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Baixo Alentejo - Portugal Arti Cle a Acessibilidade Aos Cuidados De Saúde Primários Em Regiões De Baixa Densidade

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Baixo Alentejo - Portugal Arti Cle a Acessibilidade Aos Cuidados De Saúde Primários Em Regiões De Baixa Densidade DOI: 10.1590/1413-81232021266.1.40892020 2497 Accessibility to primary health care in low-density regions. A case arti study: NUTS III - Baixo Alentejo - Portugal GO arti A acessibilidade aos cuidados de saúde primários em regiões de baixa densidade. Caso de estudo: NUTS III - Baixo Alentejo - Portugal CLE Carlos Freitas (https://orcid.org/0000-0003-0689-137X)1 Nuno Marques da Costa (https://orcid.org/0000-0003-4859-9668) 1 Abstract This study diagnosed the situation re- Resumo Decidiu-se realizar o diagnóstico de garding the physical accessibility of the resident situação sobre a acessibilidade física da popula- population to primary health care, based on the ção residente aos cuidados de saúde primários, characteristics of the population served, their spa- baseada nas características da população servi- tial distribution in the territory, based on space- da, na sua distribuição espacial, tendo por base time analysis. Thus, bearing the different means uma análise espaço/tempo, permitindo avaliar of transport available and the specific features essa mesma acessibilidade. Deste modo, e tendo of a low-density territory, we considered several em consideração os diversos modos de transporte mobility profiles under analysis, and selected the disponíveis, bem como as características especí- Baixo Alentejo as the study area. In methodolog- ficas de um território de baixa densidade, foram ical terms, besides using the location of primary considerados diversos perfis de mobilidade, sendo health facilities and their areas of influence, the a área de estudo escolhida o Baixo Alentejo. Em use of the road network and its restrictions, we termos metodológicos, além da utilização da lo- selected the use the new 1x1 km grid, recently im- calização dos equipamentos de saúde primários e plemented throughout the EU (European Union), das suas áreas de influência, da utilização da rede instead of using the statistical units or administra- viária e das suas restrições, optou-se pela utiliza- tive boundaries. Its advantages allow overcoming ção de uma cartografia base menos convencional. some of the issues of the usual base cartography. Em vez das unidades estatísticas associadas às The final results can be divided into two groups: unidades administrativas, optou-se pela utiliza- conclusions related to the methodologies used and ção da nova quadrícula de 1x1 km, implementada conclusions related to the accessibility of primary recentemente em toda a União Europeia (UE). A health care equipment in the study area. utilização desta quadrícula permite ultrapassar Key words Accessibility, Primary health care alguns dos problemas apresentados pela cartogra- equipment, Low-population-density territories, 1 fia base habitual. Os resultados podem-se dividir 1 Centro de Estudos km² grid em dois grupos: conclusões relacionadas com as Geográficos, Instituto de metodologias utilizadas, e conclusões relacionadas Geografia e Ordenamento com a acessibilidade aos equipamentos de saúde do Território (IGOT), Universidade de Lisboa. primários na área de estudo. Edifício IGOT, Rua Palavras-chave Acessibilidade, Equipamentos de Branca Edmée Marques. saúde primários, Territórios de baixa densidade 1600-276 Lisboa Portugal. [email protected] populacional, Quadrícula 1 km² 2498 Introduction region is represented by an orthogonal triad of Freitas C, Costa NM Costa C, Freitas axes, with a pair of labeled axes (x and y) defin- The accessibility to primary health care has re- ing the two-dimensional plane space, and an axis cently been the target of high interest by the representing time (z). A point object located in researchers in health geography. The World xi and yi shows the object’s location coordinates Health Organization has also expressed this in- in the two-dimensional space in time. However, terest since the end of the 20th century, concerned as time progresses (i.e., positive movement along with accessibility to health care, including one of the z-axis), the object, usually representing an the 28 goals equated in the “Global Strategy for individual, becomes visible in its movement in Health for All by the Year 2000”1. space over time. Also, the European Union (EU) stresses the This three-dimensional perception conceives need to improve accessibility to health care in the activities of individuals and allows them to each Member State as one of the prominent top- travel according to continuous trajectories or ics of the SeIG, since these are related to a set of paths in the three-dimensional space-time. Those public obligations that aim to ensure the provi- paths do not exist randomly in space-time but are sion of