Small-Area Estimation of Spatial Access to Care and Its Implications for Policy

Using mobile phone data to evaluate access to essential services following natural hazards

Natural hazards bring about changes in the access to essential services such as grocery stores, healthcare, schools, and day care because of facility closures, transportation system disruption, evacuation orders, power outages, and other barriers to access. Understanding changes in access to essential services following a disruption is critical to ensure equitable recovery and more resilient communities. However, past approaches to understanding facility closures and inaccessibility such as surveys and interviews are labor-intensive and of limited geographic scope. In this article, we develop an approach to understanding facility-level inaccessibility across a broad geographic area based on location-based services data collected from cell phones. This approach supplements current approaches and helps both researchers and emergency response planners better understand which communities lose access to essential services and for how long. We demonstrate our approach by analyzing loss of access to supermarkets, schools, healthcare facilities, and home improvement stores in Southwest Florida leading up to and following the landfall of Hurricane Irma in 2017.

Gentrification, Mobility, and Exposure to Contextual Social Determinants of Health

This study uses individual level consumer trace data for 2006 residents of low- and moderate-income neighborhoods for the principal cities of the 100 largest metropolitan regions in the US using their location in 2006 and 2019 to examine exposure to the following four cSDOH: healthcare access (Medically Underserved Areas), socioeconomic condition (Area Deprivation Index), air pollution (NO2, PM 2.5 and PM10), and walkability (National Walkability Index). The results control for individual characteristics and initial neighborhood conditions. Residents of neighborhoods classified as gentrifying were exposed to more favorable cSDOH as of 2006 relative to residents of low- and moderate-income neighborhoods that were not gentrifying in terms of likelihood to be in a MUA, and level of local deprivation and walkability while experiencing similar level of air pollution. As a result of changes in neighborhood characteristics and differential mobility pattern, between 2006 and 2019, individuals who originally lived in gentrifying neighborhoods experienced worse changes in MUAs, ADI, and Walkability Index but a greater improvement in exposure to air pollutants. The negative changes are driven by movers, while stayers actually experience a relative improvement in MUAs and ADI and larger improvements in exposure to air pollutants. The findings indicate that gentrification may contribute to health disparities through changes in exposure to cSDOH through mobility to communities with worse cSDOH among residents of gentrifying neighborhoods although results in terms of exposure to health pollutants are mixed.

Quantifying Disparities in Accessibility and Availability of Pediatric Primary Care across Multiple States with Implications for Targeted Interventions

OBJECTIVE

To quantify disparities in accessibility and availability of pediatric primary care by modeling interventions across multiple states that compare publicly insured versus privately insured children, and urban versus rural communities.

DATA SOURCES

Secondary data sources include 2013 National Plan and Provider Enumeration System, 2009 MAX Medicaid claims, 2012 American Community Survey.

STUDY DESIGN

The study models accessibility and availability of care for all children in seven states.

METHODS

Optimization modeling with access constraints is used to estimate access. Statistical hypothesis testing is used to quantify systematic disparities.

PRINCIPAL FINDINGS

California has the best accessibility for privately insured children and Minnesota for publicly insured children. Mississippi has the lowest availability for both populations. Overall, the disparities in availability for pediatric primary care are not as significant as in accessibility. Both rural and urban communities are in need of improvement in accessibility to primary care for publicly insured children, although at varying levels across states.

CONCLUSIONS

Disparities in availability are not as significant as disparities in accessibility. Opportunities to improve access to pediatric primary care vary by state. Generating specific recommendations for small areas is critical to enabling health policy decision makers to improvement access.

Disparities in Preventive Dental Care Among Children in Georgia

INTRODUCTION

We compared access to preventive dental care among low-income children eligible for public dental insurance to access among children with private dental insurance and/or high family income (>400% of the federal poverty level) in Georgia, and the effect of policies toward increasing access to dental care for low-income children.

METHODS

We used multiple sources of data (eg, US Census, Georgia Board of Dentistry) to estimate, by census tract, measures of preventive dental care access in 2015 for children aged 0 to 18 years. Measures were percentage of met need, 1-way travel distance to a dentist, and scarcity of dentists. We used an optimization model to estimate access, quantify disparities, and evaluate policies.

RESULTS

About 1.5 million children were eligible for public insurance; 600,000 had private insurance and/or high family income. Across census tracts, average met need was 59% for low-income children and 96% for high-income children; for rural census tracts, these values were 33% and 84%, respectively. The average 1-way travel distance for all census tracts was 3.7 miles for high-income and/or privately insured children and 17.2 miles for low-income children; for rural census tracts, these values were 11.6 and 32.9 miles, respectively. Increasing dentists' acceptance of public insurance-eligible children increased met need more in rural areas than in urban areas. To achieve 100% met need in rural tracts, however, an 80% participation rate among dentists would be required.

CONCLUSION

Across census tracts, high-income children had better access to preventive dental care than low-income children had. Identifying tracts with disparities in access could result in more efficient allocation of public health dental resources.

Addressing Inequities in Urban Health: Do Decision-Makers Have the Data They Need? Report from the Urban Health Data Special Session at International Conference on Urban Health Dhaka 2015

Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum.We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO's Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities.We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities.