Brazilian health regions and scales: A geographical perspective

Abstract:  This paper offers a geographical perspective on the way in which health regions have been defined and established in São Paulo as part of overall Brazilian health policy. To accomplish this, I first situate the Brazilian case in the international debate over the regionalization of health services. Second, I examine health regionalization in the case of São Paulo and show how the process is dynamic and complex, involving geographical scales that go well beyond the administrative boundaries of Brazilian municipalities.     

Proximity in a Ghanaian savanna: Human reactions to the African palm civet Nandinia binotata

Understanding human reactions to wildlife, including the differing reactions of different groups to different species, is important given that expanding human population and settlements increasingly result in natural habitat loss or modification and, consequently, wildlife adaptation and encroachment into cleared and created human spaces such as wastelands and farms. This paper examines the importance of gender and age in the responses of rural coastal villagers in Ghana to the presence of African palm civets. Social data gathered from 450 residents in six villages indicated that women and young people were significantly more fearful of civets, seeing them as village marauders, food thieves and livestock predators. Women were also more likely to carry sticks and beat thick vegetation to dispel civets out of concern for the safety of their children and homes. These findings may inform both rural development and conservation debates and policies.     

Exploiting available data sources: location/allocation modeling for health service planning in rural Ghana

The preconditions for applying GIS-based location-allocation analysis for health service planning in rural Ghana are examined in terms of data availability and quality. A population map is established from the latest available census using geo-coding methods and digital topographic sheets. A vector-based transport model of the region is established by merging data from several sources including GPS. It is suggested that a hybrid transport model is required. This model combines the possibilities for all-direction transportation inherent in the raster-based approach with the possibilities for road/path transportation inherent in the vector-based approach. All-direction movements are expected to take place close to the villages in order to reach a suitable linear transport corridor represented by a vector. Several scenarios for improving the accessibility aspects of the health service provision are examined in light of Ghana's current health service policy. Location-allocation modelling tools are used to select optimal locations and provide statistics on average distance to health centres and percentage of population covered.     

Measuring the need for primary health care: an index of relative disadvantage

The prime objective of primary health care provision is the maintenance or improvement of the population's health. The equitable distribution of resources is paramount to this and measures of disadvantage are implemented to assess differential levels of need as a basis for calculating deprivation payments according to general practitioner workload. Despite research that highlights the benefits of measures of social disadvantage, indices have not been used to fundamentally shape resource allocation for health authorities. This paper uses the results from a patient survey into utilization behaviour to define and model the determinants of the need for health care based on components of relative need and accessibility. Proxy indicators are derived from routine sources of data to create an Index of Relative Disadvantage (IRD). A sensitivity analysis confirms the robustness of the index and shows that—although the index employs a wider range of variables than most previous deprivation indices—there is no gross data redundancy. Simplified versions of the index are also explored and evaluated. The IRD developed here is closely correlated with other indices of disadvantage, but its greater breadth and more logical construction mean that it may be more likely to be a more widely applicable instrument for health care planning of resource allocation.     

Accessibility in designing centralised warehousing: Case of health care logistics in Northern Finland

Long distances and sparse service networks set challenging conditions for material logistics in health care. Globally, health care organisations have been making structural changes towards centralised warehousing and deliveries. In Northern Finland, material logistics of the public health care system rely mainly on numerous separate order and delivery systems, although logistics needs, ordering and stock in different health care facilities correspond to each other. As centralised logistics in orders and deliveries may lead to remarkable savings, pressure for centralised management is high. This paper analyses how effectively a potential centralised warehousing system can be organised based on its spatial components. These include optimal location of one or more warehouses, delivery network coverage and efficiency of routes, as well as accessibility of health centres and hospitals. The geographic information systems (GIS) -based accessibility analytical framework described in this study applies vehicle routing and heuristic computations to location-allocation of warehouses to potential sites by optimising transport cost with a constraint to provide service to at least 90% of delivery demand. The spatial data include the road network, health care facility locations with rough estimates of freight demand nodes and potential locations of warehouse facilities. The main findings of the study show that majority of health centres and hospitals can be effectively reached by a delivery network based on one or two warehouses. Furthermore, the efficiency of the delivery network does not increase remarkably by increasing the number of warehouses, when measured as driving time.     

