Pub Date : 2025-09-01DOI: 10.1016/j.healthplace.2025.103543
Isabelle Chiera , Jess Doe , Melissa Stoneham , Saranne Herrington , Amanda Devine , Emily Humphreys , Stephanie L. Godrich
Food security is a particular challenge in rural, regional and remote locations due to complexities associated with food availability, access, utilisation, stability, agency and sustainability dimensions. Existing approaches, such as emergency food relief, have been found to inadequately address these challenges, suggesting that a comprehensive portfolio of solutions could be more effective. Understanding what food security initiative leaders operating in these areas consider important will help establish a shared goal to guide the development of a portfolio approach. This paper aimed to determine government and community-led food security initiative leaders' visions of a food secure regional Australia. This qualitative study was conducted across inner regional, outer regional, remote and very remote townships in Western Australia. Participants' perspectives of a food secure region were sought through semi-structured interviews. A total of 101 participants provided evidence for 148 food security initiatives. Many initiative leaders' visions focused on improved access to food and education programs such as food growing and food literacy programs. Less emphasis was placed on solutions such as community-led food security action and advocacy for increased government support and funding. Participants typically described existing and siloed solutions that, despite their widespread implementation, have been critiqued for their inability to adequately address the complexities of food security. This suggests a disconnect between participants' visions and a more effective portfolio approach. More time should be invested in enhancing community and interest holder’ understanding of systems change and a portfolio approach to bridge this gap.
{"title":"‘More prioritisation on food security’ – exploring what initiative leaders envision for a food secure regional Australia","authors":"Isabelle Chiera , Jess Doe , Melissa Stoneham , Saranne Herrington , Amanda Devine , Emily Humphreys , Stephanie L. Godrich","doi":"10.1016/j.healthplace.2025.103543","DOIUrl":"10.1016/j.healthplace.2025.103543","url":null,"abstract":"<div><div>Food security is a particular challenge in rural, regional and remote locations due to complexities associated with food availability, access, utilisation, stability, agency and sustainability dimensions. Existing approaches, such as emergency food relief, have been found to inadequately address these challenges, suggesting that a comprehensive portfolio of solutions could be more effective. Understanding what food security initiative leaders operating in these areas consider important will help establish a shared goal to guide the development of a portfolio approach. This paper aimed to determine government and community-led food security initiative leaders' visions of a food secure regional Australia. This qualitative study was conducted across inner regional, outer regional, remote and very remote townships in Western Australia. Participants' perspectives of a food secure region were sought through semi-structured interviews. A total of 101 participants provided evidence for 148 food security initiatives. Many initiative leaders' visions focused on improved access to food and education programs such as food growing and food literacy programs. Less emphasis was placed on solutions such as community-led food security action and advocacy for increased government support and funding. Participants typically described existing and siloed solutions that, despite their widespread implementation, have been critiqued for their inability to adequately address the complexities of food security. This suggests a disconnect between participants' visions and a more effective portfolio approach. More time should be invested in enhancing community and interest holder’ understanding of systems change and a portfolio approach to bridge this gap.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103543"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.healthplace.2025.103548
Maxson K. Anyolitho , Stella Neema , Paskari Odoi , Moses Adriko , Birgitte J. Vennervald , Edridah M. Tukahebwa , Shona Wilson
Introduction
Schistosomiasis presents a significant public health concern with debilitating effects on millions of people, mostly in sub-Saharan Africa. In Uganda, despite intervention via mass drug administration (MDA) of praziquantel to combat the disease, prevalence remains alarmingly high within hotspots such as Lake Albert. Integrated control methods, including water-contact reducing behavioural change, have therefore been advocated. Despite the potential benefits of community involvement in the design of schistosomiasis behavioural change interventions, this approach has not been implemented in these Ugandan hotspots. Utilising community involvement, this study explored societal resource-based causes of lake-derived schistosomiasis transmission in hotspot communities of Hoima, western Uganda, how changing levels in these resources and access to them are altering infection-risk behaviour, and locally devised solutions for reducing infection-risk behaviours.
