No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
A comparative analysis of transportation-based accessibility to mental health services
Abstract
The demand for mental health services has been growing stronger over the last couple of decades. This indicates the need to study and assess the access to these mental health services especially with a focus on the vulnerable populations having the greatest need. As such, this paper presents a Geographical Information Systems (GIS)-based analysis in order to study and evaluate the accessibility of mental health facilities using the information on the spatial distributions of population and facilities, and regional traffic characteristics. For this purpose, different age group segments are utilized including the total population as well as those aged between 18 and 21, 22 and 49, 50 and 64, and those aged over 65 and 85. Focusing on the State of Florida, spatially detailed accessibility metrics are calculated with regard to healthcare facilities using travel times between population block groups and these critical mental health facilities. These estimates are used to calculate the weighted county accessibility scores for each county. Findings clearly delineate those counties that lack access to mental facilities, especially those in Northwest Florida, a demographically diverse and substantially rural region. This type of analysis can help planners and policy makers develop better strategies in order to provide adequate mental health care options needed in targeted locations.
... Since accessing mental health services is the pre-condition for service utilisation, and service shortage could lead to low level of utilisation, it is important to explore the potential access to mental health services for Indigenous populations. The potential access to mental health services could involve individuals who need the services, the way individuals travel to access the services, and the types of services available to individuals [22]. Potential access can be measured as geographical accessibility, namely the extent of individuals' potential access to available services within a specific geographical area [23]. ...
... The use of spatial techniques such as Geographic Information System (GIS) has also progressed from simple mapping to spatially explicit modelling of accessibility to uncover how individuals access health services through the built environment they live in, with outcomes contributing to assisting government authorities in identifying disparities in the provision of health services [28,29]. Given the different needs of health services by people with different demographic and socioeconomic characteristics, it has attracted scholarly interest to measuring geographical accessibility to health services for various population groups (e.g., by ages [22] and income [25]). Methodological advancement has been made in measuring geographical access to health services in recent years, and the outcome being used to support decision-making relating to health service allocation [30]. ...
... More recently, Tadmon and Bearman employed the 3SFCA method to measure accessibility to psychiatrists and psychotherapists, identifying a misalignment between mental healthcare access and the need in the USA [27]. In addition, Ghorbanzadeh et al. used a measure of population-weighted travel time to the closest facility to examine mental healthcare accessibility for various age groups at the county level, focusing on seniors as a vulnerable group that may require more mental health services [22]. Jin et al. utilised a Gaussian-based 2SFCA method to assess the accessibility to multi-tier health facilities for different income groups in China, using the average housing price (i.e., RMB per square metre) in each kilometre grid as a proxy of income levels when mapping income groups [73]. ...
Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations’ mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.
... In addition et al. [72] refer to "competition-based" assessment at transport nodes. For further di sion of approaches to accessibility measurement, readers are referred to, among ot these authors [9,24,25,68,[88][89][90][91][92][93][94]. ...
... In addition, Sun et al. [72] refer to "competition-based" assessment at transport nodes. For further discussion of approaches to accessibility measurement, readers are referred to, among others, these authors [9,24,25,68,[88][89][90][91][92][93][94]. ...
The significant climate change the planet has faced in recent decades has prompted global leaders, policymakers, business leaders, environmentalists, academics, and scientists from around the world to unite their efforts since 1987 around sustainable development. This development not only promotes economic sustainability but also environmental, social, and corporate sustainability, where clean production, responsible consumption, and sustainable infrastructures prevail. In this context, the present article aims to propose a development framework for sustainability in food sector SMEs, which includes Life Cycle Assessment (LCA) and the integration of Environmental, Social, and Governance (ESG) strategies as key elements to reduce CO2 emissions and improve operational efficiency. The methodology includes a comparative analysis of strategies implemented between 2019 and 2023, supported by quantitative data showing a 20% reduction in operating costs, a 10% increase in market share, and a 25% increase in productivity for companies that adopted clean technologies. This study offers a significant contribution to the field of corporate sustainability, providing a model that is adaptable and applicable across different regions, enhancing innovation and business resilience in a global context that requires collective efforts to achieve the sustainable development goals.
... Heavy traffic, especially at peak times, increases the travel cost to healthcare services, influencing the accessibility of healthcare facilities in the city center [32]. It has also been shown that public transport (PT) [33], income [34], the population distribution [35,36], and demographic statuses [37] affect access to public services. To evaluate the equity of access to healthcare services, it is essential to analyze whether and to what degree the difference in healthcare accessibility aligns with variations in both spatial and non-spatial factors [38][39][40][41][42]. ...
... To be consistent with previous studies [26,28,[30][31][32][33][34][35][36][37], four categories of variables were used in this research: (i) location characteristics reflecting the geographical advantages; (ii) neighborhood characteristics representing the surrounding environment; (iii) income characteristics affected by regional development and the strength of the economy; and (iv) population characteristics considering the health needs of various groups. The specific indicators are summarized in Table 1. ...
It is essential to understand the spatial equity of healthcare services to achieve the Sustainable Development Goals. Spatial and non-spatial factors affect access to healthcare, resulting in inequality in the hierarchical medical treatment system. Thus, to provide a comprehensive equity evaluation, it is indispensable to investigate the extent to which spatial accessibility to healthcare services varies due to various factors. This study attempted to analyze the determinants of healthcare accessibility under multi-trip modes and integrate them into Theil index, as a demand index to evaluate spatial equity in the system. The results reveal an inadequate and inequitable distribution of healthcare resources. While access to primary hospitals is limited (47.37% of residential locations cannot access them on foot), 96.58% of residential locations can access general and tertiary hospitals via public transport or driving. Furthermore, inequitable access to the three-tiered medical system was evaluated on a more granular scale, with primary hospitals being closest to achieving equity (inequitable for only 48.83% of residential locations), followed by general and tertiary hospitals (82.01% and 89.20%, respectively). The unequal residential locations brought on by an abundance of medical resources are far from those with a shortage of resources (66.86% > 5.34%). It is thus suggested that services be expanded or resources be transferred to move toward a more equitable system. Our findings provide policymakers with insights into how to increase accessibility to public health.
... The literature, which largely focuses on adult mental health in rural places, indicates that there is often a lack of services and specifically few specialized physicians in rural Canada (Friesen, 2019). In addition, the lack of transportation and stigma can act as barriers to accessing supports and services (Blackstock, Chae, Mauk, & McDonald, 2018;Boydell et al., 2006;Corrigan, 2004;Ghorbanzadeh, Kim, Ozguven, & Horner, 2020;Jensen, Wieling, & Mendenhall, 2020;Knight & Winterbotham, 2018). Yet, Caxaj and Gill (2016) and Statistics Canada (2015) suggest, however, that rural places may create a sense of belonging which can foster supportive social networks and work to facilitate access to mental health services (e.g., help with transportation). ...
... At the time of data collection for our research there had been several mental health service closures in the study area including the closure of the area's inpatient mental health unit and the retirement of the local psychiatrist (Henderson, 2016;Musick, 2018). A lack of available mental health services in rural communities and transportation-related barriers are also well cited in the literature (Church et al., 2020;Ghorbanzadeh et al., 2020;Jensen et al., 2020;Radez et al., 2020). ...
There is limited literature on youths’ experiences of accessing mental health supports and services in rural Canada. Through interviews with young women, this research explored barriers and facilitators to accessing mental health services and supports in rural Nova Scotia. Participants shared numerous barriers at the family, school, and community levels, including stigma from family, lack of knowledge of school supports, and limited community service options. Facilitators also existed at these three levels, including supportive parents, school-based service availability, and supportive community members. Increased investment in school-based services may improve access; however, an understanding of young men’s experiences is needed first.
... Mental health services are not distributed evenly in space, which can result in under-serviced neighbourhoods in socioeconomically disadvantaged areas (Ngui and Vanasse, 2012). Geographic access to service providers and local availability of care have been identified as important factors that influence the utilization of mental health services and mental health outcomes (Fortney et al., 1999;Ghorbanzadeh et al., 2020). Other major barriers to effective mental health services include a lack of mental health literacy and stigma that widely exists in culturally diverse populations. ...
... One key neighbourhood characteristic is potential spatial or geographical accessibility to mental health services, as spatial accessibility measured by distance and/or travel time can work as either an enabler or barrier to the use of a mental health service (Ngui and Vanasse, 2012). With equitable spatial access to care, mental health outcomes in the general population can be improved as individuals and communities will be able to access the services and support that they need (Fleury et al., 2012;Ghorbanzadeh et al., 2020). ...