Neighbourhoods and health: A review of the New Zealand literature

Over the past two decades, there has been a resurgence of interest into place‐based influences on health. Researchers have identified that various characteristics of neighbourhoods exert an influence on the health outcomes and behaviours of local residents. Understanding the processes linking places to health provides considerable potential for a range of policy interventions. We review the New Zealand‐based neighbourhoods and health research. Consideration is given to the types of neighbourhood characteristics, as well the range of health outcomes that have been studied. Finally, we suggest some priorities for further research into the mechanisms underpinning neighbourhood influences on health in New Zealand.     

国外地理学对公共卫生问题的研究与启示

在工业化、城镇化、信息化持续发展,全球变化和全球事件轮番冲击的背景下,公共卫生研究不断深化,已发展为全球性的跨学科议程及研究热点.回顾相关文献发现,国内外地理学对公共卫生问题的研究在数量上均经历了缓慢上升、加速上升和当前的快速上升阶段,但切入角度和关注议题存在差异.本文通过梳理国外地理学对公共卫生问题的研究,对这一领域...     

批判地缘政治学视角下原住民组织对北极事务的参与和影响

从自发组建的非政府组织到北极事务中颇具影响力的权力组织,原住民组织已经成长为北极事务中不可忽视的利益攸关方。在获取北极事务参与权及实施行动决策中,北极原住民组织展现了独特的思考和实践。基于批判地缘政治学的理论视角观察因纽特环北极理事会为代表的原住民组织的发展历程,发现：（1）北极原住民组织强调基于文本生产的知识权力获取方式;（2）制度性参与是原住民组织的主要行动路径。北极事务参与权的获取及针对性行动策略的实施帮助原住民组织成功影响和重塑了北极的治理理念、身份认同与地理空间,推动北极地区向着善治和良治发展。通过对因纽特环北极理事会案例的解析,可以为中国拓展自身在北极地区的合作空间提供参考。     

广州市城中村农民工医疗行为及其空间特征——以新凤凰村为例

运用结构式访谈和深度访谈的调查方法,以城中村的农民工为研究对象,分析其医疗行为及空间特征,并探讨其形成原因。研究发现:城中村的农民工医疗保健水平低,医疗机构的使用率低;在医疗制度不完善的背景下,农民工能动地通过各种途径解决医疗需求,形成三种类型的医疗行为模式,即"自力更生"型、"社会资本"依赖型及"经济实力"型。结合医疗机构的空间分布,农民工医疗行为的空间特征符合距离衰减规律,同时表现出明显的波动性,表现为一个跳跃式五圈层结构。本研究试图为改善农民工的健康行为模式提供科学基础,并在一定程度上补充国内城市保健地理及行为地理的研究。     

A multi-level perspective on small-area health and mortality: a case study of England and Wales

"This paper considers morbidity and mortality variations at the small-area level in England and Wales and their relation to socio-economic factors. Separate affluence and deprivation effects on illness and mortality are identified from a single-level analysis, both exceeding the influence of social class, urbanity or ethnicity. A multi-level perspective is then adopted to explore ecological associations operating both at micro-area and higher level spatial scales. Contextual effects (higher level variability in the impacts of ward level variables) are identified in the effects of small area deprivation on mortality and illness, as well as cross-level interactions; thus the impact of small area social structure on health is partly defined by the wider regional and district setting."     

郊区化背景下居民健身活动时空约束对心理健康影响——以广州为例

本文从健康地理跨学科的视角入手,以广州市典型郊区的102个样本为研究对象,并选择10个城区街道的927个样本作为参照组进行对比研究,重点探讨中国式快速郊区化背景下,郊区居民健身活动时空约束对心理健康状况的影响。通过构建多元线性回归模型,从微观层面探讨居民城市建成环境、健身行为和心理健康之间的相互关系。结果表明：基于WHO-5反映心理健康量表的评分,郊区样本心理健康状况平均分值只有8.411分,远低于城区样本的平均12.788分,郊区居民的心理健康问题需要引起重视。相对于城区居民,郊区居民健身活动受长距离的通勤及不完善的公共交通系统的时空约束更为明显,健身活动频率更低、时间更短、空间上主要集中在住宅附近。这种差异除了受个人经济社会属性、邻里社区融入等因素影响外,还明显受到建成环境因素的影响。研究结论对弥补过度市场化逐利下造成的城市公共性缺失,维护社会空间公平,完善中国式郊区化下的公共服务设施配套体系,改善郊区居民心理健康状况有重要意义,同时也可为郊区规划及公共政策制定提供参考。     

