to a map

by the World Health Organization (Fig.2)

which shows the quantity of reported cases

of malaria in 2010. There is a clear color

hierarchy as to the areas affected. The

green stands out from the reds as areas that

are affected by the epidemic, and the red

scaling shows how intense the infection

is. Though it does not show spread it does

give clear information when one compares

the rates in different countries and areas.

A good example of showing spread over

time is (Fig.3) where the affected areas are

clearly labeled and one can see the speed

and intensity at which the radiation spreads

across the Pacific. (Fig.4) effectively shows

how the Black Plague spread across Europe

in five years.

Fig.3Australian Radiation Services

Fig.4Philip’s World Atlas of World History

Using shades of green from high intensity to low, the map

shows areas affected by the Plague in different years, and

areas not affected in a highly contrasting orange. “The

success of grey compared to more spectacular color shows

us how multifunctioning graphical elements can commu-

nicate complex information without turning into puzzles.”

(Tufte, Quantitative Information 140)

Fig.5Tracking a century of global expansion and evolution of HIV to drive understanding and to combat diseaseDenis M. Tebit, Eric J Arts

Though the map is not grey, the greens are neutral and allow the addition

of lighter details, such as rivers and city names, without distracting the

viewer with bright colors. These unaffected areas are small so the dots

of orange do not draw the attention of the viewer too heavily. The area

near Nürnberg is the first thing that the viewer notices, as it is somewhat

centered, and larger than any of the other unaffected areas. The addition of

the major sea routes gives a viewer the chance to see how sea travel affected

the spread in the major port cities. A worse example can be seen in (Fig.5),

where the map tracks the different strains of HIV across the map. There are

seven different colored arrows, coming from a small portion of the map

and going in different directions. There is no clear direction for the eye to

follow, as the arrows are large, and so brightly colored. It is very difficult to

follow an arrow to its end without being distracted by the one next to it.

The type is the same color as the arrow, has no hierarchy, and runs into

itself. The type gives the name of the strain of the HIV virus, and where it

spreads. Where it spread to, and when, should not be listed on the arrow,

as the arrow shows where the strain spreads to, and listing it again is re-

dundant. There is also a timeline at the bottom that does not seem to have

any relation to the arrows, as it does not have the colors associated with it.

Overall it is just a jumbled mess.

Fig.5Tracking a century of global expansion and evolution of HIV to drive understanding and to combat diseaseDenis M. TebitEric J Arts

Info Graphic

Scale in info graphics can be expressed in many ways, such

as using images to present the message rather than words or

numbers. “We have no choice but to be drawn to images. Our

brains are beautifully wired for the visual experience. For

those with intact visual systems, vision is the dominant sense

for acquiring perceptual information. (Malamed 9). Info

graphics are very popular, as they give viewers information

without requiring them to read a wall of text. “There are lots

of opportunities to intensify the resolution of scientific data

graphics, since many are cartoonish and low resolution”

(Tufte, Beautiful Evidence 53). The ways to present the

information effectively is much wider, as it can range from

graphs that, for example, show Napoleon’s Russian campaign,

comparing time to the soldiers remaining to the falling

temperatures (Fig.6) the map uses two basic colors to show

the journey to Russian in brown, and back, in black.

Fig. 6Napoleon’s Russian Campaign

by: Charles Joseph Minard

Along the route the artist, Charles Joseph Minard, added

the number of soldiers who were left in the army, with the

path growing ever smaller the further Napoleon got in

the campaign. The colors are effective as the light brown

makes the journey stands out, but not so that the viewer’s

eye is focused on it, this allows for the journey back to

have equal weight, and also leads the eye back into the

image. The text is a script typeface that gives the graphic

a hand-drawn impression, which also fits the simple lines

that indicate borders. Some of the type is rather small so

that it can be hard to read because it is sideways and very

light. The main piece of type that pops out to the viewer

is ‘Moscow’ in the far right edge of the graphic, as it is

in a bold serif that pulls the eye towards the end of the

campaign, and also shows that it is the goal of Napoleon’s

march. At the very bottom of the page are the falling tem-

peratures for the march back.