Materials and methods
A bottom-up participatory qualitative research design was employed. Purposive sampling was utilised to select 84 community advisory board (CAB) members to participate in focus group discussion sessions and participatory workshops. The CAB members comprised of fishermen, housewives, snail harvesters, village health teams, female and male youths, and community leaders. The data collected was analysed thematic-wise.
Results
The importance of the lake includes fish for both consumption and sale, water mainly for domestic use, papyrus for a variety of purposes, including roofing, sleeping mats, and mattresses and other resources such as oil, clay, sand, and salt. Community members reported that local conflicts, unfavourable and restrictive government policies, floods, migration, and instability have changed lake-derived resource levels. Recommendations for minimising contact with the lake suggested by participants were the provision of alternative water sources, promoting education, literacy and vocational skills, financial support, community empowerment and joint collaborative approaches.
Conclusions and recommendations
Despite challenges, Lake Albert provides a significant source of livelihood to communities. Providing alternative water sources and empowering local communities through the provision of alternative livelihood strategies is critical to reducing contact with the lake. A bottom-up participatory approach to community engagement facilitates community understanding of schistosomiasis problems and allows them to devise sustainable solutions to the problem.
{"title":"Community insights into societal causes of and solutions for schistosomiasis transmission in Lake Albert fishing villages: A participatory approach","authors":"Maxson K. Anyolitho , Stella Neema , Paskari Odoi , Moses Adriko , Birgitte J. Vennervald , Edridah M. Tukahebwa , Shona Wilson","doi":"10.1016/j.healthplace.2025.103548","DOIUrl":"10.1016/j.healthplace.2025.103548","url":null,"abstract":"<div><h3>Introduction</h3><div>Schistosomiasis presents a significant public health concern with debilitating effects on millions of people, mostly in sub-Saharan Africa. In Uganda, despite intervention via mass drug administration (MDA) of praziquantel to combat the disease, prevalence remains alarmingly high within hotspots such as Lake Albert. Integrated control methods, including water-contact reducing behavioural change, have therefore been advocated. Despite the potential benefits of community involvement in the design of schistosomiasis behavioural change interventions, this approach has not been implemented in these Ugandan hotspots. Utilising community involvement, this study explored societal resource-based causes of lake-derived schistosomiasis transmission in hotspot communities of Hoima, western Uganda, how changing levels in these resources and access to them are altering infection-risk behaviour, and locally devised solutions for reducing infection-risk behaviours.</div></div><div><h3>Materials and methods</h3><div>A bottom-up participatory qualitative research design was employed. Purposive sampling was utilised to select 84 community advisory board (CAB) members to participate in focus group discussion sessions and participatory workshops. The CAB members comprised of fishermen, housewives, snail harvesters, village health teams, female and male youths, and community leaders. The data collected was analysed thematic-wise.</div></div><div><h3>Results</h3><div>The importance of the lake includes fish for both consumption and sale, water mainly for domestic use, papyrus for a variety of purposes, including roofing, sleeping mats, and mattresses and other resources such as oil, clay, sand, and salt. Community members reported that local conflicts, unfavourable and restrictive government policies, floods, migration, and instability have changed lake-derived resource levels. Recommendations for minimising contact with the lake suggested by participants were the provision of alternative water sources, promoting education, literacy and vocational skills, financial support, community empowerment and joint collaborative approaches.</div></div><div><h3>Conclusions and recommendations</h3><div>Despite challenges, Lake Albert provides a significant source of livelihood to communities. Providing alternative water sources and empowering local communities through the provision of alternative livelihood strategies is critical to reducing contact with the lake. A bottom-up participatory approach to community engagement facilitates community understanding of schistosomiasis problems and allows them to devise sustainable solutions to the problem.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103548"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.healthplace.2025.103512
Richard M. Weinmeyer , Aparna Balakrishnan , Salva N. Balbale , Seema K. Shah
Restroom access acts (RAAs) provide persons with inflammatory bowel disorders (IBD) and other health conditions emergency access to a business's employee restroom. Despite the important role these laws can play in supporting a person's health and dignity, they remain understudied. This Article is the first to explore what if any role a RAA has in the lives of persons living with IBD.
We conducted a qualitative study to explore what persons with IBD living in Illinois know about the influential RAA in this state; their experiences finding and using restrooms in public; and what changes they would like to see in the provision of publicly available restrooms.
We interviewed nine participants living with IBD, primarily women living in the Chicago metropolitan area, and found that knowledge of the law was low. Participants also described harms resulting from limited access to public restrooms, including to their autonomy, freedom, and dignity. Our participants expressed skepticism of the law's ability to effectively improve bathroom accessibility yet also found hope in the law's existence.
This Article concludes by grounding these findings in legal precedent, disability law scholarship, and research on IBD. Our findings can be used to motivate future research on RAAs and influence future laws and policies to improve public health.
{"title":"No public restroom: Illinois's restroom access act and bathroom accessibility","authors":"Richard M. Weinmeyer , Aparna Balakrishnan , Salva N. Balbale , Seema K. Shah","doi":"10.1016/j.healthplace.2025.103512","DOIUrl":"10.1016/j.healthplace.2025.103512","url":null,"abstract":"<div><div>Restroom access acts (RAAs) provide persons with inflammatory bowel disorders (IBD) and other health conditions emergency access to a business's employee restroom. Despite the important role these laws can play in supporting a person's health and dignity, they remain understudied. This Article is the first to explore what if any role a RAA has in the lives of persons living with IBD.</div><div>We conducted a qualitative study to explore what persons with IBD living in Illinois know about the influential RAA in this state; their experiences finding and using restrooms in public; and what changes they would like to see in the provision of publicly available restrooms.</div><div>We interviewed nine participants living with IBD, primarily women living in the Chicago metropolitan area, and found that knowledge of the law was low. Participants also described harms resulting from limited access to public restrooms, including to their autonomy, freedom, and dignity. Our participants expressed skepticism of the law's ability to effectively improve bathroom accessibility yet also found hope in the law's existence.</div><div>This Article concludes by grounding these findings in legal precedent, disability law scholarship, and research on IBD. Our findings can be used to motivate future research on RAAs and influence future laws and policies to improve public health.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103512"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.healthplace.2025.103486
Yi Wang , Emma X. Zang , Kendra Davis-Plourde , Thomas M. Gill , Robert D. Becher
{"title":"Corrigendum to “Novel indices of state- and county-level social disadvantage in older Americans and disparities in mortality” [Health Place 92 (2025) 103438]","authors":"Yi Wang , Emma X. Zang , Kendra Davis-Plourde , Thomas M. Gill , Robert D. Becher","doi":"10.1016/j.healthplace.2025.103486","DOIUrl":"10.1016/j.healthplace.2025.103486","url":null,"abstract":"","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103486"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is a substantial unmet need for contraception in West Africa. Providing contraception in private pharmacies, which often are highly accessible, may alleviate some access barriers. However, privacy is a key concern for provision of contraceptives in pharmacies, and whether users view pharmacies as private is ambiguous. While some pharmacy users note their privacy benefits, others suggest a lack of privacy. The ACEPT Project aims to introduce the administration of injectable and implant contraceptives into pharmacies across Côte d’Ivoire, Senegal, and Togo. Baseline data collected prior to implementation of the ACEPT project across the 3 countries included in-depth interviews with both pharmacies and users and ethnographic observations of pharmacies. Qualitative data were first analysed by country teams, and emergent cross-cutting themes were identified collaboratively. Physical, private space is scarce in pharmacy settings in West Africa. In this context, users employ tactics to uphold both audio (not being heard) and visual (not being seen) privacy. These tactics include using coded language or hiding a contraceptive purchase among other products. Pharmacists are experts at reading user privacy cues and “play along” with user tactics. Pharmacists also engineer “virtual” private space in the pharmacy through arrangement of shelving and products and identifying private corners of the pharmacy when needed. Privacy is currently constructed momentarily in ways that render the public pharmacy space private. As contraceptive services in pharmacies expand, especially to include injectable and implant administration, this type of privacy creation may need to be addressed, and physical private space will become essential.
{"title":"Creating privacy in pharmacies in West Africa","authors":"Sethson Kassegne , Robert-Hugues Yaovi Nagbe , Ibitola Tchitou , Rhiana Mills , Farida Moussa , Edoh Léon Soklou , Dzidzova Kossitsè Apédo , Ami Aféfa Allado , Fidèle Dissirama Doukou , Lorimpo Babogou","doi":"10.1016/j.healthplace.2025.103540","DOIUrl":"10.1016/j.healthplace.2025.103540","url":null,"abstract":"<div><div>There is a substantial unmet need for contraception in West Africa. Providing contraception in private pharmacies, which often are highly accessible, may alleviate some access barriers. However, privacy is a key concern for provision of contraceptives in pharmacies, and whether users view pharmacies as private is ambiguous. While some pharmacy users note their privacy benefits, others suggest a lack of privacy. The ACEPT Project aims to introduce the administration of injectable and implant contraceptives into pharmacies across Côte d’Ivoire, Senegal, and Togo. Baseline data collected prior to implementation of the ACEPT project across the 3 countries included in-depth interviews with both pharmacies and users and ethnographic observations of pharmacies. Qualitative data were first analysed by country teams, and emergent cross-cutting themes were identified collaboratively. Physical, private space is scarce in pharmacy settings in West Africa. In this context, users employ tactics to uphold both audio (not being heard) and visual (not being seen) privacy. These tactics include using coded language or hiding a contraceptive purchase among other products. Pharmacists are experts at reading user privacy cues and “play along” with user tactics. Pharmacists also engineer “virtual” private space in the pharmacy through arrangement of shelving and products and identifying private corners of the pharmacy when needed. Privacy is currently constructed momentarily in ways that render the public pharmacy space private. As contraceptive services in pharmacies expand, especially to include injectable and implant administration, this type of privacy creation may need to be addressed, and physical private space will become essential.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103540"},"PeriodicalIF":4.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-29DOI: 10.1016/j.healthplace.2025.103542
Susan Cassels , Sean C. Reid , Alan T. Murray , Sofia Kaloper , Vania Wang , Steven Shoptaw , Pamina Gorbach
For gay, bisexual, and other sexual minority men (SMM), geo-social exposures in residential and non-residential places are important to consider for health, as home, social, sexual, substance use, and healthcare-related locations may be different. We use survey data from a sample of 219 Black and Hispanic SMM within Los Angeles County to examine the places that individuals visit for eight specific activities, categorized as either lifestyle or healthcare-related. Spatial clustering techniques are used to identify hotspots, or places where individual's activities are clustered in space, for each activity. We then use descriptive statistics to characterize each hotspot based on the socio-demographic characteristics of individuals who engaged in activities within the hotspot, and then assess whether activity-based hotspots overlap in space. We find unique spatial patterns of hotspots, distinct by activity. Additionally, lifestyle activity space hotspots are spatially patterned by socio-demographic characteristics, primarily along race and ethnic categories, whereas healthcare-related hotspots are not. The overlap, or spatial congruence of hotspots, is higher than we hypothesized, as hotspots of residential locations contained the majority of sex hotspots and substance use hotspots. Our work ultimately identifies four distinct areas of Los Angeles County in which activities are clustered among men in the sample, and health interventions can be tailored to the individuals and their activities in those places. Our findings demonstrate the importance of geographically and demographically targeted interventions, at a fine spatial scale, for health promotion among SMM, as interventions and policy to provide equitable care to reduce racial disparities in health among SMM are sorely needed.
