Measuring Potential Access to Primary Healthcare Services: The Influence of Alternative Spatial Representations of Population

Spatial accessibility measures are an important policy tool for managing healthcare provision and reducing health inequality. The two‐step floating catchment area technique, in common with many alternative methodologies, requires that demand‐side population be estimated using spatial interpolation techniques. This article studies the implications of adopting differing spatial representations of population on healthcare accessibility modeling outcomes. Results indicate that a dasymetric model yields lower accessibility scores than a standard pro rata model. More important, the difference is spatially disproportionate, suggesting that the degree of disadvantage experienced in rural areas may be greater than has previously been recognized.     

Using GIS and perceived distance to understand the unequal geographies of healthcare in lower-income urban neighbourhoods

Geographers play important roles in public health research, particularly in understanding healthcare accessibility, utilisation, and individual healthcare experiences. Most accessibility studies have benefited from the increased sophistication of geographic information systems (GIS). Some studies have been enhanced with semi-structured in-depth interviews to understand individual experiences of people as they access healthcare. However, few accessibility studies have explicitly utilised individual in-depth interview data in the construction of new GIS accessibility measures. Using mixed methods including GIS analysis and individual data from semi-structured in-depth interviews, we offer satisfaction-adjusted distance as a new way of conceptualising accessibility in GIS. Based on fieldwork in a predominantly lower-income community in Columbus, Ohio (USA), we find many residents felt neighbourhood healthcare facilities offered low-quality care, which suggested an added perceived distance as they attempt to access high-quality healthcare facilities. The satisfaction-adjusted distance measure accounts for the perceived distance some residents feel as they search for high-quality healthcare in lower-income urban neighbourhoods. In moving beyond conventional GIS and re-conceptualising accessibility in this way, we offer a more realistic portrayal of the issues lower-income urban residents face as they attempt to access high-quality healthcare facilities. The work has theoretical implications for conceptualising healthcare accessibility, advances the mixed-methodologies literature, and argues for a more equitable distribution of high-quality healthcare in urban neighbourhoods.     

A three-step floating catchment area method for analyzing spatial access to health services

Gravity-based spatial access models have been widely used to estimate spatial access to healthcare services in an attempt to capture the interaction of various factors. However, these models are inadequate in informing health resource allocation work due to their inappropriate assumption of healthcare demand. For the purpose of effective healthcare resource planning, this article proposes a three-step floating catchment area (3SFCA) method to minimize the healthcare-demand overestimation problem. Specifically, a spatial impedance-based competition scheme is incorporated into the enhanced two-step floating catchment area (E2SFCA) method to account for a reasonable model of healthcare supply and demand. A case study of spatial access to primary care physicians along the Austin–San Antonio corridor area in central Texas showed that the proposed method effectively minimizes the overestimation of healthcare demand and reflects a more balanced geographic pattern of spatial access than E2SFCA. In addition, by using an adjusted spatial access index, the 3SFCA method indicates strong potential for identifying health professional shortage areas. The study concludes that 3SFCA is a promising method to provide health professionals and decision makers with useful healthcare accessibility information.     

A spatial analysis of the geographic distribution of musculoskeletal and general practice healthcare clinics in Auckland,New Zealand

Despite the high incidence of musculoskeletal health problems in New Zealand, the use of specialised musculoskeletal healthcare providers appears to be limited to a small subsection of society. Analysis of the spatial distribution of musculoskeletal and general practice clinics in Auckland, New Zealand was undertaken to understand the geographical component of the issue of musculoskeletal healthcare accessibility. The locations of all physiotherapy, chiropractic, osteopathic, podiatry, acupuncture and general practitioner (GP) clinics in urban Auckland were mapped and analysed using a combination of spatial statistical tools. Results showed a contrast between the distribution of the predominantly privately-funded musculoskeletal clinics, which appeared clustered in central areas of the city, and predominantly publicly-funded GP clinics, which appeared more evenly spread across the study area. Several physical and social environmental variables appeared to be correlated with clinic location, including clinic proximity to major roads and urban centres, and residential socioeconomic status and ethnicity. This study represents a first step in understanding the underlying causes of the demographic divide between users and non-users of musculoskeletal healthcare. These results may help to inform the development of strategies to improve the accessibility of musculoskeletal healthcare services for people living or working in areas with low provision of musculoskeletal clinics.     