They are a bit hard to notice as it is at

the bottom of the page, with only very

thin lines connecting it to points on the

march back. The map was clearly made for

someone who has prior knowledge of what

happened during the campaign, as though

some information is given in the descrip-

tion, it is more of an overview. Those who

know what happened would find it inter-

esting to see where Napoleon lost chunks of

his troops and how cold effected casualties.

A similar graph would be “The Spread

of Disease in 14th century Europe” by

Rebecca Williams (Fig.7). It has three

distinct sections that relate to each other

in certain ways. The categories are named

in the title, with a bracket and arrow next

to the word that is the title of the category.

The three categories are: spread, disease,

and Europe. The spread is a sea-foam green

that shows what affected the spread, with

the main topic being an “increased human

interaction between cultures”, which breaks

down into war and trade. These categories

then also link to disease, which shows the

carriers and effects of the Plague, and also

to Europe, which shows what was going on

in Europe at that time.

Fig. 7

“The Spread of Disease in 14th century Europe”

by: Rebecca Williams

All of the type is in a serif font, that gives for a consistent

look, with the only other typefaces for the title of the topics.

This display face is used to remind the viewer of typefaces of

the 14th century, of illuminated manuscripts and wood block

movable type. All three of the categories are equal color-wise,

as they are all the same tone of their respective color.

The arrows that link the different categories are clear to

follow, as they do not intersect too much, or stretch across

the entire graphic. All the arrows give reasons for the link,

such as between ‘religious lost faith in church’ and ‘plague’

the arrow is labeled ‘because of ’. The arrows seem to create

sentences that allow the viewer an easier intake of the

information. For example, a sentence followed from start

to finish would read something like this: “Europe/ suffered

major decline in/ population/decreased by/ 75 million/

mass deaths/ resulted in/ overflow of dead bodies/ mass

disposal/ cremation”. Everything is linked so that some

things would not make sense if taken out of the context,

“Mongol Warriors”, for example needs a context to relate

to why they helped spread the Black Plague. “A pattern

performs best when it represents a single idea and not

the complex layering of multitude of patterns. I believe

The red of disease is more a muted orange that creates

a good contrast to the black silhouettes of the plague

carriers, and the white text. Europe is represented by a

lime green which is much colder than the sea-foam spread

category.

there are maps that don’t occur on paper. There is a map

in your mind, a mental map. There is a map memory that

speaks about remembered relationships” (Wurman 14).

This mental map can be used in this info graphic as the

mind connects all of the sentence fragments and different

categories that link one another.

Fig. 8Life Cycle of the Guinea Wormby: Al Granberg for the Carter Center

A different style could also be shown as images such as the

info-graphic about the lifecycle of the Guinea worm and

its use of humans as hosts (Fig.8). Images are effective in

telling the viewer what is happening at a glance, conveying

emotion and tone. “Pictorial representations are not neces-

sarily ‘easier’, rather, they are more concise, more compact,

clearer and when well-done, more compelling” (Mijkse-

naar 30). (Fig.8) uses a sans-serif font as it is less formal.

People can relate to it and not see it as an image from a

text book. The path the eye should take should be clear as

it is indicated by the desaturated red arrows. Again, even

though the arrows are red, they do not jump out of the

image, distracting from the content. The circles show what

happens inside the body of the host, but they also distract

from the clear order, as one easily skips over step three, to

see what the other circles mean. But even without reading

the steps it is clear what happens, is good for countries

with low literacy.

Fig. 9How Stuff Works

The way the information is read can largely

depend on how the information is presented.

The colors can be a determinant of the viewers

focus. If one were to make a large field of red

in Southeast-Asia and a smaller blue field in

Mexico that is partly opaque, the viewer will

focus on the bright red field and want find out

why it is red, only later looking at the blue as

they study the rest of the map.

Other examples of this can be seen in (Fig.

9-10). Where the use of image explains some

outbreak, or how a disease works. These

graphics do need more type as the process is

more complex and the relationships between

the different subjects need explaining.

Fig.