{"title":"Patterns of sexual minority men's lifestyle and healthcare related activity spaces in Los Angeles","authors":"Susan Cassels , Sean C. Reid , Alan T. Murray , Sofia Kaloper , Vania Wang , Steven Shoptaw , Pamina Gorbach","doi":"10.1016/j.healthplace.2025.103542","DOIUrl":"10.1016/j.healthplace.2025.103542","url":null,"abstract":"<div><div>For gay, bisexual, and other sexual minority men (SMM), geo-social exposures in residential and non-residential places are important to consider for health, as home, social, sexual, substance use, and healthcare-related locations may be different. We use survey data from a sample of 219 Black and Hispanic SMM within Los Angeles County to examine the places that individuals visit for eight specific activities, categorized as either lifestyle or healthcare-related. Spatial clustering techniques are used to identify hotspots, or places where individual's activities are clustered in space, for each activity. We then use descriptive statistics to characterize each hotspot based on the socio-demographic characteristics of individuals who engaged in activities within the hotspot, and then assess whether activity-based hotspots overlap in space. We find unique spatial patterns of hotspots, distinct by activity. Additionally, lifestyle activity space hotspots are spatially patterned by socio-demographic characteristics, primarily along race and ethnic categories, whereas healthcare-related hotspots are not. The overlap, or spatial congruence of hotspots, is higher than we hypothesized, as hotspots of residential locations contained the majority of sex hotspots and substance use hotspots. Our work ultimately identifies four distinct areas of Los Angeles County in which activities are clustered among men in the sample, and health interventions can be tailored to the individuals and their activities in those places. Our findings demonstrate the importance of geographically and demographically targeted interventions, at a fine spatial scale, for health promotion among SMM, as interventions and policy to provide equitable care to reduce racial disparities in health among SMM are sorely needed.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103542"},"PeriodicalIF":4.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-29DOI: 10.1016/j.healthplace.2025.103531
Natalia Gonzalez Bohorquez , Christina Malatzky , Sanjeewa Kularatna , Steven M. McPhail
{"title":"Liveable regional places for people with disabilities: exploring intersections and priorities","authors":"Natalia Gonzalez Bohorquez , Christina Malatzky , Sanjeewa Kularatna , Steven M. McPhail","doi":"10.1016/j.healthplace.2025.103531","DOIUrl":"10.1016/j.healthplace.2025.103531","url":null,"abstract":"","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103531"},"PeriodicalIF":4.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.healthplace.2025.103538
Shuo Jim Huang , Kaitlynn S. Robinson-Ector , Neil Jay Sehgal , Sherita H. Golden , Esa M. Davis , Alexandria Ratzki-Leewing , Chixiang Chen , Oluwadamilola Akintoye , Darius Jake Roy , Olohitare Abaku , Marissa L. Ding , Bradley A. Maron , Rozalina G. McCoy
Background
Racial health disparities persist in hospital care access, quality, and outcomes. These disparities are geographically patterned but paradoxically hospital proximity is not protective. Historical governmental policies such as redlining may explain this paradox. Redlining, proxied by explicitly race-based maps drawn by the Home Owners’ Loan Corporation (HOLC) in the 1930s, led to extensive depopulation, property devaluation, and political disempowerment in neighborhoods with significant proportions of Black residents in the latter half of the 20th centuries. Hospitals expanding in the post-World War II period due to the Hill-Burton Act may have taken advantage of these racialized economic and political gradients. Our study investigates whether historical HOLC redlining categories are associated with present day hospital location and size.
Methods
We used hospital locations from the 2023 Homeland Infrastructure Foundation-Level hospital dataset and redlining locations and categories from the Mapping Inequality dataset. We calculated expected counts of hospitals and total number of beds based on the proportion of land covered by each HOLC category. We compared observed counts of hospitals and beds using Pearson chi-squared tests.