Mental illness includes a wide range of disorders that affect mood, thinking, behaviour and overall wellbeing. One in five Canadians has mental health care needs, many of which are unmet. Within the City of Toronto, the provision of specialized mental health care is delivered by over 100 public and private community service organisations and over 700 physicians with a psychiatric specialization - each providing community-based general or specialised care to residents in need. Research has shown that travel distance is an enabling factor of health service utilisation, thus equitable spatial access to services remains a key priority. Using spatial quantitative methods, this study examines potential spatial accessibility to both general and specialized mental health services within the City of Toronto, and levels of statistical association between access to care and prevalence of mental health crisis events. The main datasets analyzed including geo-referenced Census data and occurrence data on mental health crisis (represented by apprehensions under the Mental Health Act undertaken by the Toronto Police Service). The enhanced two-step floating catchment area (E2SFCA) method is used to model spatial accessibility to mental health services based four modes of transportation: driving, walking, cycling and public transit. Areas that are underserved by mental health specialists and mental health community services are identified and shown to have different socioeconomic characteristics. The study reveals spatially explicit patterns of access to various mental health services in Toronto, providing detailed data to inform the planning of and policy on mental health care delivery concerning severe mental health crisis.
... In the broader literature, it has been recognized that access to healthcare resources is critical to overall population health (Guagliardo, 2004), and numerous researchers have investigated accessibility to healthcare resources and facilities (e.g., Apparicio et al., 2008;Ghorbanzadeh et al., 2020;Langford and Higgs, 2006;Luo and Qi, 2009;Luo and Wang, 2003;Yin, 2018). However, given the recent timing and onset of this disaster, there have been limited studies examining accessibility to healthcare resources in the context of the COVID-19 pandemic. ...
... Given the range of approaches available for addressing accessibility to healthcare, the two-step floating catchment area (2SFCA) methodbased accessibility measures have been applied to different types of healthcare facilities; for instance, hospitals (Delamater, 2013), primary cares (Gilliland et al., 2019;Langford and Higgs, 2006;Luo and Qi, 2009;Luo and Wang, 2003;McGrail and Humphreys, 2009;Wan et al., 2012), and mental healthcare (Ghorbanzadeh et al., 2020;Ngamini Ngui and Vanasse, 2012). The 2SFCA method, introduced by Luo and Wang (2003), combines an accessibility metric based on service coverage with a measure of provider-to-population ratios. ...
Healthcare resource availability is potentially associated with COVID-19 mortality, and the potentially uneven geographical distribution of resources is a looming concern in the global pandemic. Given that access to healthcare resources is important to overall population health, assessing COVID-19 patients' access to healthcare resources is needed. This paper aims to examine the temporal variations in the spatial accessibility of U.S. COVID-19 patients to medical facilities, identify areas that are likely to be overwhelmed by the COVID-19 pandemic, and explore associations of low access areas with their socioeconomic and demographic characteristics. We use a three-step floating catchment area method, spatial statistics, and logistic regression to achieve the goals. Findings of this research in the State of Florida revealed that North Florida, rural areas, and zip codes with more Latino or Hispanic populations are more likely to have lower access than other regions during the COVID-19 pandemic. Our approach can help policymakers identify potentially possible low access areas and establish appropriate policy intervention paying attention to those areas during a pandemic.
... In addition et al. [72] refer to "competition-based" assessment at transport nodes. For further di sion of approaches to accessibility measurement, readers are referred to, among ot these authors [9,24,25,68,[88][89][90][91][92][93][94]. ...
... In addition, Sun et al. [72] refer to "competition-based" assessment at transport nodes. For further discussion of approaches to accessibility measurement, readers are referred to, among others, these authors [9,24,25,68,[88][89][90][91][92][93][94]. ...
The equitable accessibility to higher education favours social fairness in economic opportunities. This paper provides an empirical approach to the assessment of the (in)equity of accessibility from universities to sustainable transport modes: Light Rail Transit, Bus Rapid Transit, buses, and bicycle infrastructure in the Guadalajara Metropolitan Area (Mexico). In particular, the study designed and calculated an Access to Sustainable Transport from University Index by combining governmental and crowdsourced Open Access Data. It used spatial analysis techniques within a Geographic Information Systems environment, and multivariate statistical methods such as Principal Component Analysis and Cluster Analysis. The findings highlight the weakness in the accessibility to sustainable transport modes from the universities in the Metropolitan Area. Furthermore, this study revealed an unfavourable bias in the location of sustainable transport stations/stops in the vicinity of public universities. The results provide a methodology and empirical evidence for transport policy makers to reduce inequalities and therefore transport-related social exclusion in this under-represented, but socially relevant, student community.
... In addition to experiencing heightened risk factors for MBDs, youth in rural areas face several additional challenges surrounding access to mental health care. Rural communities contend with a myriad of access-related challenges including significant transportation barriers (Ghorbanzadeh et al., 2020), an on-going shortage of mental health care professionals in rural areas (Merwin et al., 2003), and considerable stigma around utilization of mental health services (Green et al., 2013). The low availability of mental health resources in rural areas presents a significant barrier to rural youth accessing mental health services and calls for alternative service delivery in these areas. ...
School, community, and youth-serving system partnerships can support the implementation of comprehensive school mental health (SMH) programs including services beyond direct therapy for students (i.e., including prevention and early intervention). Utilizing a comprehensive approach to SMH allows clinicians to form stronger relationships with administrators, school staff, and most importantly, students who may need services. This approach to SMH includes incorporating clinicians into the culture and daily activities of the schools, to increase available services, and to increase visibility, relationship development, and outreach to students, school staff, and families. SMH is particularly important for rural youth, given strong evidence that they are less likely to receive mental health care in more traditional settings such as clinics. The Pee Dee Resiliency Project utilized a schoolwide approach to enhance the roles of SMH clinicians in eight underserved elementary schools in South Carolina. In this work, we describe the Pee Dee Resiliency Project and its impact on student outcomes through a comprehensive evaluation including measures of parent-rated student emotional/behavioral functioning and students’ ratings of their resilience.
... interventions for older adults, such as computer and internet training, have also shown positive effects on psychosocial outcomes, including increased life satisfaction and reduced depression levels [13]. ...
Digital health interventions (DHIs) have emerged as a promising approach to address mental health issues across various demographics, including different age groups, cultural contexts, and socio-economic backgrounds. This review aims to critically examine the role of digital interventions in mental health, focusing on their effectiveness, benefits, and limitations compared to traditional therapies. The review seeks to assess various digital tools, including mobile apps, online therapy platforms, AI-driven solutions, virtual reality (VR) therapies, and wearable technologies, to determine their impact on mental health outcomes. In addition, the review explores the challenges of implementing these technologies, such as data privacy concerns, the digital divide, and regulatory issues, while highlighting opportunities for innovation and integration into traditional healthcare systems. Policymakers are faced with the daunting challenges of managing rapid innovation against concerns with respect to data privacy and security and ethical considerations related to applications of AI and IoT.
... For mental health, while some research focuses on disparities in access to mental health services (e.g. (Ghorbanzadeh et al., 2020;Vallée et al., 2022)), others have directly examined how disparities in access are associated with mental health outcomes. For example, the review by Rambaldini-Gooding et al. (2021) finds that better access by public and active transport positively affects physical and mental health for older individuals. ...
... Transport is identified as a derived demand because via mobility people can get access to healthcare, education and job opportunities, and engage in social activities (Rodrigue, 2006). Although difficulty in getting access to and affording transportation influences numerous outcomes, including mortality (Bayliss & Hinton, 1990;Emodi et al., 2022), well-being (Churchill & Smyth, 2019), access to health-care services (Ghorbanzadeh et al., 2020), education, training (Zhou & Schweitzer, 2009;Bierbaum et al., 2021), employment (Tyndall, 2017), social networking (Farber & Páez, 2009) and economic development (Button & Taylor, 2000), relatively little is known about their impact on hours of work. The only study close to this study that we are aware of has examined the relationship between transport-related fatigue and hours of work (Jones et al., 2005). ...
In this study, we examine the effect of transport-related deprivation on hours of work using 17 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia. We measure transport-related deprivation using indicators that reflect transport accessibility and affordability. The overall finding indicates that transport-related deprivation reduces hours of work. This outcome is more pronounced for public transport than private transport, and consistent across instrumental variable techniques, an alternative fixed effect model, and heterogeneity analysis. Further analysis reveals that the hours of work-reducing effect of transport-related deprivation is transmitted through time spent travelling to work.
... sociodemographic considerations), relocation to specialised services (e.g. shelters) as a process of forced migration (Coy et al. 2011), and transportation-based accessibility (Ghorbanzadeh et al. 2020). ...
... Several strategies have been developed for analysing the accessibility of healthcare with Geographic Information Systems (GIS) (Finch et al., 2019;Ghorbanzadeh et al., 2020). Some methods consist of fundamental ratios of suppliers to the population (Connor et al., 1995;Schonfeld et al., 1972), analyses of defined catchment areas based on straight-line buffers (Gyimah et al., 2006;Haynes et al., 1999), Determining the network-based catchment area (Schuurman et al., 2006), or decreasing density distributions reflecting the reduction in healthcare accessibility with increasing distance (kernel density (Guagliardo et al., 2004)). ...
