Comparing alternative methods to measuring pedestrian access to community pharmacies

Strategic Assessment of Neighbourhood Environmental Impacts on Mental Health in the Lisbon Region (Portugal): A Strategic Focus and Assessment Framework at the Local Level

Scientific evidence shows that each place/environment generates specific conditions with associated impacts on the mental health and well-being of the population. A holistic, multilevel and integrated environmental approach to mental health enhances the understanding of this phenomena, supporting the local decision-making processes to improve spatial planning of neighbourhood environments. The aim of this study is to develop a strategic assessment framework, based on four municipalities in the Lisbon Region (Portugal), that explores policy and planning initiatives capable of generating favourable neighbourhood environmental conditions for mental health while also detecting risks. Using baseline results of significant statistical associations between individuals’ perceptions of their neighbourhood environment and their mental health in the Lisbon Region, a Strategic Focus on Environmental and Mental Health Assessment framework (SEmHA) was built, by applying the methodology “Strategic Thinking for Sustainability” in Strategic Environmental Assessment, developed by Partidário in 2012. Taking into account the promotion of the population’s mental health, four critical decision factors of neighbourhood environments were identified: (1) public space quality (e.g., improving sense of place), (2) physical environment quality (e.g., low levels of noise exposure), (3) professional qualification and creation of economic activities (e.g., attracting new economic activities), and (4) services and facilities (e.g., improving access to health and education services). The proposed strategic focus and assessment framework contributes to ensuring that interventions in neighbourhood environments truly achieve community mental health benefits and reduce inequalities, thus helping policy makers to assess impacts at the local level.

Towards routine, city-scale accessibility metrics: Graph theoretic interpretations of pedestrian access using personalized pedestrian network analysis

A wide range of analytical methods applied to urban systems address the modeling of pedestrian behavior. These include methods for multimodal trip service areas, access to businesses and public services, diverse metrics of "walkability", and the interpretation of location data. Infrastructure performance metrics in particular are an increasingly important means by which to understand and provide services to an urbanizing population. In contrast to traditional one-size-fits all analyses of street networks, as more detailed pedestrian-specific transportation network data becomes available, the opportunity arises to model the pedestrian network in terms of individual experiences. Here, we present a formalized and city-scale framework, personalized pedestrian network analysis (PPNA), for embedding and retrieving pedestrian experiences. PPNA enables evaluation of new, detailed, and open pedestrian transportation network data using a quantitative parameterization of a pedestrian's preferences and requirements, producing one or more weighted network(s) that provide a basis for posing varied urban pedestrian experience research questions, with four approaches provided as examples. We introduce normalized sidewalk reach (NSR), a walkshed-based metric of individual pedestrian access to the sidewalk network, and sidewalk reach quotient (SRQ), an estimate of inequity based on comparing the normalized sidewalk reach values for different pedestrian profiles at the same location. Next, we investigate a higher-order and combinatorial research question that enumerates pedestrian network-based amenity access between pedestrians. Finally, we present city-scale betweenness centrality calculations between unique pedestrian experiences, highlighting disagreement between pedestrians on the "importance" of various pedestrian network corridors. Taken together, this framework and examples represent a significant emerging opportunity to promote the embedding of more explicit and inclusive hypotheses of pedestrian experience into research on urban pedestrian accessibility, multimodal transportation modeling, urban network analysis, and a broader range of research questions.

Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study

OBJECTIVES

Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal.

DESIGN

This study estimates road network-based access times from the centroids of statistical sections (census block groups equivalent) to locations of EMS and hospital emergency services. Each statistical section has been linked to a Material Deprivation Index (MDI). A non-parametric analysis of variance (ANOVA) was undertaken to compare MDI-linked statistical sections in terms of access to emergency care. Geographical access analysis was conducted for 2018.

PRIMARY OUTCOME MEASURE

Road network-based access time (in minutes) for EMSs to statistical sections and then on to emergency units in hospitals.

RESULTS

Overall, 82.4% of the LMA population is located less than a 10 min drive from an EMS without transport, and 99.1% from an EMS with transport. Travel time from EMS with transport to hospital is potentially less than 20 min for 95.2% of the population. However, 63.1% of residents living beyond a 30 min threshold (total time from emergency call to hospital arrival) are in areas with very high MDI (18.8% in high MDI, 13.3% in medium MDI, 4.7% in low MDI, 0% in very low MDI). Kruskal-Wallis ANOVA confirms discrepancies in access times between better-off and poorer areas.

CONCLUSION

Poorer areas experience worse geographical access to EMS and hospital emergency units. More research is needed to explore the quality of services and their outcomes, and to refine the analysis by focusing on specific vulnerable groups.

Disparities in Geographical Access to Hospitals in Portugal

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.