Results
Hospitals were significantly overrepresented in HOLC D red areas by 20.5 % and underrepresented in HOLC A green areas by 35.6 %. Hospital beds were overrepresented in D areas by 56.5 % and underrepresented by 44.7 % in A, 5.2 % in B, and 20.8 % in C.
Discussion
We show that hospital locations are not evenly distributed throughout the US with regard to 1930s HOLC categories. The expansion of hospital capacity in the post-World War II period may have taken advantage of exploitative policies. Hospitals have the ability and opportunity to correct past injustices and improve health equity today by increasing investments in community benefits.
{"title":"Persistent effects of historical redlining on present day hospital siting and size","authors":"Shuo Jim Huang , Kaitlynn S. Robinson-Ector , Neil Jay Sehgal , Sherita H. Golden , Esa M. Davis , Alexandria Ratzki-Leewing , Chixiang Chen , Oluwadamilola Akintoye , Darius Jake Roy , Olohitare Abaku , Marissa L. Ding , Bradley A. Maron , Rozalina G. McCoy","doi":"10.1016/j.healthplace.2025.103538","DOIUrl":"10.1016/j.healthplace.2025.103538","url":null,"abstract":"<div><h3>Background</h3><div>Racial health disparities persist in hospital care access, quality, and outcomes. These disparities are geographically patterned but paradoxically hospital proximity is not protective. Historical governmental policies such as redlining may explain this paradox. Redlining, proxied by explicitly race-based maps drawn by the Home Owners’ Loan Corporation (HOLC) in the 1930s, led to extensive depopulation, property devaluation, and political disempowerment in neighborhoods with significant proportions of Black residents in the latter half of the 20th centuries. Hospitals expanding in the post-World War II period due to the Hill-Burton Act may have taken advantage of these racialized economic and political gradients. Our study investigates whether historical HOLC redlining categories are associated with present day hospital location and size.</div></div><div><h3>Methods</h3><div>We used hospital locations from the 2023 Homeland Infrastructure Foundation-Level hospital dataset and redlining locations and categories from the Mapping Inequality dataset. We calculated expected counts of hospitals and total number of beds based on the proportion of land covered by each HOLC category. We compared observed counts of hospitals and beds using Pearson chi-squared tests.</div></div><div><h3>Results</h3><div>Hospitals were significantly overrepresented in HOLC D red areas by 20.5 % and underrepresented in HOLC A green areas by 35.6 %. Hospital beds were overrepresented in D areas by 56.5 % and underrepresented by 44.7 % in A, 5.2 % in B, and 20.8 % in C.</div></div><div><h3>Discussion</h3><div>We show that hospital locations are not evenly distributed throughout the US with regard to 1930s HOLC categories. The expansion of hospital capacity in the post-World War II period may have taken advantage of exploitative policies. Hospitals have the ability and opportunity to correct past injustices and improve health equity today by increasing investments in community benefits.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103538"},"PeriodicalIF":4.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-20DOI: 10.1016/j.healthplace.2025.103530
Evi Siti Sofiyah , Sapta Suhardono , Chun-Hung Lee , Betanti Ridhosari , I Wayan Koko Suryawan
This study examines gendered perspectives on sanitation resilience, defined as the capacity of sanitation systems to adapt, function, and recover from environmental, social, and infrastructural challenges, in Kecamatan Cilincing, a coastal district in Jakarta, Indonesia. Using Importance-Performance Analysis (IPA) and logistic regression models, the research evaluates how different gender groups perceive the importance and effectiveness of sanitation programs in ensuring safe, reliable, and accessible facilities despite challenges such as flooding, infrastructure limitations, and socio-economic disparities. The study focuses on four key sanitation indicators: ability to cope (capacity to manage daily sanitation demands), ability to learn (access to sanitation-related education and training), ability to plan (participation in sanitation-related decision-making), and level of interest (engagement in sanitation programs and initiatives). The findings reveal notable gender disparities, with women consistently rating sanitation performance lower than men, despite recognizing its importance. Logistic regression results further indicate that women, individuals in permanent housing, older adults, formal workers, and higher-income residents are more likely to engage in sanitation resilience programs.This study highlights the need for gender-responsive urban sanitation policies that address specific challenges faced by women and marginalized groups, including safety, accessibility, and decision-making inclusion. By offering insights into gendered sanitation experiences, the research provides practical recommendations for policymakers, urban planners, and community organizations to design more inclusive and adaptive sanitation interventions in rapidly urbanizing areas.