基于最优供需分配的公共设施空间可达性分析

空间可达性是衡量公共服务设施公平性的重要指标,在医疗、教育、休闲等公共服务的布局规划中得到广泛应用。然而已有设施服务可达性模型难以充分反映服务供需关系,计算指标也缺乏物理意义。本文提出新的最优供需分配的公共设施空间可达性计算方法（OSD）取代现有方法。该方法基于最优供需分配模型,将设施服务分配给需求者,根据分配结果计算空间可达性指标。给定服务设施与需求的空间分布,以最小化旅行成本为目标,顾及设施服务能力,采用经典的运输问题模型确定最优的服务供需分配方案,进而度量服务的空间可达性。以郑州市金水区社区卫生服务为例,求解25个中心与1333个居住小区的最优服务配置。使用最优配置结果确定每个设施的服务范围、每个居住小区使用服务的旅行时间,以及特定时间阈值的服务覆盖比率。与流行的两步移动搜索法相比,新方法的计算指标具有明确的物理意义。本文提出的可达性评价方法无需参数,计算高效,结果易于解释,在公共服务评价及设施布局规划方面具有应用潜力。     

Job Accessibility and Male Teenage Employment, 1980–1990: The Declining Significance of Space?*

The spatial mismatch hypothesis, which argues that job decentralization has had a major impact on the economic fortunes of inner-city minorities, has been a popular argument in academic and policy circles. It is possible, however, that employment decentralization was a temporary shock to inner-city labor markets and that labor supply has successfully adjusted by residential relocation and alterations in job search patterns. This paper examines this issue with an empirical analysis of the 1980 and 1990 employment probabilities of black and white male teenagers living in the largest metropolitan areas of the United States. Findings indicate that the impact of job accessibility on employment probabilities declined between 1980 and 1990, especially for black male teenagers not enrolled in school. Accessibility had a declining effect for this group because of losing the advantage of accessibility rather than overcoming the disadvantage of inaccessibility. By 1990, black male teens living in job-accessible areas no longer enjoyed as much of an employment advantage relative to teens living in job-inaccessible areas as they did in 1980. We should thus be cautious about ascribing too much theoretical or policy importance to job accessibility factors.     

人类移动性与健康研究中的时间问题

随着地理信息科学的发展,地理学围绕着社会热点问题不断向其他学科交叉渗透,同时学科的交叉也为地理学研究本身注入了热量。空间一直是地理学研究中的基本问题,而时间与空间密不可分,从时间维度研究人类移动性及其丰富内涵具有重要意义。本文在总结人类移动性热点问题的基础上,重点从时间维度探讨了可达性、出行体验与幸福感、人类健康与疾病等问题的研究内容和方法,并从低收入者社区医疗保健可达性研究和阿帕拉契亚乡村地区吸烟者影响因素研究等案例进行详细阐释,最后对人类移动性与健康研究的发展方向进行了展望。     

铁路网规模测算方法体系与实证分析

通过对路网规模多种测算方法的比较,系统地建立了用于测算铁路网规模的方法体系;经比较分析,发现地理空间特征和经济社会指标是影响路网规模的基本因素。根据数据的可获得性和测算方法的适应性,选择连通度模型对中国铁路基础路网规模进行测算,引入空间运输绝对联系强度和首位联系度对快速路网规模进行测算,并结合GIS技术测定最终的铁路网规模。研究结果表明,为实现铁路服务的普适化,并解决主要运输通道运力紧张的困境,中国未来铁路网的合理规模应达到15万公里,较目前铁路网规模增长近1倍。     