The study of access to health centers is gaining global attention due to it is critical role in ensuring equitable and easily accessible healthcare services for all citizens, leading to long-term social equity and an improved quality of life. This paper aims to assess the efficiency of healthcare facility locations in Istanbul from two perspectives: accessibility of healthcare facilities and sufficiency of healthcare capacity. The analysis of accessibility considers the geographic locations of health services, the road network, and traffic conditions, particularly during two peak travel times in Istanbul. The evaluation of healthcare capacity utilizes the ratio of the number of beds to the population in each district. According to the findings, while the majority of the population has reasonable access to the nearest hospital, there exists a significant disparity in hospital location and bed availability in Istanbul. This indicates notable challenges in achieving a balanced distribution of hospitals based on their bed capacity. Addressing this imbalance is crucial in selecting suitable locations for new health facilities. To enhance the accessibility and effectiveness of public and private hospitals, decisions regarding site selection should aim to mutually support one another. Additionally, it is recommended to plan new healthcare facilities based on the population and density distribution of the city to increase public interest and optimize the efficiency of health services.
... Table 1 presents access indicators, parameters used, approach to measuring access indicators and related studies. [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [ [34], [9], [12], [35], [14], [36], [37], [16], [17], [18], [38], [20], [22], [39], [40], [41], [42], [24], [43], [44], [25], [45], [46], [26], [47], [48], [27], [28], [49], [50], [51], [52], [53], [54], [55], [56], [57], [31], [33], [58], [59], [60], [61], [62], [63], [64], [65], [66] Clustering [67], [15], [36], [37], [20], [22], [68], [47], [48], [69], [49], [70], [31], [32], [60], [29] STP, ASTP, FCA, CBA, MCA, WNR, PNR Demographic (Such as Household Size, Income, Car Ownership, Education Survey Data) ...
Urban transportation systems and their integration with spatially distributed opportunities are pivotal for ensuring effective accessibility. This study aims to rigorously evaluate urban accessibility by scrutinizing established criteria and measurement approaches within the literature. A systematic literature review was executed, targeting articles selected for their pertinence and citation impact. Through meticulous analysis, four cardinal indicators of access and their respective subsets were distilled. Synthesizing data from 61 scholarly publications elucidated the key indicators of accessibility. The findings underscore the adaptability and utility of these criteria as evaluative instruments and in guiding policy decisions. On the other hand, availability and quality of data, greater attention to travel reliability and user preferences are among the factors that should be considered in the accessibility assessment. The study's insights advocate for a nuanced application of accessibility indicators, promoting their evolution as multifaceted tools in urban planning domains. These results serve as a foundation for future research and contribute to the refinement of methods for comprehensive accessibility analysis in urban settings.
... Evaluating the disparities in spatial access to health services is critical to enhancing the adequate allocation of resources (Syed et al., 2013;Russell et al., 2019;Parker, 2021;Ujewe and van Staden, 2021;Jia et al., 2022), identification of underserved populations (Rosero-Bixby, 2004;Pan et al., 2016;Richard et al., 2016;Russell et al., 2019;Ashiagbor et al., 2020) and enhance efficiency and performance evaluation of the health system (Amer, 2007;Agbenyo et al., 2017;Ghorbanzadeh et al., 2020;Shao and Luo, 2022). While equity of health access is a challenge worldwide, the situation is much more severe in sub-Sahara Africa (SSA) due to inadequate health facilities (Dumedah et al., 2021;Ashu et al., 2022), low access (Anselmi et al., 2015;Ujewe and van Staden, 2021) and high costs of healthcare (Anselmi et al., 2015;Ujewe and van Staden, 2021;Ashu et al., 2022). ...
Consideration of health equity is fundamental to enhancing the health of those who are economically/socially disadvantaged. A vital characteristic of health equity and therefore health disparity is the level of spatial access to health services and its distribution among populations. Adequate knowledge of health disparity is critical to enhancing the optimal allocation of resources, identification of underserved populations, and improving the efficiency and performance of the health system. The provision of such insight for sub-Saharan African (SSA) cities is a challenge and is severely limited in the literature. Accordingly, this study examined the disparities in potential spatial access to health services for four selected urban areas in Ghana based on: (a) the number of physicians per population; (b) access score based on a weighted sum of access components; (c) travel time to health services; and (d) the combined evaluation of linkages between travel distance, settlement area, population, and economic status. The overall spatial access to health services is low across all selected cities varying between 3.02 and 1.78 physicians per 10,000 persons, whereas the access score is between 1.70 and 2.54. The current number of physicians needs to be increased by about 5 times to satisfy the World Health Organization’s standard. The low spatial access is not equitable across and within the selected cities, where the economically disadvantaged populations were found to endure longer travel distances to access health services. Inequities were found to be embedded within the selected cities where economically poor populations are also disadvantaged in their physical access to healthcare. The health facilities in all cities have reasonable travel distances separating them but are inadequately resourced with physicians. Thus, increasing the physician numbers and related resources at spatially-targeted existing facilities would considerably enhance spatial access to health services.
... In the spatial analysis of urban medical facilities, accessibility is of great significance in identifying regions with inadequate and unequal medical resources. A large and growing body of literature has investigated the accessibility of various types of medical resources, such as hospitals (Delamater 2013), primary care (Luo and Wang 2003), mental healthcare (Ghorbanzadeh et al. 2020), prenatal care (Yin 2019), and dental care (Zainab et al. 2015). Equity in access to medical resources for older adults has recently been the focus of many studies, which are usually based on accessibility analysis (Tavares and Zantomio 2017; Cheng et al. 2020). ...
With population aging becoming increasingly prominent, it has been recognized as a critical issue for urban planners whether older adults can access fair, high-quality medical services. Yet, few studies have investigated urban medical accessibility at a departmental level for older adults. Taking Beijing as a case study, this study puts forth a novel framework augmented by multisource data to analyze subdistrict-scale accessibility to urban medical departments, with a particular emphasis on older adults’ common diseases. Online registration data were collected to indicate the supply capacity of medical services, with the influence of department reputation taken into account when determining the facilities’ service range. A hierarchical two-step floating catchment area method was employed to examine accessibility for
older adults to the cardiovascular, orthopedic, endocrinology, respiratory, and neurology departments. Subsequently, Gini indices were calculated to evaluate medical accessibility equity across urban spaces. Additionally, multiple linear regression was used to explore the correlations between medical accessibility and potential influencing factors. Results showed that medical accessibility is typically higher in downtown areas and decreases from the urban center to the peripheral areas in Beijing. Cardiovascular, respiratory, and orthopedic patients face relatively greater difficulty in accessing appropriate medical resources. Furthermore, significant inequity in medical accessibility was observed among the subdistricts at different locations, with accessibility inequity in the ecological conservation area being particularly concerning. Additionally, seven factors were found to significantly affect accessibility, including distance to the urban center, density of arterial and collector roads, proportion of residential land use, proportion of public service land use, proportion of transportation land use, and proportion of vehicle ownership. The proposed framework could identify subdistricts with low accessibility for older adult patients to access different medical departments. Therefore, it could potentially support the policy-making process by offering guidelines to adjust the construction plan of the medical system in metropolises and optimize the direction for resource input.
... In addition, Sun et al (2018) refer to "competition-based" assessment at transport nodes. For further discussion of approaches to accessibility measurement, readers are referred to, among others, these authors (Al Mamun & Lownes, 2011;Ben-Elia & Benenson, 2019;Delbosc & Currie, 2011b;Ghorbanzadeh et al., 2020;Handy & Niemier, 1997;Levine, 2020;Litman, 2012;Martinez & Viegas, 2017;E. J. Miller, 2018;Pritchard et al., 2019;Stępniak et al., 2019). ...