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This is also true when showing different levels of a map.

If you show the topography in subtle shades of blue and

brown you can place lines over it to show other changes

on the map, but if you have high contrasting colors to

show the different heights people will only focus on the

colors and not the context in which they are represented.

Sure they show the heights, but what do heights mean for

the viewer? Are the heights by themselves unimportant?

(Tufte, Visual Explanations 77) “By indicating depth

with visually minimal gradations in color the cartogra-

phers were able to add an extra two-dimensional layer of

grey-line data right on top of the ocean contours. Minimal

differences allow more differences” (Tufte, Visual Expla-

nations 76). In addition to the color you also have the

choice of typography used. Often serif typefaces are used

to give a more official look to information, but info graphs

on posters or handouts often use sans-serifs for a more ap-

proachable feel. Lastly, the images used in the info graphs

can convey the message. When you want to be informative

and get people to understand you would use an image like

(Fig. 8). It may disgust some viewers, but the message is

clear and gives an understanding of the organism that can

live inside the host for about a year. There is a clear cause

and effect, from the drinking of the water, to the worm

coming back to lay eggs in that drinking water. All of these

factors affect how the viewer will move through and react

to info graphics presented to them, and how useful they

can be.

Fig. 8Life Cycle of the Guinea Wormby: Al Granberg for the Carter Center

Conclusion

When looking at options to present data through images

it is important to identify the purpose of the data and to

apply the proper presentation so that the data. “Excellence

in statistical graphics consists of complex ideas communi-

cated with clarity, precision and efficiency. Graphic displays

should: show data; induce the viewer to think about the

substance rather than about methodology, graphic design,

the technology of graphic production, or something else;

avoid distorting what the data have to say; present many

numbers in a small space; make large data sets coherent;

encourage the eye to compare different pieces of data;

reveal the data at several levels of detail, from a broad over-

view to the fine structure; serve a reasonably clear purpose:

description, exploration, tabulation, or decoration; [and]

be closely integrated with the statistical and verbal descrip-

tions of a data set.” (Tufte, Quantitative Information 13)

To show how a disease spreads requires different data sets.

And to show the information most effectively one needs

to know the target audience. All of these sets are of equal

importance to understanding how a disease

can become wide spread, but the sets need

to be tailored to a specific audience. The

effect that air travel has on the way a disease

moves can be linked to how markets react

to an epidemic. However some viewers

would be more interested in how travel

is related to how population centers can

become focal points for a disease.

In graphic design the use of color is important, however it

is even more so when creating maps. The need for hierar-

chy is important as there are so many more layers at play.

When designing a poster or other piece, there are usually 4

or 5 different layers of hierarchy between the headers, body

copy, and the image. However, with maps or info graphics

the image takes presedent over the other elements, as that

is what conveys most of the information. There needs to be

many more layers with in the image so that the viewer can

move through the information effectively.

The information within requires the most attention as that

will be looked at the most. Within print it more difficult

as one cannot turn on or off certain elements with a tap of

a button. The information needs to be legible, and unlike

other elements of the design should not be messed around

with to create a certain aesthetic. If, for example, one gives

the title of the poster a distressed look or changes the

kerning in order give it a certain style, this should not be

carried over to the info graphic. This information is for an

educational purpose. Though it could be used as a promo-

tional piece to draw interest in the topic, that is not the key

function of the piece. It is there for students, scientists, or

those who live in a region affected by disease find out how

this disease functions and not to draw sponsorship.

-In the book The World Reduced to Infographics

by P. Casey and J. Miller, the authors theorize that

“People like knowing things, but hate learning them.”

How do images in info-graphics contribute to learning

the information?

To the Casey/Miller quote (it’s deliberately a fun-

ny book, so i wouldn’t quote from it too much in an

academic paper...not that there’s anything wrong with

humor) i’d add: “...but people really like pictures,”

and I have always traded on that simple fact. Wil-

liam Playfair (inventor of the bar chart, line, or

fever, graph, and pie chart) wrote in c.1800: “charts

are pictures of information; they show trends. If you

want the actual data, refer to the tables I (Play-

fair) used when making the charts.” (i’m paraphras-

ing, but that was his gist.) So in this sense, ALL

infographics are images (as opposed to pure data).

But adding images that are not data is what I’m in-

terested in.

Interview with Nigel Holmes

Nigel Holmes is a graphic designer and illustrator who has

specialized in information design, working for Time magazine,

while also doing many freelance jobs for large companies such

as BMW and National Geographic

However they must be images that help the reader/

viewer understand more about the subject of the chart or graphic.

Purely decorative, random clip art is not generally helpful, and it

muddles the message. So the answer to your question is this: yes,

the right images contribute immensely to understanding the informa-

tion.

-The image attached is one I used in my paper, but I was wonder-

ing what your take is on it, how the use of color, images, and the

layout affects the composition; and to which audience would this be

most appropriate for?

I’m afraid there is so much wrong with this image, that it would

take me too long to go through them all. But you can use that as a

good starting point for your discussion. There are small but sig-

nificant mistakes: “Europe” (in red box) has an arrow pointing TO

the “Far East”, with the word “from”; we know what’s intended, but

it’s anti-intuitive. The whole idea of an arrow leading from one

item to another is used in different ways here; most arrows are

used to connect one thing to another with a directional intention,

but in other cases the direction is reversed. A second example:

the little chart about population is labelled “the rapid rise...

deaths,” but the line is a downward slope. What is charted is the

decrease in population, so the title should be “the rapid decrease

in population due to plague.” Above it is a green box that says “75

million.” Is this referring to the chart below? that shows a de-

crease of 25 million, since it starts at 50, not zero. Lots more...

I suggest you look hard at the piece, and be very critical. It

could make for a good, strong piece. I’m sorry if you are using

this example because you think it’s good, and have already done

most of your work; I’ll leave it up to you to ignore what I’ve said

about it. Just be aware of the mistakes, and see if your professor

has anything to say.

-When designing pieces about subjects that are not visible to the

human eye, what is the best way to present information about dis-

eases and other abstract ideas into info graphics?

Most things do actually have a visual equivalent, or can be illumi-

nated with a metaphor. In the example you sent, there are many pic-

torial opportunities. The organisms, the geography, old engravings

of the plague, and so on. (You should redesign it!)

-In your piece “The Carbon Bathtub” for the National Geographic,

who did the target audience (if there was a specific one) and me-

dium in which it is presented affect your design choices. How does

the way your pieces are presented (online or magazines or posters

or newspaper) affect the way you approach a design?

People give me jobs these days because they want my take on it...

and that’s usually going to include images of some sort. They don’t

want a piece where the data is visualized in an abstract way, how-

ever beautiful that might be in someone else’s hands. The carbon

bathtub was an obvious gift, of course: a phrase in common use that

has a direct visual idea attached to it. But in other cases, my ap-

proach has potential pitfalls: that an information designer should

have ideas about the good or bad aspects of a data set (and who is

willing to include them in some way in the graphic) can lead to

charges of bias, or at least of opinion. And many say this has no

place in information graphics.

So this brings me to your question about the audience. It

matters a lot. While most of my work is pictorial in some way,

there a plenty of times when it’s just not appropriate (and it’s

the same with humor.) Magazines generally have been more relaxed

about pictures in charts; books are in the middle of this pictori-

al-to-abstract spectrum; academic papers are right at the abstract

end...but I think this is a pity: scientists and other academics

are just as likely to need help in understanding even their own ar-

eas of interest as the general reading public is in reading every-

day statistics and other data. So who the audience is does affect

the way I work. At the pictorial end, my mind is split between the

picture and the data (and it’s sometimes a struggle!); but at the

academic end, i’m just thinking about the numbers. In all cases,

pictorial elements should never outweigh the information, they are

there to help.

And remember, there is a natural bias in any selection of numbers,

anyway. It’s called editing! What gets chosen to be included or

excluded from a chart is freighted with the opinions and views of

the chooser (editor or designer), so I have never shied away from

putting my ideas into a chart, given that the choice of numbers is

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