Too far to walk : maternal mortality in context

https://www.jhsph.edu/research/affiliated-programs/baltimore-neighborhood-research-consortium/Research_Libr/Macintyre2002.pdf

Place effects on health: how can we conceptualise, operationalise and measure them?

Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. 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. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.

/pdf/spatial-accessibility-of-primary-care-concepts-methods-and-t8qwwilkou.pdf

Spatial accessibility of primary care: concepts, methods and challenges

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.

/pdf/traveling-towards-disease-transportation-barriers-to-health-2jfktgxy3s.pdf

Traveling Towards Disease: Transportation Barriers to Health Care Access

Any study that examines the effects of area-based attributes on individual behaviors or outcomes faces another fundamental methodological problem besides the modifiable areal unit problem (MAUP). I...

/pdf/the-uncertain-geographic-context-problem-1is4yid5v2.pdf

The Uncertain Geographic Context Problem

Therapeutic landscapes: medical issues in light of the new cultural geography.

The goal of this analysis is to determine the importance of geographic and spatial behavior factors in the health care utilization of the residents of rural communities. These geographic factors are part of a general conceptual framework of rural health care utilization. The health and health care of rural Americans are complex. Rural Americans are disadvantaged compared with their urban counterparts in several important ways that affect their health: they are disproportionately poorer, proportionately fewer are of working age, and they have less education (Ricketts 1999). The rural U.S. has 20 percent of the national population, but less than 11 percent of its physicians. Rural versus urban residents are more often uninsured (18.7 versus 16.3 percent), more likely to report being in fair or poor health, have restricted activity, and lower levels of access to a regular primary care provider (Ricketts 1999).

A major problem that rural dwellers face is access to care (Ricketts and Savitz 1994; Medicare Payment Advisory Commission 2001). Although access can be measured in many ways, geographic access is of primary concern in many rural areas. People who live in isolated places, relatively far from metropolitan areas or urban centers, often find it very difficult to contact health care personnel or facilities. In comparison with urban dwellers, rural residents have to travel farther to care and face other problems such as poor quality roads and lack of public transportation. These problems are well known and yet their solution eludes the efforts of the U.S. Congress, state legislatures, and regional governments (Ricketts 1999).

/pdf/the-effects-of-geography-and-spatial-behavior-on-health-care-fiqe0tzf65.pdf

The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

Context: Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. Purpose: This analysis addresses the association of transportation and health care utilization in a rural region. Methods: Using survey data from a sample of 1,059 households located in 12 western North Carolina counties, this analysis tests the relationship of different transportation measures to health care utilization while adjusting for the effects of personal characteristics, health characteristics, and distance. Findings: Those who had a driver's license had 2.29 times more health care visits for chronic care and 1.92 times more visits for regular checkup care than those who did not. Respondents who had family or friends who could provide transportation had 1.58 times more visits for chronic care than those who did not. While not significant in the multivariate analysis, the small number who used public transportation had 4 more chronic care visits per year than those who did not. Age and lower health status were also associated with increased health care visits. The transportation variables that were significantly associated with health care visits suggest that the underlying conceptual frameworks, the Health Behavior Model and Hagerstrand's time geography, are useful for understanding transportation behavior. Conclusions: Further research must address the transportation behavior related to health care and the factors that influence this behavior. This information will inform policy alternatives to address geographic barriers to health care in rural communities.

Access to Transportation and Health Care Utilization in a Rural Region

Background
"Activity space" has been used to examine how people's habitual movements interact with their environment, and can be used to examine accessibility to healthcare opportunities. Traditionally, the standard deviational ellipse (SDE), a Euclidean measure, has been used to represent activity space. We describe the construction and application of the SDE at one and two standard deviations, and three additional network-based measures of activity space using common tools in GIS: the road network buffer (RNB), the 30-minute standard travel time polygon (STT), and the relative travel time polygon (RTT). We compare the theoretical and methodological assumptions of each measure, and evaluate the measures by examining access to primary care services, using data from western North Carolina.

/pdf/a-suite-of-methods-for-representing-activity-space-in-a-2tmmn818ub.pdf

A suite of methods for representing activity space in a healthcare accessibility study

Putting Health into Place draws together original works that collectively argue for a reinvention of medical geography. There is a growing interest worldwide in relationships between human health and the experience of place, an interest driven both by developments in sociocultural theory and observed health concerns. This book is a resource for those wishing to explore or to teach beyond the frontiers of conventional medical geography. As the first word of the book's title suggests, this is an active volume, one that contributes to situating health in the simultaneously tangible, negotiated, and experienced realities of place. Robin A. Kearns and Wilbert M. Gesler argue that medical issues are a necessary but insufficient focus in developing geographies of health and healing. This contention is supported by the authors of the thirteen substantive chapters who convey research findings from the Americas, Britain, and the Pacific. This book represents a collective commitment to exploring links between social and cultural theory, ideas about place, and discourses on health that will be of interest to readers across the social and health sciences.

Wilbert M. Gesler

Papers

Therapeutic landscapes: medical issues in light of the new cultural geography.

The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

Access to Transportation and Health Care Utilization in a Rural Region

A suite of methods for representing activity space in a healthcare accessibility study

Putting Health Into Place: Landscape, Identity, and Well-being