Traveling is a fundamental right of democratic societies and provides opportunities for the social, economic and cultural development that the city offers. Mobility is largely determined by transport systems and their relationship with the urban environment, by people's socioeconomic conditions, and by the location and relevance of opportunities. In metropolitan contexts with structural inequities, access to mass transportation systems is limited. This increases vulnerability and contributes to social exclusion related to transport. This exclusion, in turn, leads to an increase in inequality and poverty. This dissertation contributes to the comprehension of the underlying social and spatial dimensions of public transport (PT) in Latin American metropolises. The general hypothesis was that the social and spatial dimensions of mass public transport can be estimated through accessibility, specifically by identifying areas with different degrees of transport related social exclusion through open-access data and spatial and multi-criteria analyses. To prove the hypothesis, a quantitative methodology was proposed to estimate access to PT as an indicator of social exclusion, and designed for contexts with financial and technical limitations. This was applied to the Guadalajara Metropolitan Area (GMA), Mexico, addressing structural problems intrinsic to transportation, such as social inequality, urban sprawl and poor air quality, as social and spatial dimensions of PT. Is the mass transit system adequate to meet the social needs of transportation? Does the spatial distribution of PT stations provide access to vulnerable groups? What are the conditions of the urban environment when active mode users commute? To answer these and other questions, this dissertation proves theoretical and methodological concepts in the study area mentioned above. Thus, it shows empirical findings to contribute to the comprehension of the role of PT in the context of urban complexity. This document is structured using three empirical case studies (CS) published in high-impact international academic journals. In addition to the specific findings in each case, this research confirms High degrees of social exclusion related to transport in the metropolitan area studied. Results of the first CS show that reduced mobility, illiteracy, unemployment and income are variables that largely define the social needs of transportation in the metropolis. In addition, it was observed that the mass transit system scarcely served the social needs of transportation in the periphery and some central areas. The second CS highlights that users of sustainable transport are exposed to episodes of poor air quality in a small proportion of trips. In addition, the limited generation of open-access data produced by authorities from the transport and environmental sectors is confirmed. The findings of the third CS show that the university group is in transport disadvantage compared to other groups in the city, thus they suffer from transport related social exclusion. The three CS prove that the social and spatial dimensions of transport can be estimated with open-access data, spatial analysis and multicriteria. In particular, the relevance of using simplified cumulative methods to estimate access to public transport for contexts with technical and financial limitations is confirmed. The results provide empirical evidence for public policies in the urban planning and transportation sectors, as a complement to social and economic policies that promote social inclusion and development in Latin American cities.
... 40 The above methods offer a variety of ways to measure spatial accessibility and are widely used among different regions around the world. [41][42][43] ...
Population demand, healthcare resourcing, and transportation linkage are considered as major determinants of spatial access to health care. Temporal changes of the 3 determinants would result in gain or loss of spatial access to health care. As a remarkable milestone achieved by Targeted Poverty Reduction Project launched in China, the significant improvements in spatial access to health care served as an ideal context for investigating the relative contributions of these 3 determinants to the changes in spatial access to health care in a rural county. A national level poverty-stricken county, Chishui county from Guizhou province, China, was chosen as our study area. The enhanced two-step floating catchment area model and the chain substitution method were employed for analysis. The relative contributions of the 3 determinants demonstrated variations with villages. The relative contributions of healthcare resourcing were positive in all villages as indicated by sharp increases in healthcare resources. Population changes and transportation infrastructure expansion had both negative and positive effects on spatial access to health care for different villages. Decisionmakers should take into account the duration of travel time spent between where people live, where transport hubs are located, and where healthcare services are delivered in the process of formulating policies toward rural healthcare planning. For villages with poorly-established infrastructure, the optimization of population distribution and healthcare resourcing should be considered as the priority. A stronger marginal effect would be induced by transportation infrastructure expansion with increased spatial accessibility. This study provides empirical evidences to inform healthcare planning in low- and middle-income countries.
... Not only do these findings provide valuable information for identifying vulnerabilities to PHC access, these findings have potentially broad-reaching health implications; wherein, individuals may face barriers to primary care, they may also face barriers to other forms of healthcare, such as urgent care centers [54] and mental health services [55]. While this paper has focused on the beneficial effects of PHC and factors that might hinder access, disparities in PHC access likely reflect broader health access disparities, which would be appropriate targets for intervention, as lack of access to PHC, urgent care, and mental health services increase the burden placed on emergency services [56]. ...
Primary healthcare (PHC) is a keystone component of population health. However, inequities in public transportation access hinder equitable usage of PHC services by minoritized populations. Using the multimodal enhanced 2-step floating catchment area method and data in 2018 and 2019 for spatial access to PHC providers (n = 1166) and social vulnerability markers through census block (n = 543) and tract data (n = 226), a generalized linear mixed-effect model (GLMEM) was constructed to test the effects of sociodemographic and community area correlates on both car and bus transit spatial access to PHC in the Albuquerque, New Mexico (NM) metropolitan area. Results for bus spatial access to PHC showed lower access for Hispanics (B = − 0.097 ± 0.029 [− 0.154, − 0.040]) and non-Hispanic Whites (B = − 0.106 ± 0.032 [− 0.169, − 0.043]) and a positive association between single-family households and bus spatial access (B = 1.573 ± 0.349 [0.866, 2.261]). Greater disability vulnerability (B = − 0.569 ± 0.173 [− 0.919, − 0.259]) and language vulnerability (B = − 0.569 ± 0.173 [− 0.919, − 0.259]) were associated with decreased bus spatial access. For car spatial access to PHC, greater SES vulnerability (B = − 0.338 ± 0.021 [− 1.568, -0.143]), disability (B = − 0.721 ± .092 [− 0.862, − 0.50 9]), and language vulnerability (B = − 0.686 ± 0.172 [− 1.044, − 0.362]) were associated with less car spatial access. Results indicate a disproportionate burden of low PHC access among disadvantaged population groups who rely heavily on public transportation. These results necessitate targeted interventions to reduce these disparities in access to PHC.
... For health care facilities, it is necessary to consider the influence of travel time, hospital scales, and urban population distribution to evaluate health care service accessibility accurately. Different methods have been proposed to evaluate hospital accessibility at city level and country level under normal conditions [8][9][10][11][12][13][14][15]. However, these studies focused on normal conditions without considering the health care service accessibility after extreme events, especially earthquakes. ...
In the aftermath of an earthquake, damage to buildings and transportation networks severely affects post-earthquake emergency rescue and medical health care services. This paper presents a quantitative framework considers seismic damage to buildings and transportation networks, post-earthquake available numbers of patient beds and medical staff to evaluate post-earthquake health care service accessibility. The modified two-step floating catchment area method and seismic fragility analysis are integrated into the proposed framework. Spatial distributions of demand point, hospital, and transportation network data are used to evaluate health care service accessibility. The accessibility results for a medium-sized city under normal conditions and post-earthquake conditions are analyzed as a case study. Demand points that lack access to health care service can be clearly delineating from the findings, indicating that large earthquakes will dramatically impact people’ normal health care service accessibility. The results of this work may provide a workable basis for planners and policy makers to pragmatically select health care facility sites.
... Apart from the availability/provision of healthcare services, access to mental health services is also influenced by other barriers that may access, such as the lack of connectivity to public transport services or the lack of private vehicles to drive to the healthcare facilities. Subsequently, people tend to use healthcare services and facilities that are within shorter travel distances or time from their homes more often (Ghorbanzadeh et al., 2020). Thus, it is critical to adjust for the availability of healthcare services and the level of difficulty in healthcare access in the examination of mental health across capital cities and regional areas. ...
This study establishes a novel empirical framework using machine learning techniques to measure the urban-regional disparity of the public's mental health signals in Australia during the pandemic, and to examine the interrelationships amongst mental health, demographic and socioeconomic profiles of neighbourhoods, health risks and healthcare access. Our results show that the public's mental health signals in capital cities were better than those in regional areas. The negative mental health signals in capital cities are associated with a lower level of income, more crowded living space, a lower level of healthcare availability and more difficulties in healthcare access.
... First, this study focused only on spatial inequity across income groups. Differences in accessibility between senior and non-senior, households with and without cars can be evaluated in future studies (Ghorbanzadeh et al., 2020). ...
Accessibility equity is a critical factor in developing equitable and sustainable communities. Although numerous studies have analyzed accessibility inequity, few of them examined inter-group and intra-group inequity and made comparisons between private cars and public transit. In this paper, a Gaussian-based Two-step Floating Catchment Area method was applied to evaluate the spatial accessibility of multitier healthcare services among different income groups in Shanghai, China. The results show that high-income households have better access to healthcare services than low-income households. The gap between low- and high-income groups increases as the level of healthcare services rises. The Theil index was used to assess inequity between groups and within groups, as well as overall inequity. The inter-group inequity for public transit is greater than that for private cars, suggesting that accessibility by public transit is more unequally distributed across groups of people compared with private cars. Inter-group inequity increases with the tier of healthcare services. The bivariate local Moran index shows that underserved areas are found primarily in low-income neighborhoods. Overall, the research findings indicate the quality of public transit services might have a more significant impact on accessibility inequity than the spatial distribution of health services. This study provides valuable information for designing targeted policy provisions to improve equity and efficiency in healthcare access.
... In copious research on health care inequalities across the globe, accessibility is a frequently cited concept [8][9][10]. Patterns of unequal accessibility have been studied from both the demand side (e.g., use and affordability of health services [11,12]) and the supply side (e.g., differences in proximity to care, availability, and distribution of resources [13][14][15]). Among these supply-side differences, spatial accessibility is a classic measure for assessing health care inequality [9,11,16]. ...
Geographic accessibility plays a key role in health care inequality but remains insufficiently investigated in China, primarily due to the lack of accurate, broad-coverage data on supply and demand. In this paper, we employ an innovative approach to local supply-and-demand conditions to (1) reveal the status quo of the distribution of health care provision and (2) examine whether individual households from communities with different housing prices can acquire equal and adequate quality health care services within and across 361 cities in China. Our findings support previous conclusions that quality hospitals are concentrated in cities with high administrative rankings and developmental levels. However, after accounting for the population size an “accessible” hospital serves, we discern “pro-poor” inequality in accessibility to care (denoted as GAPSD) and that GAPSD decreases along with increases in administrative rankings of cities and in community ratings. This paper is significant for both research and policy-making. Our approach successfully reveals an “unexpected” pattern of health care inequality that has not been reported before, and our findings provide a nationwide, detailed benchmark that facilitates the assessment of health and urban policies, as well as associated policy-making.
... Access to health services is a controversial issue both in developing and developed countries (Yin et al., 2018;Ngui & Apparicio, 2011). Some research in the United States on the detection of inequality in the use of healthcare has noted accessibility as an important factor in geographical inequality in the healthcare services (Ghorbanzadeh et al., 2020;Sharma, 2015). In the United Kingdom, the 'Rural Health Plan', in the form of the Rural Health Innovation Fund (RHIF), is one of the policy initiatives that addresses the welfare and deficit of rural health through access to services, integration of services plus health and social care, and community cohesion (Best & Myers, 2019). ...
The inequity in accessibility to healthcare services and their distribution for urban and rural populations are always major challenges for health planners and policy makers. The present study focuses on challenges associated with estimating the geographical scope of access to health services in rural and remote areas. Assuming that measuring GIS-based accessibility for rural health services varies across a geographic analysis unit, estimating techniques can influence the analysis and interpretation of spatial access to rural healthcare services. Thus, this study aims to provide a spatial model for accessibility measurement of health services based on the fuzzy inference system (FIS). Accessibility to health services is not distributed equitably across the study area. The results revealed that higher levels of accessibility to health services appear in the central parts of the Fars province while lower levels of exist in its northern and southern parts, except a few small regions adjacent to the southern borders of the province. The level of accessibility is high around the urban centers, where there is a high concentration of services and population, but it reaches its minimum on the margins. The minimum travel time to health services tends to increase from urban centers and populated villages to more rural and remote areas. About 62.8 percent of the rural population was found to have high accessibility (very high and high classes) to healthcare, while 14.5 percent of the rural population have low accessibility (very low and low classes). This method of analysis can be used as a guide for planners to strategically plan infrastructure investment for areas with lower accessibility to healthcare services. It also provides adequate healthcare options required in targeted locations.
... LANDSAT satellite data from 2016 was geocoded using the UTM projection, Arc 1960, Zone 36S, with a spatial resolution of 30 meters, using remote sensing and GIS mapping, as well as document analysis [7].The FSUTMS model and Closest Facility tool in the Network Analyst module of ArcGIS software were used to calculate the ideal path with the least cost between origins and destinations. Based on the obtained route times between each orig in-destination combination, the healthcare facilities were estimated and visualized using GIS-based maps [8].The tool was connected to a spatial database to filter the parameters. Several maps based on PQI data were created to test the application. ...
... This study arrives in a moment in which accessibility in palliative care is especially important due to the pandemics, as people with palliative care needs may be more susceptible to the COVID-19 pandemic. Some studies have started analyzing accessibility in context to COVID-19 during the pandemic [57][58][59]. ...
Background:
Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations' driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland.
Methods:
Network analysis of the population's driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated.
Results:
The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland.
Conclusion:
Inequities in access to specialized palliative care are noticeable amongst countries, with implications also at the sub-national level.
... Several studies have used GIS-based measures on accessibility to health facilities [9,23] and that are innovative in various ways, such as investigating accessibility with respect to different age groups [24]. Other studies use survey-based measures on perceived accessibility [25], while the novelty of the study presented in this article, is to combine GISbased measures with the survey-based measure of accessibility. ...
Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.
... Family members are the only services available for them to care and support. In this regard, it is proposed to apply the principle of approximate service [10,11]. Its application is meant in a research cluster, where the immune system of a person is being studied. ...
The features of the modern development of urban agglomerations should be considered from the standpoint of the changed conditions of the socio-ecological space. They are associated with the situation of a pandemic, which is especially aggravated in large cities. Since Kazan is a developing city, the possibilities of creating new conditions on the territory of expansion were considered. Two aspects of design are considered, which are associated with the study of the clinical manifestations of viral diseases and the formation of resilience in the organization of the environment for elderly people. The study highlights the main features of design approaches for centers studying human immunology and residential clusters that take into account the characteristics of the elderly. In the context of the territory, design principles were proposed, considered as infrastructure principles and residential cluster principles. The infrastructure associated with human learning is expressed in the following: isolation, planning cyclicality, polyfunctionality, accessibility for the elderly. Residential development is based on: spatial identity, human scale of the environment, continuity of communications, inclusion in the natural environment. Thus, it seems possible to work out a unique solution in terms of sustainable development of previously abandoned territories. Attentive attitude to landscape components is on a par with a humanistic attitude towards the most vulnerable groups of the population.
... Rapid population growth, urbanization, and economic development have been creating challenges in providing transportation-based accessibility to all segments of the population over the last decade (Litman, 2020;Ozel et al., 2016). This is especially critical when we consider ensuring the transportation-based accessibility to essential facilities such as healthcare providers since these facilities provide important services to people (Freeman et al., 2020;Ghorbanzadeh et al., 2020a). During a disaster such as the COVID-19 pandemic, this issue becomes all the more confounding since these facilities play crucial roles in helping their communities to better prepare and recover from this uncontrolled outbreak (Cartenì et al., 2021;Shamshiripour et al., 2020). ...
During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the “equal access” assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.
... In contrast, severe mental illness and substance use disorder (SUD) often require treatment at specialized facilities. Often clustered in urban centers, these specialized facilities may necessitate prolonged travel for residents of suburban and rural areas (Ghorbanzadeh et al., 2020). Patients seeking medication therapy for opioid use disorder, a type of SUD, have been particularly burdened by frequent trips to care. ...
The Coronavirus disease 19 (COVID-19) pandemic has disrupted both transportation and health systems. While about 40% of Americans have delayed seeking medical care during the pandemic, it remains unclear to what extent transportation is contributing to missed care. To understand the relationship between transportation and unmet health care needs during the pandemic, this paper synthesizes existing knowledge on transportation patterns and barriers across five types of health care needs. While the literature is limited by the absence of detailed data for trips to health care, key themes emerged across populations and settings. We find that some patients, many of whom already experience transportation disadvantage, likely need extra support during the pandemic to overcome new travel barriers related to changes in public transit or the inability to rely on others for rides. Telemedicine is working as a partial substitute for some visits but cannot fulfill all health care needs, especially for vulnerable groups. Structural inequality during the pandemic has likely compounded health care access barriers for low-income individuals and people of color, who face not only disproportionate health risks, but also greater difficulty in transportation access and heightened economic hardship due to COVID-19. Partnerships between health and transportation systems hold promise for jointly addressing disparities in health- and transportation-related challenges but are largely limited to Medicaid-enrolled patients. Our findings suggest that transportation and health care providers should look for additional strategies to ensure that transportation access is not a reason for delayed medical care during and after the COVID-19 pandemic.
... Their findings revealed that many areas in Southeast and Eastern Tallahassee were highly affected in terms of accessibility to fire stations with regard to high emergency response travel time (more than 8 min). Recently, Ghorbanzadeh et al. (2020) developed a metric to assess the access of different age groups to mental health services in the State of Florida. The results revealed that residents which are mainly located in rural areas have the least accessibility to mental health facilities. ...
Public libraries are critical community facilities through which librarians support their communities before, during, and after natural disasters such as hurricanes. In their disaster responses, public librarians work to effectively restore library buildings, provide library materials, and, most critically, provide services that strengthen community resiliency and sense of safety. However, a neglected aspect of disaster policy and response is the lack of documentation regarding library transportation accessibility. In this study, the researchers used geographical information systems (GIS) approaches to investigate the extent to which public libraries are sited to serve vulnerable, rural populations in Northwest Florida. Results suggest that many public library branches are inopportunely sited relative to pockets of high-need populations, indicating that disaster services may need to be offered outside of the library building or transportation options be made available to residents of disaster-prone, inaccessible areas. The study’s findings have the potential to inform library and information studies education, multidisciplinary research and policy-making, and to develop a public library disaster preparedness and response.
... For our accessibility estimates, we did not take into account operating hours of each facility, which could bias mammography capacity upward, and thus higher estimated accessibility. Finally, the role of the ecological fallacy in 2SFCA studies has been discussed previously elsewhere (Ghorbanzadeh et al., 2020;Ngui and Apparicio, 2011;Rodgers et al., 2012;Williams and Wang, 2014;Yin, 2019), and it is important to note that our study provides only population-level information and cannot be used to infer mammography access, intention to receive mammography, or reasons underlying facility selection for any given individual. ...
Limited spatial accessibility to mammography, and socioeconomic barriers (e.g., being uninsured), may contribute to rural disparities in breast cancer screening. Although mobile mammography may contribute to population-level access, few studies have investigated this relationship. We measured mammography access for uninsured women using the variable two-step floating catchment area (V2SFCA) method, which estimates access at the local level using estimated potential supply and demand. Specifically, we measured supply with mammography machine certifications in 2014 from FDA and brick-and-mortar and mobile facility data from the community-based Breast Screening and Patient Navigation (BSPAN) program. We measured potential demand using Census tract-level estimates of female residents aged 45–74 from 5-year 2012–2016 American Community Survey data. Using the sign test, we compared mammography access estimates based on 3 facility groupings: FDA-certified, program brick-and-mortar only, and brick-and-mortar plus mobile. Using all mammography facilities, accessibility was high in urban Dallas-Ft. Worth, low for the ring of adjacent counties, and high for rural counties outlying this ring. Brick-and-mortar-based estimates were lower for the outlying ring, and mobile-unit contribution to access was observed more in urban tracts. Weak mobile-unit contribution across the study area may indicate suboptimal dispatch of mobile units to locations. Geospatial methods could identify the optimal locations for mobile units, given existing brick-and-mortar facilities, to increase access for underserved areas.
Purpose of review
To offer an integrative overview of mental health services in urban areas across different social groups and underscore the challenges and potential solutions to improve access to mental health services in urban areas.
Recent findings
The process of urbanization places a lot of tolls on the current mental health services system. Challenges to both mental health and mental health services include the elevated risk of some mental and behavioral health issues, the increased demand for mental health services, and the intensification of mental health inequalities. The phenomenon of mental health inequalities is exacerbated in urban areas, with certain disadvantaged population groups more likely to report higher mental health issues and difficulties in accessing mental health services. Targeted and dedicated strategies are warranted to develop and allocate resources to address the mental health services needs among those simultaneously with multiple disadvantaged social and economic characteristics.
Summary
Urbanization places a substantive burden on both mental health and mental health services and creates challenges to mental health services access. Integrative and multisectoral initiatives could shed light on effectively addressing the issues of access to mental health services in urban cities.
Improving transit access for people in low-income communities is an important consideration for transit providers. However, there has only been a limited amount of research on the transit accessibility of affordable housing units. This paper aims to develop a method for evaluating the transit equity of existing affordable housing units and propose easy-to-implement modifications to local bus services to increase transit accessibility levels (assuming housing locations do not change in the short term). The proposed method has three steps, and it is applied to three cities in Tennessee with primarily bus-based transit systems. The first step measures the transit accessibility of specific affordable housing locations and citywide transit accessibility levels using a web-based platform built using open-source software. The second step evaluates the transit equity of affordable housing programs at the city level using Lorenz curves and Gini coefficients, and the transit equity of specific affordable housing locations by proposing a simple inequity index. The results reveal that the level of transit equity for affordable housing units differs across housing programs and cities. In the third step, an example of a modification to a local bus route is evaluated for one affordable housing location with a high inequity index to demonstrate the applicability of the method. The substantial increase in accessible jobs after modification, from 135 to 6,400, highlights the potential effectiveness of implementing short-term transit service changes to improve the accessibility of existing affordable housing locations. This three-step method primarily relies on open datasets that are also available for other regions in the U.S.A.
We investigated the transportation accessibility of special needs populations to Special Needs Shelters (SpNS) by incorporating storm surge modeling into hurricane shelter planning in Panama City, a medium-sized city located close to the landfall location of Hurricane Michael. The storm surge model validated for Hurricane Michael was used to predict the coastal inundation. Using this model, A Geographical Information Systems (GIS)-based optimization methodology was developed for evaluating the accessibility to special needs shelters and repurposing existing regular hurricane shelters for special needs populations. With the proposed optimization approach, the average travel time per person-trip decreased from 28.5 minutes to 7.4 minutes after repurposing one regular shelter and to 4.3 minutes when three regular shelters converted to SpNS. Emergency plans can be improved by the proposed methodology, which can estimate the inundation zones by storm surge modeling and allocate the emerging shelter demand by accessibility analysis and location modeling.
Purpose: to evaluate the potential accessibility to public hospitals between 2019 and 2021. Methodology/Approach: comparative analysis of travel times by public transport, calculated using the r5r package in R with the GTFS provided by the municipality. Findings: for the three hospital categories evaluated, travel times increased around 20% in the study period, and the most vulnerable quintiles of population increased their travel times 8 points above the less vulnerable quintiles. Research Limitation/implication: travel times were calculated with programmed schedules and frequencies and fixed values of maximum travel time and maximum walking distance. Originality/Value of paper: comparative analysis pre-COVID and during COVID of geographical accessibility to healthcare centers. Use of the r5r package that allows changes in the parameters to calculate travel times such as maximum walking distance, maximum travel time, departure time or percentiles.
Health is regarded as an integral component of well-being that contributes to the development of human capital. Therefore, the emphasis on improving health and inclusiveness of health services is increasing day by day. In this research, health taken as a public service in this context the current situation in health services and the spatial profile of accessibility to hospitals in Turkey aimed to determine. Quantitative research techniques were used in the study. Introductory statistics were used to analyze the current situation in health services, and network analysis was used to determine accessibility to hospitals. Both the introductory indicators on health services and the findings regarding accessibility show that the north-northeast of the country, especially the east of the country, are disadvantageous areas in terms of health services. The existing insufficiencies in health services in the these areas are a limitation in terms of the social well being of the population residing in these areas. This insufficiency also leads to a decrease in satisfaction with services, resulting in a decrease in subjective well being in these regions.
Öz
Sağlık beşeri sermayenin geliştirilmesine katkı sağlayan refahın ayrılmaz bileşenlerinden biri olarak kabul görür. Bu nedenle sağlığın iyileştirilmesi ve sağlık hizmetlerinin kapsayıcılığına ilişkin yapılan vurgu gün geçtikçe artmaktadır. Bu bağlamda kamusal hizmetlerden olan sağlığın ele alındığı bu araştırmada Türkiye'de sağlık hizmetlerinin mevcut durumunun ve hastanelere erişebilirliğin mekansal profilinin belirlenmesi amaçlanmıştır. Çalışmada nicel araştırma teknikler kullanılmıştır. Sağlık hizmetlerine ilişkin mevcut durumun incelenmesinde tanıtıcı istatistiklerden, hastanelere erişebilirliğin belirlenmesinde ise ağ analizinden faydalanılmıştır. Gerek sağlık hizmetlerine ilişkin tanıtıcı göstergeler gerekse erişebilirliğe ilişkin elde edilen bulgular ülkenin başta doğusu olmak üzere güneyinin de kamusal hizmetlerden olan sağlık hizmetleri açısından dezavantajlı alanlar olduğunu göstermektedir. İfade edilen alanlarda sağlık hizmetleri ile ilgili var olan olumsuzluk bu alanlarda ikamet eden nüfusun sosyal refahı açısından bir sınırlılıktır. Bu olumsuzluk aynı zamanda sosyal refaha ek olarak hizmetlerden duyulan memnuniyetin de azalmasına neden olarak bu bölgelerde öznel refahın da düşük olması sonucunu doğurmaktadır.
Cities represent complex arrangements of people and infrastructures, interacting in myriad ways. Although transportation and other mobility technologies have reduced frictions of distance and facilitated greater connectivity of people with their needs, the underlying physical structure of the city itself remains a key determinant in shaping activity outcomes. This chapter examines the interplay of cities, urban form, and the implications for accessibility. Accessibility is the ease with which people are able to reach the goods and services necessary to sustain their basic needs. In this way, accessibility is viewed as a product of the interplay between urban form, transportation systems, and the alternatives they provide, and other factors. Several considerations are reviewed in understanding accessibility and urban form, and then the past is traced before examining key contemporary themes at the nexus of urban form and accessibility. The chapter concludes by identifying several areas prime for further inquiry and exploration moving forward.
