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Li J, Xu M, Liu T, Zhang C. Regional Differences, Dynamic Evolution and Convergence of Public Health Level in China. Healthcare (Basel) 2023; 11:healthcare11101459. [PMID: 37239745 DOI: 10.3390/healthcare11101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
People's health is a necessary condition for the country's prosperity. Under the background of the COVID-19 pandemic and frequent natural disasters, exploring the spatial and temporal distribution, regional differences and convergence of China's provincial public health level is of great significance to promoting the coordinated development of China's regional public health and achieving the strategic goal of a "healthy China". Based on China's provincial panel data from 2009 to 2020, this paper constructs an evaluation index system for China's public health level from five dimensions: the popularization of a healthy life, optimization of health services, improvement of health insurance, construction of a healthy environment, and development of a health industry. In this paper, the entropy method, Dagum Gini coefficient, Kernel density function and spatial econometric model are used to analyze the spatiotemporal distribution, regional differences, dynamic evolution and convergence of China's public health level since the new medical reform. The study found that, first, China's public health level is generally low, structural contradictions are prominent and the construction of a healthy environment has become a shortcoming hindering the improvement of China's public health level since the new medical reform. The public health level of the four major regions showed a spatial distribution pattern of "high in the eastern, low in the northeastern, central and western" areas. Second, the overall Gini coefficient of China's public health level showed a "V-shaped" trend of first decreasing and then rising, but the overall decrease was greater than the increase, among which the regional difference was the main source of regional differences in China's public health level, but its contribution rate showed a downward trend. Third, except for the basic maintenance of a healthy environment, the Kernel density curves of China's public health level and its sub-dimensions have shifted to the right to a certain extent, and there is no polarization phenomenon. Finally, the level of public health in China has a significant spatial correlation. Except for the northeast region, the growth rate of low-level public health provinces in China and the other three major regions is higher than that of high-level public health provinces, showing a certain convergence trend. In addition, the impact of economic development, financial pressure, and urbanization on the convergence of public health levels in the four major regions is significantly heterogeneous.
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Affiliation(s)
- Jixia Li
- School of Government, Beijing Normal University, Beijing 100875, China
| | - Mengzhi Xu
- School of Government, Beijing Normal University, Beijing 100875, China
| | - Tengfei Liu
- School of Business Administration, The Open University of China, Beijing 100039, China
| | - Can Zhang
- School of Government, Beijing Normal University, Beijing 100875, China
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Martín-Turrero I, Valiente R, Molina-de la Fuente I, Bilal U, Lazo M, Sureda X. Accessibility and availability of alcohol outlets around schools: An ecological study in the city of Madrid, Spain, according to socioeconomic area-level. ENVIRONMENTAL RESEARCH 2022; 204:112323. [PMID: 34774513 PMCID: PMC8875292 DOI: 10.1016/j.envres.2021.112323] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Neighborhood accessibility and availability of alcohol products has been associated with increased alcohol consumption and harms among adolescents. This availability has been shown to be higher in neighborhoods with lower socio-economic status (SES). The aim of this study was to examine inequalities in alcohol outlet density and proximity around schools by area-level SES in Madrid, Spain. Data on schools, SES, alcohol outlets and population density at census tract level were obtained through public databases from the local government of Madrid. We examined (1) density as the number of alcohol outlets around schools within 3 buffers (i.e. 200 m, 400 m and 800 m) and (2) proximity as the distance from schools to their nearest alcohol outlet. We performed multilevel analyses to examine the associations between alcohol outlet density and proximity and SES, adjusted by population density. Secondary schools (n = 576) located in less deprived areas had lower densities of alcohol outlets at walking distances of 200 and 400 m (50% and 37% lower, respectively p < 0.05). No significant differences were found for the proximity measures. The socioeconomic level of the area in which adolescents go to school is a determinant of their exposure to alcohol, where those who study in high SES areas have lower exposure to alcohol outlets. This study highlights the need to prioritize equity in the design and implementation of policies to limit alcohol accessibility among adolescents, including establishing minimum distances between schools and alcohol outlets or limiting the number of outlets per inhabitant in neighborhoods.
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Affiliation(s)
- Irene Martín-Turrero
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Roberto Valiente
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Geology, Geography and Environmental Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Irene Molina-de la Fuente
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain; Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA
| | - Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Johns Hopkins, Center for Health Equity, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Xisca Sureda
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, United States; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; CIBER Respiratory Diseases (CIBERES), Madrid, Spain.
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