services to all citizens, following specific subject to several personal or social restrictions, standards, responding to principles of economic, network features, mobility limitations resulting social and territorial fairness and standards that from available transport technology, and physical confer the feature of service of general interest need for rest. In short, the distance has played so quality and variety2. far one of the leading roles in shaping contempo- In health geography, the most pertinent mat- rary cities and human behavior according to tra- ters are related to issues such as inequalities in ditional models. However, the approach through health care access, re-emergence of infectious space-time measures goes beyond to overcome diseases, health policies, and adequacy of health the limitations of the conceptual foundation and services to the local population3. the spatial and temporal structures of tradition- Health care access inequality is commonly as- al models6. This is when GIS are essential to this sumed to arise from the accessibility conditions, methodology’s success because they allow the in- namely accessibility to primary care services, corporation and model the complexities of the hence the interest in analyzing the population real world in unprecedented inconceivable ways accessibility conditions to this type of health and transcend simplifications used on tradition- services. Accessibility is a crucial concept in stud- al, proximity-based urban models and accessibil- ies in transport and mobility, and, through GIS ity measures7. (geographic information systems), are increas- Thus, also having the theories based on spa- ingly used to measure the impacts of geographic tial-temporal measures as starting point, we mea- accessibility. The capacity of GIS networks has sured people’s accessibility in NUTS III (Com- gradually favored the implementation of the geo- mon statistical classification of territorial units) graphic in-depth analysis and allowed the incor- of Baixo Alentejo to the primary care equipment poration of other relevant elements, such as cal- (PCE) network in the influence areas predefined culating travel times and defining shortest routes by the National Health Service (SNS), regardless to reach health services4. However, there is still no of medical valences, schedules or medical staff consensus on the standard measure to be used in provided by primary care equipment. the health geography and which of the principal Contrary to many studies using the method methodologies has better results, namely, gravi- of determining access to health services that use ty-based model measures, measures of cumula- the two-step floating catchment area method, in tive opportunities, and space-time measures. which competition between different equipment In this work, we chose the one that seemed is assumed7-9, we have an administrative defini- more consensual, and at the same time, with a tion of service in the national case areas of each more straightforward understanding and a more PCE. direct interpretation: space-time measurements. Space-time measurements are based on the tem- Paper Organization poral structure of Hägerstrand’s space-time geog- raphy5, i.e., the space-temporal prism determines This paper is essentially organized in three the feasible set of locations for the participation key points: 1) Modeling methods and techniques, of travel and activities in a limited extent of space where the concept of cartography in 1km² grid and time interval. A delimited space-temporal is highlighted instead of the traditional admin- 2499 Ciência & Saúde Coletiva, 26(Supl. 1):2497-2506, 2021 1):2497-2506, 26(Supl. Coletiva, & Saúde Ciência istrative limits; influence areas are defined; and possibility of carrying out comparative analy- requirements of each of the analyzed accessibility ses between regions, which is not the case with profiles for PCE are identified; 2) Results, where administrative or statistical limits of very dif- the modeling results will be analyzed considering ferent dimensions. The information of each cell the chosen methods; 3) Conclusions, where the in the network is an index, since when its spa- main conclusions of the set of results are present- tial unit has the same dimension, each variable ed. is by nature a density and the spatial precision associated with the grid size, 1x1km, is most of Modeling methods and techniques the time closer to reality. On the other hand, the The 1km² grid significant drawbacks result from the difficulty in crossing this information with the information The analysis results vary with size and scale collected from the official administrative limits, of the statistical unit for data collection. In this since this crossing does not exist naturally. case, we would aim to be as thorough as possi- Thus, since administrative boundaries rarely ble regarding the population location,
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