Health care is one of the most important facility and it helps to improve the quality of life and social welfare of modern society. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. This study presents a two stages methodology to evaluate the existing locations of healthcare facilities in Thiruverumbur block, Tiruchirappalli district of Tamil Nadu, India and includes to identify the optimal site for new healthcare facility. Firstly, the Spatial Accessibility index to healthcare facilities are measured using Three Step Floating Catchment Area (3SFCA) in a geospatial framework, considering three variables; namely, attractiveness of healthcare facilities, travel time or distance between the locations of the service centre and the residence, and population demand for healthcare facilities. This index would define the disparity region in the healthcare accessibility in the block. Secondly, the Multi-criteria decision analysis would be developed to find optimal sites for new healthcare facility in the deprived area. The analysis also includes road network analysis, to determine the closest facility and shortest route to these healthcare facilities from the population. The study is thus, recommended as a spatial decision support system for urban policy makers regarding accessibility of healthcare facilities in the urban and rural area.
Background
Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.
Methods
This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations.
Results
The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.
Conclusions
The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.
Mobile object analysis is a well-studied area of transportation and geographic information science (GIScience). Mobile objects may include people, animals, or vehicles. Time geography remains a key theoretical framework for understanding mobile objects' movement possibilities. Recent efforts have sought to develop probabilistic methods of time geography by exploring questions of data uncertainty, spatial representation, and other limitations of classical approaches. Along these lines, work has blended time geography and kernel density estimation in order to delineate the probable locations of mobile objects in both continuous and discrete network space. This suite of techniques is known as time geographic density estimation (TGDE). The present paper explores a new direction for TGDE, namely the creation of a density-based accessibility measure for assessing mobile objects' potential for interacting with opportunity locations. As accessibility measures have also garnered widespread attention in the literature, the goal here is to understand the magnitude and nature of the opportunities a mobile object had access to, given known location points and a time budget for its movement. New accessibility measures are formulated and demonstrated with synthetic trip diary data. The implications of the new measures are discussed in the context of people-based vs. placed-based accessibility analyses.
Improving health services is a crucial issue and an immense challenge for the government of any Third World country. Bangladesh lacks healthcare services, one of the basic necessities of life. This paper demonstrates a method for estimating the geographical accessibility of health facilities by population coverage, average travel time and distance to the closest hospital. This analysis was applied to community units in the research area, allowing geographical access to be linked to people. The study area was divided into hexagons of equal size, and accessibility was measured from the centre of each hexagon. Despite the abundance of evidence on the inadequacy of health services in Khulna City, this study has given us a diverse dimension of possibilities. The study found that even with existing health facilities, discontent about the unavailability of health services can be mitigated in most areas. Exceptions are some peripheral areas, where average travel time to reach the city centre and distance from hospital services is greater.
Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan.
Patients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored.
Among 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9%) patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%). More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%).
Nine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.
Limited physical access to primary health care is a major factor contributing to the poor health of populations in developing countries, particularly in mountain areas with rugged topography, harsh climates and extensive socioeconomic barriers. Assessing physical access to primary health care is an important exercise for health care planners and policy makers. The development of geographic information system (GIS) technology has greatly improved this assessment process in industrialized countries where digital cartographic data are widely available. In developing countries particularly in mountain areas, however, detailed cartographic data, even in hardcopy form, are nonexistent, inaccurate or severely lacking. This paper uses GIS technology to assess physical access to primary health care in a remote and impoverished region of Andean Bolivia. In addition, it proposes an alternative model of health personnel distribution to maximize physical accessibility. Methods involved extensive fieldwork in the region, utilizing GPS (global positioning system) technology in the development of the GIS and gathering other pertinent health data for the study. Satellite imagery also contributed to the development of the GIS and in the modeling process. The results indicate significant variation in physical access to primary health care across the three study sites. More importantly, this paper highlights the use of GIS technology as a powerful tool in improving physical accessibility in mountain areas of developing countries.
This paper demonstrates a method for estimating the geographical accessibility of public hospitals. Cost path analysis was used to determine the minimum travel time and distance to the closest hospital via a road network. This analysis was applied to 38,000 census enumeration district centroids in New Zealand allowing geographical access to be linked to local populations. Average time and distance statistics have been calculated for local populations by modeling the total travel of a population if everybody visited a hospital once. These types of statistics can be generated for different population groups and enable comparisons to be made between regions. This study has shown that the northern and southern parts of New Zealand have high average travel times to hospital services.
The purpose of this study was to estimate the spatial accessibility of urban parks for residents living in large public and large private housing estates in Hong Kong. The gravity model was used to calculate the urban park accessibility for every housing estate using different transportation modes (walking, bus, mass transit railway). Google Maps API real-time travel data were used to estimate a series of regression models. We found that public transportation reduced travel time to urban parks for all residents, while it significantly increased the spatial inequality of urban park accessibility between public and private housing residents. We concluded that the spatial inequality of public park accessibility between public and private housing residents in Hong Kong did not owe to the spatial distribution of the urban parks or of the residential locations. The evidence suggested that the spatial inequality was largely attributable to differences in the accessibility and connectivity of public transportation between public housing estates and urban parks.
Urban spatial structure, transport mode and space-time constraints are known to affect accessibility to activities for a city’s residents. However, most studies measure accessibility from home only and report accessibility in terms of the travel time or number of activities. Such studies neglect the mobility and time budget constraints on people’s accessibility. Furthermore, modal accessibility disparity studies have not considered inequality between modes during the afternoon commute. We examine accessibility to non-work activities by automobile and public transport using spatiotemporal measures that determine the number of minutes people have available to participate in activities, given time budget and activity duration constraints, rather than simply the number of activities. We examine modal accessibility disparity in Warsaw, Poland. Our two major findings are the reverse of findings in previous studies: that disparity shifts toward public transport as the activity duration increases and the travel time decreases; and that it shifts toward public transport with increasing distance away from the city center.
To accommodate network allocation, population polygons are frequently transformed into singular, weighted centroids which are then integrated into the network either by snapping each centroid to the nearest network segment or by generating an artificial connector that becomes part of the network. In this article, an investigation of the connection method of network allocation is undertaken with two primary foci: (1) how the density of centroid connectors effects travel cost along the network; and (2) how the algorithms utilized to determine the placement of connectors are affected by the density of connectors. We hypothesize that both issues have an effect on network travel cost and, therefore, on network‐based modeling. These hypotheses are tested on three nested spatial networks in the New England region of the United States. Two fundamental facility location models, the p‐median problem, and p‐center problem, are solved at each spatial extent while varying the density of connectors from one to four. When generating more than one connector thought must be given to the method of connection, the angle of dispersion, the acceptable tolerance of connector length, segment crossing, and saturated connectivity. A novel and thorough framework is proposed to address these concerns.
Objective
To determine accessibility of the primary healthcare system for patients with stroke recently discharged from hospital.
Methods
This project mapped retrospective patient location data and the location of primary healthcare services in the same region. Patient location data were from all patients with stroke ( N = 1595: January 2011–January 2017) discharged from one metropolitan hospital to the local Primary Health Network. Geographic Information System technology was used to map the patient discharge locations and the spatial distribution of primary healthcare services (general practitioner, pharmacy, allied health) across the region. Road network data were used to measure the level of access from each patient’s discharge location to the services.
Results
Access to primary healthcare services was variable. Areas with larger proportions of patients with stroke did not necessarily have good service access. With an increase in travel time, the number of services accessible to patients also increased. However, the spatial variation of access to services remained largely unchanged.
Conclusion
Access to primary healthcare services for patients with stroke varies spatially, with a trend towards relatively low levels of accessibility for many patients. There is an urgent need for future planning to consider geographical access to primary healthcare services for patients with stroke.
The proportion of individuals age sixty-five and over is growing at an astronomical rate in the United States, and some estimate that this demographic age group will double by the year 2025. Older adults and adults nearing retirement age tend to reside in suburban neighborhoods and rely heavily on personal vehicles. This study uses travel diary data on automobile trips to construct activity spaces to explore whether or not travel patterns across age groups result in differential access to particular goods and services in the Orlando Metropolitan Statistical Area (MSA). Using an approach based on time geographic density estimation, this research identifies activity spaces across different age cohorts to identify differences in the automobility of different age groups. Results indicate that the geographic dispersion of activities with the Orlando MSA currently favors younger adults. Adults age fifty to sixty-four had the lowest accessibility scores compared to other age cohorts. If this preretirement group has poor access now, holding other effects constant, their access might only get worse as they get older and stop commuting. Transportation is an important consideration in planning for aging populations, and analyzing differences in how older adults travel compared to their younger counterparts can offer insight into the diverse needs of this group. Key Words: accessibility, aging populations, mobility, time geography, transportation.