人口统计数据空间化的一种方法

人口空间分布信息在环境健康风险诊断、自然灾害损失评估和现场抽样调查比较等地理学和相关学科研究中占有重要的地位。目前随着对地观测技术和地理信息科学的飞速发展, 如何精确地进行人口数据空间化成为了研究的难点和热点。针对采用传统方法解决人口空间化问题所遇到的困难和不足, 设计了遗传规划(genetic programming, GP)、遗传算法(genetic algorithms, GA) 和GIS 相结合的方法, 以GIS 确定量化影响因子权重, 以GP 建立模型结构, 以GA 优化模型参数, 成功建立研究区-山西省和顺县的人口数据格网分布表面。实验证明与传统建模方法(如逐步回归分析模型和重力模型)相比, 所提方法建模过程更为智能化与自动化, 模型结构更为灵活多样, 而且数据拟合精度更高。     

就医空间可达性分析的两步移动搜索法——以江苏省东海县为例

精确评价医疗设施可达性的空间分异样状况是合理配置医疗资源的前提。本文在回顾国内外关于医疗空间可达性研究的基础上, 采用两步移动搜索法, 以江苏省贫困县--东海县为案例, 以行政村和医院为分析单元, 基于迪卡斯特拉算法计算出各村到医院(卫生院)的最短通行时间, 进而分析各村医疗空间可达性分异情况。采用不用服务时间阈值范围进行空间敏感性分析, 综合研判缺医地区分布特点。与传统的医卫人员和人口比值的方法相比, 两步移动搜索法能有效显示县域范围内医疗可达性的空间分异情况。采用较大的时间阈值, 医疗空间可达性分异较为平滑, 采用较小服务阈值则空间分异显著, 缺医范围也较大。东海县医疗空间可达性整体呈单核结构, 并沿主要交通线延伸, 缺医地区多分布于边缘乡镇。提高边缘乡镇的行政村的甲级卫生院等级和乡村道路等级将会改善边缘乡镇的就医可达性。     

武汉都市圈城际联系通达性的测度与分析

空间- 距离- 通达性已经成为城市区域一体化联系与发展的先决条件。当前都市圈城际联 系发展与交通网络建设存在明显的不同步现象, 矛盾解决的关键是优化其路网通达性空间格局。 以武汉都市圈为实证对象, 构建最短距离矩阵, 引入时间、空间通达性模型, 建立高等级路网发育 评价指标体系, 从节点体系与网络体系两个角度, 定量分析武汉都市圈城际通达性变化及其空间 格局, 揭示出: 圈域城镇( 节点) 体系通达性空间差异明显, 与城市自身交通区位、经济发展水平密 切相关, 其空间格局与城镇等级规模呈共轭协同关系, 不同空间等级节点形成以武汉为中心的同 心圈层与“轴—辐”网络空间格局; 快速交通干道网络( 高速公路、铁路等) 是城市通达性空间演变 的重要推动力, 使其空间收敛减速, 形成显著的带状分异格局, 初步形成沪蓉东西向、京珠南北向 的两大城市经济联系交通走廊; 圈域城际交通干网发育程度偏低, 处于回路网络水平, 高等级路 网扩展潜力巨大。     

珠三角公路网络可达性空间格局及其演化

基于1990、2000和2009年公路网数据,选择空间距离、时间距离和经济潜能３个指标及在此基础上构建综合评价指标,在GIS支持下,探讨1990―2009年珠三角公路网可达性空间格局及其演化规律。研究显示：单一指标不能完整反映公路网综合可达性特征,存在一定局限性。综合评价结果表明：1）研究期内,公路可达性总体上呈现以广―佛核心都市区为最高向外围逐渐递减的圈层结构,可达性最优的核心区范围不断扩大,东西向的可达性递减态势明显快于南北向;2）区域内节点县域可达性等级差异趋于缩小、整体可达性显著提高,但第一阶段（1990―2000年）可达性提高较第二阶段（2000―2009年）更为显著;3）随着路网的逐步完善,东部和南部县市可达性提高明显,中部区域提高幅度低于东、南部县市,西部县市提高较慢。三大地带可达性空间差异明显,中部最高,东部次之,但与中部差异趋于缩小,西部相对最低且与中、东部的差异进一步扩大。     

