Accessibility to Health Care Within the Context of the Behavioral Model for Vulnerable Populations
Erin Roark, University of Texas, ArlingtonShow Abstract
Courtney Cronley, University of Tennessee, Knoxville
Noelle Fields, University of Texas, Arlington
Vivian Miller, Bowling Green State University
Stephen Mattingly, University of Texas, Arlington
Dana Hill, University of Texas, Arlington
We conducted in-depth interviews with 18 individuals from environmental justice (EJ) backgrounds for the purposes of capturing their direct perceptions on how transportation accessibility contributes to their healthcare access and utilization. This issue is important because EJ populations have higher rates of chronic health conditions and fewer healthcare options. Theories such as Gelberg’s Behavioral Model for Vulnerable Populations (BMVP) and Ryvicker’s Behavioral-Ecological Model suggest that individuals’ healthcare utilization is partly a function of factors within the built environment, including transportation access. Direct content analysis followed by axial and iterative coding indicate that first/last mile accessibility intersects with chronic health conditions to intensify mobility challenges. The first/last mile inaccessibility for many participants meant that they relied on para-transit mobility programs for healthcare access, which necessitated complex planning. At times, though, transport resources were simply not available. Thematic results also confirm theoretical models and underscore the importance of spatial distribution and the intersection of transportation and healthcare resources in order to improve healthcare access and utilization among EJ population members. Moreover, while new technologies may reduce first/last mile barriers, they must be implemented strategically in terms of regulation to reduce potential discrimination and use transport navigators to support the adoption of emerging transport technologies like ridehailing and car- and ridesharing by new users.
Housing, Mobility, and Well-Being Among the Older Population in the United States: A Literature Review
Shengxiao Li, University of PennsylvaniaShow Abstract
In view of the demographic profile of the older population in the US, in the next two decades, the cities and communities in the US need to adapt the form, environment and transportation systems to accommodate the growing aging population. In this paper, I review two streams of literature in the mobility among the older population: the relationship between housing and mobility; the mobility and wellbeing. I argue that two streams of literature in elderly mobility should be combined to inform the future research.
Is Spatial Mismatch Really Spatial, and Really a Mismatch?: Recent Evidence on Employment Among Minorities in U.S. Cities and Suburbs
Julene Paul, University of California, Los AngelesShow Abstract
Eric Morris, Clemson University
In 1968, John Kain hypothesized that the suburbanization of jobs had not been matched by a suburbanization of African Americans due to housing market discrimination. Geographic and transportation difficulties were thus said to have led to suboptimal labor market outcomes for them (Kain, 1968). This paper investigates “spatial mismatch” using new and contemporary data from the U.S. Current Population Survey and American Time Use Survey, drawn from 2003-2017. We find some evidence for spatial mismatch. In OLS models that control for other sociodemographic characteristics we find that that the wages of both principal city non-Hispanic African Americans and principal city Hispanics are measurably lower than those of their suburban counterparts. Second, multinomial probit modeling shows a slightly higher probability of unemployment for principal city as opposed to suburban African-Americans. However, other evidence calls spatial mismatch into question. The wage premium for suburban minorities has been dropping over time and may now have disappeared entirely. Probit modeling shows that principal city and suburban minorities do not hold meaningfully different types of jobs. Further, OLS models of commute time show that, for minorities, principal city residence is not associated with longer commutes, and that, when controlling for travel mode, city commutes may actually be shorter. As a whole, our evidence thus suggests that spatial mismatch may only be a minor problem, if a problem at all, at the present time. Still, we present proposed policy interventions that seek to improve labor market outcomes for all minorities, suburban as well as urban.
Spatial Access by Public Transport and Likelihood of Health Care Consultations at Hospitals
Boer Cui, McGill UniversityShow Abstract
Genevieve Boisjoly, Ecole Polytechnique de Montreal
Rania Wasfi, Universite de Montreal
Heather Orpana, Public Health Agency of Canada
Kevin Manaugh, McGill University
Ron Buliung, University of Toronto, Mississauga
Yan Kestens, Universite de Montreal
Ahmed El-Geneidy, McGill University
As healthcare is a right in Canada, analyzing the distribution of spatial access to medical consultations, which are crucial for the prevention, diagnosis and early treatment of illnesses, is fundamental to understanding health equity. Spatial accessibility is a factor that can influence whether individuals can reasonably reach the services they seek or not. However, as an indicator of potential access, it does not guarantee realized access due to predisposing and need factors. This study examines the influence of spatial accessibility to hospitals on the likelihood of consulting with a healthcare professional at a hospital in eight Canadian metropolitan regions while controlling for individual characteristics including need for care through multilevel regression modelling. Spatial accessibility was computed using the two-step floating catchment area (2SFCA) method. Self-reported consultations and socio-demographic characteristics were obtained from the Canadian Community Health Survey. We found that the likelihood of consultations did not differ by age nor sex but followed a positive household income gradient (high-income OR: 1.205 CI: 1.109-1.309; middle-income OR: 1.073 CI: 0.996-1.156; compared to low-income). Living in areas with higher spatial accessibility was significantly and positively linked to consultations (OR: 1.012 CI: 1.005-1.020), even after controlling for perceived health (OR: 0.526 CI: 0.491-0.563), chronic conditions (OR: 1.860 CI: 1.747-1.981) and having a regular doctor (OR: 1.251 CI: 1.116-1.402). Policies that may improve spatial accessibility to healthcare services should be considered as doing so may improve the ability of individuals to consult healthcare professionals, which could lead to better health outcomes.
Utilizing Geographic Information Systems to Map Food Availability
Tysean Wooten, North Central Carolina UniversityShow Abstract
Timothy Mulrooney, North Carolina Central University
This study plans to examine the spatial relationship of neighborhoods with low- and high-income levels and their proximity to nutritious food sources. There are many perceived barriers that lower income communities face in getting their daily share of the healthy food that is available. Some of these barriers include availability, transportation, and of course financially. By using Geographic Information Systems (GIS) we can analyze and map out what community’s face food insecurity and how it affects them.
Beyond Quantitative Analysis: Examining Equity Practices at U.S. Public Transit Agencies
Alex Karner, University of Texas, AustinShow Abstract
Kaylyn Levine, University of Texas, Austin
Transportation equity is an idealized outcome that encompasses a fair distribution of the benefits and burdens of transportation system investments and policy decisions. According to federal anti-discrimination and environmental justice law and guidance, transportation planning agencies seek to advance equity-related outcomes in their work in multiple ways. Quantitative analyses of plan impacts can be used to highlight and mitigate disparities, but analyses are often conducted after major decisions have already been made and agencies have substantial flexibility in data collection and analysis. Public engagement can also affect equity-related outcomes, but agencies still rely heavily on public meetings and one-way information dissemination approaches that alienate potential participants. In this review of practice, we summarize our findings from interviews with public transit decision makers, staff, and transportation equity advocates related to promising strategies that can enhance equity outcomes at public transit agencies across the US. We identify eight types of approaches that agencies can employ to ensure that the benefits and burdens of their decisions do not fall disproportionately on one group or location. These approaches will be useful for transportation practitioners seeking best practices that can be used to advance equity-related objectives in their work.
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