Despite collaborative efforts by government, CSOs and the private sector in the provision of health facilities in Ghana, a substantial proportion of communities in rural Ghana still have poor accessibility to basic health services. Using a mixed approach, this paper presents an overview of geographic accessibility to health care services in Wa West District. Semi-structured interviews were conducted with randomly selected 100 households to ascertain their perception on accessibility to health services. Based on the major means of transport to each level of health service, GIS was used to model communities accessibility to health facilities. The findings revealed that, three levels of health services – CHPS, Health Centres and District Hospital exist in Wa West District. Over 50% of communities were found to have high accessibility to CHPS compounds and Health Centres because of their widespread distribution. In contrast, only few communities (4%) have high physical access to District hospital. Poor conditions of roads were a major barrier in household’s accessibility to District hospital. The findings therefore underscore the need for an integrated and cross-sectoral approach to improve accessibility to health care services.
Over the last two decades, the task of providing transportation accessibility for aging people has been a growing concern as that population is rapidly expanding. From this standpoint, serious challenges arise when we consider ensuring aging people’s transportation-based accessibility to critical emergency facilities such as hurricane shelters. An efficient strategy to address this problem involves using Geographical Information Systems (GIS)-based tools in order to evaluate the available transportation network in conjunction with the spatial distribution of aging people, and critical emergency facilities, plus regional traffic characteristics. This study develops a Geographical Information Systems (GIS)-based methodology to measure and assess the transportation accessibility of these critical facilities through a diverse set of case study applications in the State of Florida. Within this evaluation, spatially detailed county-based accessibility scores are calculated with respect to designated hurricane shelters (both regular and special needs shelters) using both static and dynamic travel times between population block groups and critical facilities. Because aging of the Baby Boom generation (people born between 1946 and 1964) is expected to produce a 79 % increase in the number of people over the age of 65 in the next two decades, the proposed methodology and case studies can inform transportation agencies’ efforts to develop efficient aging-focused transportation and accessibility plans.
A significant responsibility of officials involved in transportation planning is ensuring people’s accessibility to multi-modal facilities. This challenging task depends on the available transportation infrastructure as well as the overall population, traffic, roadway and regional characteristics. Such planning takes on additional complexity when aging populations are considered because any extra time they incur reaching these facilities can be especially confounding in light of their potential health and other safety concerns. As such, there is a need for transportation plans to have a multi-modal transportation assessment component that specifically focuses on the accessibility of aging people to critical facilities. To accomplish this goal, this paper describes a Geographical Information Systems (GIS)-based methodology for measuring the aging population-focused accessibility to multi-modal facilities in Florida. Spatially detailed population block- and county-based accessibility scores are calculated with respect to key intermodal facility types (airports, bus stations, and railway and ferry stations), and visually assessed via GIS maps. The knowledge obtained from this accessibility analysis can successfully contribute to the development of more reliable aging population-focused multi-modal transportation plans, as the analysis points to specific areas where accessibility could be improved.
Accessibility is facilitated by well-organized transportation systems that move people efficiently, and it is improved as more activities are reachable to people given the means of available travel. As the current population ages, it will ultimately challenge those who manage transportation systems in their attempts to satisfy the older population’s basic needs. Scanning the literature, accessibility has not been fully explored in relation to aging and older populations. We construct a systematic quantitative analysis of the older population’s accessibility to potential activities. Given their residential patterns and the prevailing transportation system, we ask whether they have as much potential accessibility to activities as their younger counterparts. Our study area is a smaller metropolitan area in the state of Florida. Using highly disaggregate spatial data containing the locations of populations and possible activities, we implement accessibility models in a Geographic Information Systems (GIS) environment, accounting for mode of transportation. Scenarios and activities analyzed are informed by a review of the broader literature as well as our own analysis of the 2009 National Household Travel Survey. We find that the potential accessibility of the aging population varies by activity type and differs with other age group cohorts. When we look in detail at subgroups within the aging population, the oldest group (those 85+) tends to have higher levels of accessibility.
Improving nutrition in urban regions involves understanding which neighborhoods and populations lack access to stores that sell healthy foods, such as fruits and vegetables. To this end, recent work has focused on mapping regions without access to places like supermarkets, often terming them ‘food deserts’. Until recently, this work has not considered residents’ mobility as facilitated by transportation systems, and even among those that do, few have considered alternative forms of transportation, like public transit, opting for automobile-oriented travel assumptions. This paper analyzes people’s spatio-temporal constraints to accessing supermarkets, and focuses on the transit commuting population. Analysis of commute data from Cincinnati, Ohio shows there are a significant number of residents that have improved access to supermarkets when a grocery shopping trip is made on the way home from work, than if they were to depart from their home location. These results extend previous work showing relatively few automobile commuting residents have better access to supermarkets given their work locations.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Canadian provincial health systems are obligated to ensure access to health services for all citizens, based primarily on the principles of "universality" and "accessibility" which is enshrined in the Canada Health Act. Nevertheless, less than 40% of Canadian with mental health problems uses mental health services. Efforts to understand underutilization of mental health services have focused on individual and neighborhood characteristics. The aim of this study was to examine whether we could identify areas with mental health facilities shortage in the southwest of Montreal which may possibly explain disparities in access to mental health facilities. We applied the two-step floating catchment area method for our analyses. The results of our analysis show that mental health services are not equally distributed in the southwest of Montreal and in consequence, accessibility scores vary greatly from one DA to another.
In this paper we propose Bayesian and frequentist approaches to ecological inference, based on R×C contingency tables, including a covariate. The proposed Bayesian model extends the binomial-beta hierarchical model developed by King, Rosen and Tanner (1999) from the 2×2 case to the R×C case. As in the 2×2 case, the inferential procedure employs Markov chain Monte Carlo (MCMC) methods. As such, the resulting MCMC analysis is rich but computationally intensive. The frequentist approach, based on first moments rather than on the entire likelihood, provides quick inference via nonlinear least-squares, while retaining good frequentist properties. The two approaches are illustrated with simulated data, as well as with real data on voting patterns in Weimar Germany. In the final section of the paper we provide an overview of a range of alternative inferential approaches which trade-off computational intensity for statistical efficiency.
This paper presents a framework for evaluating house-level accessibility to urban services based on detailed geo-referenced socio-demographic census data. The framework is applied to assess spatial equity regarding the accessibility of individuals and social groups to urban parks in the city of Tel Aviv. Availability of house-level data was found to be essential for identifying differential accessibility of social groups according to income and national-ethnic identity as well as for evaluating the validity of accessibility assessments based on traditional aggregated measurement at the administrative district level. Also discussed are data usability issues arising when employing local-scale geo-referenced census data, including the potential effect on decisions regarding allocation of local urban services as well as spatial equity practice and discourse.
Despite its potential pitfalls, ecological inference is an unavoidable part of some quantitative settings, including US voting rights litigation. In such applications, the analyst will typically encounter two-way tables with more than two rows and columns. Although several ecological inference methods are currently available for 2×2 tables, there are fewer options for analysing general "R"×"C" tables, and virtually none that model counts as opposed to fractions. We propose a count "R"×"C" method that respects the bounds deterministically, that allows for complex relationships between internal cell quantities, that is easily extensible and that results from transparent assumptions. We study the method via simulation, and then apply it to an example that is drawn from the state of Texas relevant to recent redistricting litigation there. Copyright Journal compilation (c) 2009 Royal Statistical Society.
We sought to describe the role and function of nursing facilities after disaster.
We surveyed administrators at 144 widely dispersed nursing facilities after the Los Angeles Northridge earthquake.
Of the 113 (78%) nursing facilities that responded (11 365 beds), 23 sustained severe damage, 5 closed (625 beds), and 72 lost vital services. Of 87 nursing facilities implementing disaster plans, 56 cited problems that plans did not adequately address, including absent staff, communication problems, and insufficient water and generator fuel. Fifty-nine (52%) reported disaster-related admissions from hospitals, nursing facilities, and community residences. Nursing facilities received limited postdisaster assistance. Five months after the earthquake, only half of inadequate nursing facility disaster plans had been revised.
Despite considerable disaster-related stresses, nursing facilities met important community needs. To optimize disaster response, community-wide disaster plans should incorporate nursing facilities.
Caught in the Eye of the Storm: The Disproportionate Impact of Natural Disasters on the Elderly Population in the United States
- M Maltz
Maltz, M., 2019. Caught in the Eye of the Storm: The Disproportionate Impact of Natural Disasters on the Elderly Population in the United States.
MapQuest Developer, 2019. URL https://developer.mapquest.com/documentation/tools/latitude-longitude-finder/.
Florida Statewide Network Model
FSUTMS, 2018. Florida Statewide Network Model. URL http://www.fsutmsonline.net/.
Population and housing unit estimates
- Us Census
US Census, 2017. Population and housing unit estimates. URL https://www.fgdl.org/metadataexplorer/explorer.jsp.
Facts about Mental Health in Florida Florida - Mental Health Statistics Osceola
- F Ranks
- P Beach
- S Lucie