职住建成环境对郊区居民通勤方式的影响

郊区化带来的职住空间分离与机动化出行问题受到了城市地理与城市规划界的广泛关注。汽车依赖已经成为大城市郊区空间发展过程中面临的现实问题,如何减少汽车通勤比例、鼓励公共交通和非机动化通勤,已经成为城市交通可持续发展的重要目标。基于城市兴趣点数据（POI）与2017年上海市郊区居民活动日志调查数据,通过多项logit模型分析了居民居住地与工作地周边建成环境对通勤方式的影响,并建立中介效应模型探讨长距离通勤对通勤方式产生的间接效应。研究发现提升居住地的地铁站可达性、土地混合利用程度,控制居住地和工作地的设施密度等措施有利于减少汽车出行,而建成环境特征差异对通勤方式的影响要大于对通勤距离的影响。通勤距离对通勤方式选择具有显著的中介效应,对于步行和自行车通勤的影响最为明显。社区环境的提升应从增加设施多样性和公共交通可达性,营造良好的步行、骑行环境等方面来促进居民的绿色通勤行为。     

基于改进潜能模型的城市医疗设施空间可达性——以上海市杨浦区为例

引入人口规模因子和医疗设施等级规模影响系数改进潜能模型,基于GIS空间分析技术,以上海杨浦区为例对其医疗设施空间可达性进行研究。结果表明：杨浦区医疗设施空间可达性分布不均,大桥街道、定海路街道及殷行街道部分区域医疗设施空间可达性较高;中部区域一些街道存在同等级医院位置密集、医疗资源相对集中的情况;杨浦区三级医院的居民就医空间可达性整体优于二级、一级医院。改进的潜能模型综合考虑了居民点人口数量、医疗设施与居民点之间的出行阻抗、以及医疗设施的等级规模对居民就医选择的影响,能更合理地评价医疗设施的可达性。研究结果可为城市医疗设施科学规划与决策提供依据。     

县域农村居民点空间格局与可达性——以江苏省射阳县为例

基于全国第二次土地利用调查数据,借助GIS 软件平台,运用核密度估算、最近邻距离指数、探索性空间数据分析、栅格成本加权距离算法等模型分析江苏省射阳县农村居民点空间格局与可达性。研究表明：在可达性成本上,镇中心半小时经济圈为5 km,成本从中心沿公路网向外围呈增长态势;村中心半小时经济圈半径为1 km,呈现“满天星”分布格局;耕作成本一般为5 min,西部村庄可达性高于东部。在点格局上,农村居民点分布集聚,呈现“西密东疏”的空间格局特征。在规模空间格局上,农村居民点规模普遍较小,具有“太极”状结构。在可达性空间格局上,镇中心平均可达性呈现“双管”结构,高值区在射阳县西部和中部形成条带状分布;村中心平均可达性空间上类似“树枝”结构,呈现中西部高值集聚和东部低值连片分布的格局;耕作平均可达性具有南部高值、东部低值连片和中部高值集聚特征。空间可达性可划分为可达性高值区、可达性中值区和可达性低值区三级,射阳县可达性以中值为主,具有圈层状和“公路沿线”布局特征。     