Understanding spatial structures and organizational patterns of city networks in China: A highway passenger flow perspective

The use of multi-perspective and multi-scalar city networks has gradually developed into a range of critical approaches to understand spatial interactions and linkages. In particular, road linkages represent key characteristics of spatial dependence and distance decay, and are of great significance in depicting spatial relationships at the regional scale. Therefore, based on highway passenger flow data between prefecture-level administrative units, this paper attempted to identify the functional structures and regional impacts of city networks in China, and to further explore the spatial organization patterns of the existing functional regions, aiming to deepen our understanding of city network structures and to provide new cognitive perspectives for ongoing research. The research results lead to four key conclusions. First, city networks that are based on highway flows exhibit strong spatial dependence and hierarchical characteristics, to a large extent spatially coupled with the distributions of major megaregions in China. These phenomena are a reflection of spatial relationships at regional scales as well as core-periphery structure. Second, 19 communities that belong to an important type of spatial configuration are identified through community detection algorithm, and we suggest they are correspondingly urban economic regions within urban China. Their spatial metaphors include the administrative region economy, spatial spillover effects of megaregions, and core-periphery structure. Third, each community possesses a specific city network system and exhibits strong spatial dependence and various spatial organization patterns. Regional patterns have emerged as the result of multi-level, dynamic, and networked characteristics. Fourth, adopting a morphology-based perspective, the regional city network systems can be basically divided into monocentric, dual-nuclei, polycentric, and low-level equilibration spatial structures, while most are developing monocentrically.     

微观视角下旅游情境人地关系的理论与经验

旅游现象与活动中的人地关系是旅游研究中的跨学科议题,但目前微观心理与行为视角下的旅游情境人地关系研究尚有不足。本文检视了旅游情境人地关系研究的特殊性和多元性,探究了微观视角下旅游情境人地关系研究的经验化路径,以旅游者行为意愿为例对人—地二元环境刺激促成人—地交互及行为反应的可能机制进行了理论推导和实证检验,并分析了上述理论与经验探讨对于旅游情境人地关系研究的启示。研究表明：① 旅游情境人地关系研究具有多元对象、层次、范式及方法论,存在4种主要情形和2种典型范式。② 心理—行为范式是拓展人地关系研究的重要方向,提炼具体问题和聚焦具体变量是微观视角下旅游情境人地关系研究经验化及本体论化的关键环节。③ 认知和情感形象、地方依恋、行为意愿等构成的经验模型是对人—地二元到人—地交互理论逻辑的一种刻画,为旅游者行为提供了一个可能的人地关系解释。④ 微观视角下旅游者行为意愿的形成经历了地的功能与人的情感两个向度环境刺激、地方依恋人地联结有机体、行为反应之间的传导过程。⑤ 微观视角下旅游情境人地关系研究需把握人地关系主题与旅游现象特性、完善多元尺度和范式、推进理论的经验化、注重方法的问题导向和理论意义。     

Towards a framework for delineating sub-districts for primary health care administration in rural Ghana: A case study using GIS

This paper examines the need to carry out primary health care administration, programming and planning beyond the established 110 districts in Ghana. The framework for delimiting the sub-districts is offered by the availability of digital data such as the district boundary, site location, road network and population. Using the specified travel distance from predetermined sites, network analysis generates approximate polygons around the health centres to create functional areas ? the health sub-districts. Additional sites are proposed based on a set of criteria which includes proximity, centrality, population and existing level of infrastructural development in an attempt to improve coverage and bring the total utilization of health facilities closer to 100% in the study area.     