{"title":"Gendered importance-performance perspective on sanitation resilience programs","authors":"Evi Siti Sofiyah , Sapta Suhardono , Chun-Hung Lee , Betanti Ridhosari , I Wayan Koko Suryawan","doi":"10.1016/j.healthplace.2025.103530","DOIUrl":"10.1016/j.healthplace.2025.103530","url":null,"abstract":"<div><div>This study examines gendered perspectives on sanitation resilience, defined as the capacity of sanitation systems to adapt, function, and recover from environmental, social, and infrastructural challenges, in Kecamatan Cilincing, a coastal district in Jakarta, Indonesia. Using Importance-Performance Analysis (IPA) and logistic regression models, the research evaluates how different gender groups perceive the importance and effectiveness of sanitation programs in ensuring safe, reliable, and accessible facilities despite challenges such as flooding, infrastructure limitations, and socio-economic disparities. The study focuses on four key sanitation indicators: ability to cope (capacity to manage daily sanitation demands), ability to learn (access to sanitation-related education and training), ability to plan (participation in sanitation-related decision-making), and level of interest (engagement in sanitation programs and initiatives). The findings reveal notable gender disparities, with women consistently rating sanitation performance lower than men, despite recognizing its importance. Logistic regression results further indicate that women, individuals in permanent housing, older adults, formal workers, and higher-income residents are more likely to engage in sanitation resilience programs.This study highlights the need for gender-responsive urban sanitation policies that address specific challenges faced by women and marginalized groups, including safety, accessibility, and decision-making inclusion. By offering insights into gendered sanitation experiences, the research provides practical recommendations for policymakers, urban planners, and community organizations to design more inclusive and adaptive sanitation interventions in rapidly urbanizing areas.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"95 ","pages":"Article 103530"},"PeriodicalIF":4.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-20DOI: 10.1016/j.healthplace.2025.103469
Behram Wali
Longitudinal impacts of the built environment and transit accessibility on neighborhood-level cardiovascular disease (CVD) prevalence are not well explored. Further, little is known about the magnitude of heterogeneity in the longitudinal links between social and built environment features and CVD prevalence. This study utilized a longitudinal ecological study design covering 26,631 neighborhoods (census tracts) in the 500 largest American cities. A novel data infrastructure is harnessed by integrating time-varying neighborhood-level data on transportation, the built and social environments, and chronic disease prevalence at two time points. In a full Bayesian framework, Markov Chain Monte Carlo-based grouped correlated random parameter models are formulated to simultaneously account for unobserved and correlated heterogeneity impacts. More walkable neighborhoods, characterized by greater density, street connectivity, and land-use mix, had lower CVD and hypertension prevalence over time. Greater transit accessibility was also correlated with lower disease prevalence. Conversely, neighborhoods with higher social vulnerability had greater CVD and hypertension rates over time. A detailed post hoc neighborhood-level assessment revealed significant unobserved and correlated heterogeneity in the impacts of social and built environment features across both neighborhoods and cities. Insights into this heterogeneity, as well as the determinants of neighborhood-level CVD and hypertension prevalence, can help public health officials, engineers, and policymakers implement localized community-based behavioral interventions for smarter and healthier cities. Implications for national disease surveillance systems are discussed.
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