公共服务设施可达性及其对新建住房价格的影响——以北京中心城为例

本文基于北京市公共服务设施的地理空间信息数据, 采用最短距离指标定量分析了商品 住房对教育、医疗、体育、文化、商业、绿地公园等6 大类公共服务设施的空间可达性( 以下简称 “可达性”) , 并通过Hedonic 特征价格模型定量分析可达性对商品住房价格的影响。研究结果表 明: 1) 按照“最短距离”可达性比较, 商品住房对绿地公园、医院和健身场所可达性最好, 而对大型 商场、文化设施、体育场馆的可达性较差; 2) 按照商品住房的区位和价格比较, 城市四环以内和高 价商品住房组别对公共服务设施的可达性明显优于其它组别; 3) 特征价格模型的定量分析表明, 重点高中、球类场馆、文化设施和绿地公园这4 种公共服务设施的可达性越好, 则商品住房价格 越高, 即目前北京市公共服务设施的规划布局在一定程度上被资本化入商品住房价格。     

20世纪中国铁路网扩展及其空间通达性

作者设计了运输距离Di和通达性系数等度量交通网络通达性的指标,并以“最短路模型”为基础,分析了100年来中国铁路交通网络的发展以及由此引起的通达性空间格局的变化。结果显示,中国铁路网络结构的演化经历了起步、筑网、延伸、优化4个阶段,但空间扩展的速度相对缓慢。路网扩展和原有路网优化是通达性提高的主要方式;100年铁路建设导致“空间收敛”效果显著。通达性空间格局呈现同心圈层结构,由华北区向四周辐射;且通达性高于全国平均水平的范围也由华北向华东区、中南区扩展,交通中心由天津向郑州逐渐转移。铁路的建设推动了社会经济空间结构的演化,运输走廊的现代化将推动空间经济轴线进一步强化。     

Proximity to Job Opportunities and African American Male Unemployment: A Test of the Spatial Mismatch Hypothesis in Indianapolis

Despite the lack of substantive research, the spatial mismatch hypothesis remains a pervasive explanation for the high rate of African American male unemployment. This research tests the hypothesis that census tract African American male unemployment rates are negatively related to the number of local job opportunities. This hypothesis is tested for Marion County, Indiana, the central county of the Indianapolis MSA. Weighted partial correlation coefficients of the logit of African American male census tract unemployment rates and indices of the availability of local job opportunities in manufacturing, services, and retail trade are statistically insignificant. The findings reject the spatial mismatch hypothesis in the specific context of Indianapolis in 1990.     

Suburban gentrification? Examining the geographies of New Urbanism in Atlanta’s inner suburbs

Since the 1990s, Atlanta’s inner suburbs have experienced rising rates of poverty alongside growing racial/ethnic diversity. ? Meanwhile, on the built landscape, high-end (re)development projects incorporating New Urbanist features such as pedestrian accessibility, compact densities, and mixed land uses have become increasingly common. Although practitioners suggest that these developments promote social inclusivity and enhanced “livability,” individual cases suggest that some New Urbanist projects may be gentrifying underserved communities of color. This paper tests the extent of this concern by examining Atlanta's inner-suburban geographies of New Urbanism using a logit model. Results indicate that neighborhoods with older housing stock, more renters, lower incomes, lower rents relative to home prices, and higher Latino populations in close proximity to inner-suburban downtowns are most likely to be targeted for New Urbanist (re)development. Thus, despite the optimistic language, New Urbanism in this region appears to be serving as the inner-suburban face of gentrification.?     

Accessibility to food retailers and socio‐economic deprivation in urban New Zealand

The spatial locations of food retailers are considered to be an influential aspect of population consumption patterns. Such contextual relationships are often related to socio‐economic deprivation, with disparities in accessibility having important implications. This study used Geographic Information Systems and an Enhanced Two‐Step Floating Catchment Area model of spatial accessibility to further understand such relationships within urban areas of New Zealand. Findings, while mixed, indicate that there is generally increased accessibility to all food retailers in highly deprived areas. Understanding these socio–spatial relationships in local environments has important implications for policy initiatives, health outcomes and sustainable development.