A geographic assessment of 'total' health care supply in Ontario: complementary and alternative medicine and conventional medicine

Shortages of family physicians, specialists and other personnel working within the realm of conventional medicine (CM) concern citizens in many regions and municipalities in Canada. Complementary and alternative medicine (CAM) approaches (such as chiropractic, holistic, homeopathic, naturopathic, massage and acupuncture) are increasingly used in conjunction with, or in some cases as replacements for, conventional medicine. Thus, to get an idea of 'total' health care supply in a jurisdiction and to draw comparisons between locations, it is useful to understand the spatial tendencies of both CM and CAM offices. With the use of a sample that contains the location, employment and sales of 4,955 CAM and 8,709 CM offices, this study details the spatial patterns of health care supply in the Canadian province of Ontario. The analysis comprises three main parts. First, the geographic tendencies of CAM and CM office activity are revealed in per capita terms and while regional differences are detectable, the main contrast is that CAM displays a much more even distribution across the urban-rural continuum in comparison to CM. Second, through the use of location quotients and a local spatial autocorrelation analysis, it is shown that certain municipalities (especially in Ontario's southwest and south-central regions) specialize in CAM and the most outstanding spatial feature is an '81 municipality CAM cluster' that represents arguably the pinnacle of CAM activity in the province. CM specialization is rarer and is biased towards the more populated municipalities. Third, a Spearman's correlation analysis suggests that CAM and CM health care supply are associated with community well-being indictors and urban density measures.     

Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

This research examines geographical accessibility to primary care providers (PCPs) across urban and rural areas of Southwestern Ontario and examines variations in the distribution of PCPs in relation to the senior population (aged 65 years and older). Information about PCP practices was provided by the HealthForceOntario Marketing and Recruitment Agency. Population data were obtained from the 2016 Census of Canada. To calculate scores for accessibility to PCPs (i.e., PCPs/10,000 population), we applied the enhanced 2-step floating catchment area method with distance decay effect within a global service catchment of 30-minute drive time. A geospatial mapping approach revealed disparities in the distribution of PCPs with a pattern of higher spatial accessibility in or around major urban areas in Southwestern Ontario. Comparative analyses were performed in association with the seniors’ population to identify how accessibility scores were mismatched with the population needs. The outcome of this study will assist researchers and health service planners to better understand the distribution of existing PCPs to address inequalities, particularly in rural areas.     

Spatial Mismatch and the Structure of American Metropolitan Areas, 1970–2000

Abstract.  This paper analyzes the impact of employment and population shifts in U.S. metropolitan areas from 1970 to 2000 on a spatial mismatch index to determine how metropolitan residents reacted to changes in metropolitan employment distributions. In particular, it seeks to determine whether suburban employment growth created new areas to which access is valued or whether it repelled metropolitan residents and sparked population growth in more distant suburban locations. The results show that residents tended to move away from areas gaining jobs. Black residents, on the other hand, appeared to be attracted to areas that are experiencing employment growth.     

An Examination of the Stochastic Distribution of Spatial Accessibility to Intensive Care Unit Beds during the COVID-19 Pandemic: A Case Study of the Greater Houston Area of Texas

Sufficient and reliable health care access is necessary for people to be able to maintain good health. Hence, investigating the uncertainty embedded in the temporal changes of inputs would be beneficial for understanding their impact on spatial accessibility. However, previous studies are limited to implementing only the uncertainty of mobility, while health care resource availability is a significant concern during the coronavirus disease (COVID-19) pandemic. Our study examined the stochastic distribution of spatial accessibility under the uncertainties underlying the availability of intensive care unit (ICU) beds and ease of mobility in the Greater Houston area of Texas. Based on the randomized supply and mobility from their historical changes, we employed Monte Carlo simulation to measure ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method. We then conducted hierarchical clustering to classify regions of adequate (sufficient and reliable) accessibility and inadequate (insufficient and unreliable) accessibility. Lastly, we investigated the relationship between the accessibility measures and the case fatality ratio of COVID-19. As result, locations of sufficient access also had reliable accessibility; downtown and outer counties, respectively, had adequate and inadequate accessibility. We also raised the possibility that inadequate health care accessibility may cause higher COVID-19 fatality ratios.     

北京都市区就业-居住空间结构及特征研究

近二十年来,在经济社会转型和城市化进程不断加快的背景下,我国许多大城市的就业-居住空间结构发生了巨大的变化。本研究以北京都市区为例,建立北京都市区就业-居住基础地理信息数据库,运用GIS空间分析技术对北京就业-居住空间关系进行多尺度分析,在界定就业中心和居住中心的基础上,评价北京都市区的就业与居住平衡状况。研究结果表明,就业-居住分离是当今北京城市空间结构的突出特征。     

Locational disadvantage and the spatial distribution of government expenditure on urban infrastructure and services in metropolitan Sydney (1988–2015)

Provision of public services by state governments rather than municipalities is considered an important urban governance factor preventing deeper levels of socio‐spatial inequality in Australian cities. The paper examines the spatial patterns of investment by the New South Wales state government in a wide range of services and infrastructure in metropolitan Sydney over 28 budget years from 1988/89 to 2015/16. We examined the relationship between volume and type of investment in infrastructure and services, and considered a local area's socioeconomic characteristics, distance from the central business district, and designation as a strategic site in metropolitan plans. Despite an overall redistributive approach favouring relatively disadvantaged areas, the most disadvantaged suburbs in metropolitan Sydney had significantly lower levels of investment. When funding was directed to the most disadvantaged suburbs, it was often in the form of new social housing development, reinforcing both the concentration of poverty and disadvantage in resource access. The findings suggest that this is a case of under‐investment by the state government in areas already populated by disadvantaged communities rather than a market‐driven process whereby disadvantaged households move into poorly resourced neighbourhoods.     

Spatial Analysis of Physicians' Offices with Respect to Population and Hospital Beds in Istanbul

Maldistribution of medical staff is a subject of criticism in many developing countries. This paper investigates the spatial distribution of physicians' offices with respect to population and hospital beds in Istanbul. The spatial distribution of physicians' offices is investigated with respect to socio-economic and locational characteristics of the districts. The results show that only a few districts benefit from an amazing growth in the concentration of physicians' offices while the periphery of the city, where mostly low-income people live, has a lower physician/population ratio than the metropolitan average. In addition, the spatial distribution of physicians offices with respect to population and hospital beds is investigated by the use of regression analysis within time. According to the results, while there was some relationship between the physicians' offices and the hospital beds in the 1980s, there was no relationship with population or hospital bed distribution in the 1990s. Increasing the number of factors which affect the distribution of physicians and testing the model in other metropolitan areas in order to obtain more general results are suggested for further research.     

General practice access in regional and remote Australia for ageing populations

Identifying and removing access barriers to the timely provision of comprehensive health care is increasingly important for the wellbeing of Australia's rapidly ageing and frail populations, particularly those in non‐metropolitan settings. This study has examined if current general practice (GP) locations in non‐metropolitan South Australia (SA) and Western Australia (WA) are geographically accessible to the rapidly growing frail and prefrail populations known to have a high level of health service use and reduced mobility. Geospatial analysis linking 60‐kilometre GP service catchments, 2016 population counts, and 2027 population projections has estimated that the size of the frail and prefrail population that live outside these GP service catchments will double, reaching 7,800 people by 2027. The maldistribution of GP locations was most evident in WA. As regional and remote populations continue to age, the challenge of health service provision, including geographic access to care, must be resolved to ensure that populations in these areas have the best opportunity to age well. Geospatial methods linking service and demographic information, such as the approach used in this analysis, can aid in planning the equitable provision of health care for older Australians.     

COVID-19, mental health,and rurality: A pilot study

COVID-19 has caused enormous economic and social disruptions that may have lasting effects on employment, income, and working conditions. Critically, these disruptions often have a negative impact on mental health. While significant research has examined the relationship between COVID-19 and mental health, most of these studies focus on urban centres. This paper presents results from a pilot study conducted in two rural counties in Ontario, Canada on the experiences of residents from small and rural communities related to COVID-19. Based on 3496 survey results, this study quantifies the negative impact of COVID-19 on overall mental health and the confounding role of gender, income, and age. Results must be used to expand the dialogue around rural mental health and to ensure appropriate programs and policies are developed.     

Self,Health, and Gender: Complementary and alternative medicine in the British mass media

The growth of complementary and alternative medicine (CAM) in the West entails complex geographies of health, identity and knowledge. Debates about why people are attracted to CAM highlight the importance of consumer agency and increasing access to health care information. The article explores a key space within which information on CAM is produced and negotiated: health and lifestyle magazines. Drawing upon interviews with the editors of eight British titles, the article outlines three ways in which CAM is discursively framed: as a pragmatic medical tool kit brought to bear on the diseased body; as a means of achieving 'total well-being' in everyday metropolitan space; and as a central pillar of an alternative lifestyle. The final section of the article considers how editors understand and address their predominantly female readerships, with an emphasis on how CAM is articulated within an ostensibly emancipatory project of self-responsibility and personal empowerment against the ambivalent backdrop of consumer culture.     

The wellsprings of candidate emergence: Geographic origins of statewide candidacies in the United States

Candidates and nominees for statewide office in the United States do not emerge from random locations within states. In this paper, we argue that densely populated areas are more likely to both foster political ambition and to afford the resources that enable candidates to wage an effective campaign. Candidates and nominees for major statewide office originate from populous counties in numbers significantly out of proportion to these counties’ share of their state’s population. Meanwhile, aspirants virtually never emerge out of rural areas or small towns. The pattern holds for all candidates and nominees for both Senate and governor and for both major political parties. Regional biases are more pronounced for institutionally strong gubernatorial offices than for weak offices and among high quality nominees for statewide office than among inexperienced candidates. Given the importance of urban/rural cleavages in the American electorate, these findings raise fundamental questions about political representation.     

A Spatial-Temporal Analysis of Health Care and Mortality Inequalities in China

Two geographers specializing in China TYalyze that country's health care inequality from 1990 to 2008, for the purpose of: (1) examining spatial-temporal variations of health care inequality at multiple scales (the regional, provincial, and county levels); (2) exploring whether economic growth and transition to a market economy have exacerbated the unevenness of health care; and (3) analyzing the impact of health care inequality on health outcomes, especially mortality. The authors apply GIS-based spatial statistical methods to detect spatial-temporal patterns of health care, and use multilevel regression to examine the linkages between health care, mortality, and regional economic inequality, and ultimately to assess the sensitivity of health care inequality to geographic scale and examine whether reforms implemented to date have resulted in more equitable access to health care. The paper also demonstrates how the concurrent transitions of decentralization, marketization, globalization, and urbanization in China have interactively contributed to health care inequality and mortality.     

武汉都市圈经济社会要素流的空间分析

都市圈城际经济联系与相互作用空间表现形式为城市间、城市-区域间的人流、物流、信息流、资金流、技术流等经济社会要素流。基于城际功能集散效应影响量建立城市流模型:F=NE,揭示出:武汉都市圈各中心城市经济社会要素流强度空间差异明显,对外经济联系呈现显著规模等级分布,空间结构上已经形成以武汉为中心的"鞍形"圈层结构。通过统计数据,利用SPSS统计软件,从实证角度分析得出:武汉成为圈域经济社会要素流集散中心,城际经济社会要素流不同程度表现出以武汉为中心的"等级放射状"空间格局。     

Land Absorption in U.S. Metropolitan Areas: Estimates and Projections from Regional Adjustment Models

This article adapts a regional adjustment model to estimate and project the spatial outcome of population and employment growth in U.S. metropolitan areas. The three-equation multiplicative model of population change, employment change, and land absorption is estimated using three-stage least squares to account for endogeneity among the dependent variables and contemporaneous correlation across the system of equations. In addition to the core model, alternative specifications are estimated, imposing the initial conditions of size, land availability, and economic structure. The stability of the solutions is then examined using reduced-form equations estimated via the seemingly unrelated regression equations approach. The results reveal substantive evidence that population and employment growth are jointly determined, of how the two affect the outcome of land development, and, perhaps most importantly, stable and fractionally reasonable estimates at projected equilibrium points. Lastly, the adapted model controlling for the initial condition of land availability is used to project patterns of land consumption at equilibrium in 50 rapid-growth metropolitan areas.     

Placing the second generation: A case study of Toronto

We examine the social mobility of the second generation in the Toronto metropolitan area by analyzing whether the adult children of immigrants live in more affluent and desirable neighbourhoods than the first generation. Using 2016 census microdata, we compare the social characteristics of census tracts where immigrants and the second and third-plus (3+) generations concentrate. The index of dissimilarity indicates the degree of residential separation among generations and for five ethno-racial second-generation groups: Chinese, South Asian, Black, Southern European, and Northern and Western European. The empirical findings show that the neighbourhoods where the first generation is over-represented are less affluent than those where the second and 3+ generations concentrate, with the largest improvements in social status occurring between the first and second generations. Although they frequently live in more distant suburban neighbourhoods than the first generation, the second generation still tends to live in inner and outer suburbs more than the exurban 3+ generation. For the second generation, the degree of residential concentration varies across ethno-racial groups with persistent segregation marking the residential locations of racial minorities. The findings highlight the variegated geographies and social mobility of the second generation in Canada's largest metropolitan area.     

Are new patterns of low‐income distribution emerging in Canadian metropolitan areas?