Planning hierarchical hospital service areas for maternal care using a network optimization approach: A case study in Hubei,China

Improving maternal health is one of the Sustainable Development Goals. Hospital service areas (HSAs), which contain most hospitalization behaviors at the local scale, are crucial for health care planning. However, little attention has been given to HSAs for maternal care and the hierarchy structure. Considering Hubei, central China, as a case study, this study aims to fill these gaps by developing a method for delineating hierarchical HSAs for maternal care using a network optimization approach. The approach is driven by actual patient flow data and has an explicit objective to maximize the modularity. It also establishes the hierarchical structure of maternal care HSAs, which is fundamental for the planning of hierarchical maternal care and referral systems. In our case study, 45 secondary HSAs and 22 tertiary HSAs are delineated to achieve maximal modularity. The HSAs perform well in terms of indices such as the Localization Index and Market Share Index. Furthermore, there is a complementary relationship between secondary and tertiary hospitals, which suggests the need for referral system planning. This study can provide evidence for the validity of the HSA and the planning of maternal care HSAs in China. It also provides transferable methods for planning hierarchical HSAs in other developing countries.     

Measuring spatial accessibility to primary care in rural areas: Improving the effectiveness of the two-step floating catchment area method

Quantifying spatial accessibility in relation to the provision of rural health services has proven difficult. This article critically appraises the two-step floating catchment area (2SFCA) method, a recent solution for measuring primary care service accessibility across rural areas of Victoria, Australia. The 2SFCA method is demonstrated to have two fundamental shortcomings – specifically the use of only one catchment size for all populations, and secondly the assumption that proximity is undifferentiated within a catchment (especially problematic when the catchment is large). Despite its advantages over simple population-to-provider ratios, the 2SFCA method needs to be used with caution.     

Wellbeing, health and geography: A critical review and research agenda

Abstract:  This paper explores different conceptual and policy spaces of wellbeing. The increasing use of wellbeing in contemporary health debates affords geographers of health new arena in which to explore the processes that promote, remedy or regenerate health and ill-health. The paper first critically reviews the theoretical approaches and challenges for operationalizing the concept of wellbeing in both research and policy. We then present a framework of the spaces of wellbeing to provoke discussion and research amongst geographers of health. The paper concludes with proposals for future research orientations.     

城市内部居住迁移对个体健康的影响——以广州市为例

居住迁移作为城市最重要的活动之一,对个体生理和心理健康的影响受到社会学和心理学的关注,但鲜有从迁移所涉及的居住环境、迁移方向、距离等地理角度展开系统研究。本文以广州市为例,利用2016年入户调研问卷数据,运用二项logistic回归分析方法,并结合深度访谈法,分析居住迁移的时间特征、空间特征等因素对个体自评生理健康与心理健康带来的影响。研究结果表明,居住迁移对个体健康的影响包括长期累积效应与短期效应。前者体现为个体18岁前频繁的居住迁移对生理和心理造成的负面影响;后者为短时间内居住迁移对心理健康造成较大的负面影响。此外,在最近一次居住迁移中,主动迁居对生理健康有显著正向影响,离心性迁移方向对心理健康亦有显著正向影响;长距离迁移对心理健康则为负向影响。研究结果对于个体择居、社区建设具有重要的意义。     

Tibetan Lake Expansion from a Pastoral Perspective: Local Observations and Coping Strategies for a Changing Environment

Global climate change is causing the majority of large lakes on the Tibetan Plateau to expand. While these rising lake levels and their causes have been investigated by hydrologists and glaciologists, their impacts on local pastoral communities have mostly been ignored. Our interviews with pastoralists in central Tibet reveal their observations and beliefs about Lake Serling’s expansion, as well as how its effects are interacting with current rangeland management policies. Interviewees reported that the most negative effects on their livelihoods have been reduced livestock populations and productivity due to the inundation of high-quality pastures by saline lake water. However, pastoralists’ collective efforts based on traditional values and norms of sharing, assistance, and reciprocity have helped them cope with these climate change impacts. These local, traditional coping strategies are particularly worthy of attention now, given that the transformation of traditional pastoralism is a goal of current government development initiatives.