Recent studies on urban poverty in Canadian cities suggest a growing spatial concentration of poor populations within metropolitan regions. This article assesses trends in the intra‐urban distribution of the poor population from 1986 to 2006 in eight of Canada's largest cities. We consider five well‐known dimensions of segregation, as identified by Massey and Denton (1988) , in order to examine changes in the spatial distribution of poor populations within metropolitan areas: evenness, exposure, concentration, clustering, and centralization. These indices were calculated for low‐income populations at the census tract level using data from five Canadian censuses. Although each metropolitan area has distinctive characteristics, we were able to identify some general trends. The results suggest that, in 2006 compared to 1986, low‐income populations lived in more spatially concentrated areas, which were, at the same time, socioeconomically more homogeneous and more dispersed throughout the metropolitan area. In addition, we observed that over the last twenty years areas of poverty have been located, for the most part, in neighbourhoods adjacent to downtown cores. Nevertheless, we found that poverty has mostly increased in suburban areas located outside inner‐city neighbourhoods. Growing socioeconomic homogeneity and dispersion of low income areas in metropolitan areas reveal new spatial patterns of urban poverty distribution. These findings should be cause for concern as social isolation in the most disadvantaged neighbourhoods could affect the life chances and opportunities for the residents of those areas.     

EQUALITY OF SPATIAL ACCESS TO PRIMARY HEALTH SERVICES FOR SINGAPORE'S BABY BOOMERS

The ageing baby boomers in Singapore, which account for one-third of the total population in 2006, will have a profound impact on the economy, society and environment. The greatest demand is for health care services. Even though Singapore has generally been regarded as a country where primary health services are easily available to all residents, this paper identifies significant spatial variations across the island-state. In particular, accessibility in some areas with high concentration of boomers is relatively lower compared to other residential areas. This paper concludes that understanding the spatial variation in primary health service accessibility is critical to the success of future policies, which may lead to a review of the provision of such services across the island. The methodology developed in this paper is also applicable to the study of service inequalities in other Asian countries with large rural settings.     

The view beyond downtown luxury towers: Diversity of condominium developments in a contemporary mid-sized city

A proliferation of condominiums is fundamentally changing the built, social, and economic fabric of Canada's cities. While developments may be found throughout the urban landscape of cities large and small, most of the contemporary research focuses on luxury towers in the urban cores of Toronto and Vancouver. The following study examines the complete inventory of all condominium units in Halifax, Nova Scotia, revealing spatial and temporal patterns in their development. Nearly 60% of Halifax's condominium units are found in the suburbs, with only 20% in the downtown. Condominium units built since 2010 command the highest prices, surpassing the median single detached house price in the city, while older units from the 1970s and 1980s remain largely affordable. Recent developments can be found in gentrifying neighbourhoods; however, they remain a minority as many more units are found in middle-class suburbs and wealthy inner-city neighbourhoods. Owing to their varied manifestations, the predominant associations of condominiums with a downtown, luxury housing format needs expanding to include locations throughout the metropolitan area, distinct building types, and wide range of prices.     

Exploring the associations between cooling centre accessibility and marginalization in Montreal,Toronto, and Vancouver,Canada

Cooling centres provide respite, safety, and social support during extreme heat events for populations that do not have the resources to own or operate in-home air conditioning. The objective of this study was to measure the spatial accessibility of cooling centres and analyze the associations between cooling centre access and marginalization in Montreal, Toronto, and Vancouver, Canada. The potential spatial accessibility of cooling centres within a 15-minute walk was measured at the dissemination area scale using the two-step floating catchment area method. A two-stage modelling approach was used to analyze the associations between cooling centre access and marginalization. Approximately 62%, 58%, and 54% of the populations in Montreal, Toronto, and Vancouver had access to at least one cooling centre. In Montreal and Vancouver, high marginalization areas were more likely to have cooling centre access than low marginalization areas. Of the areas with cooling centre access, smaller access scores were observed in areas with high residential instability. Approximately one-fifth of the areas in each city had no cooling centre access and high marginalization, and may be considered for future cooling centres or programs that improve accessibility to existing centres.     

Une histoire de résidus : à propos des facteurs généraux et locaux de croissance régionale au Canada,de 1971 à 2001

Starting from an econometric model of local employment growth, applied to Canada (1971–2001), residuals—relative to model predictions—are analyzed over time and over space, in turn allowing us to draw a distinction between general explanatory variables and factors of a more local, cyclical or accidental nature. The model's explanatory power grows over time, founded on variables such as urban size, market access and industrial structure, allowing us to conclude that local employment growth in Canada follows an increasingly geographically predictable pattern. However, an examination of the residuals reveals more localized processes. Growth volatility is most manifest in Alberta and British Columbia, home to the most erratic local economies. Emerging patterns are visible in the last period, most notably the underperformance of Northern Ontario and of non‐metropolitan communities between Windsor and Québec City, lying along the Great Lakes and the Saint Lawrence. The over‐performance—compared to model predictions — of small and mid‐sized towns in south‐eastern Québec can, on the other hand, be interpreted as a sign of truly local social processes, generally associated with a particularly dynamic local entrepreneurial class.