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Electronic Letters to:

Dolores Acevedo-Garcia, Theresa L. Osypuk, Nancy McArdle, and David R. Williams Toward A Policy-Relevant Analysis Of Geographic And Racial/Ethnic Disparities In Child Health Health Affairs, March/April 2008; 27(2): 321-333. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Electronic letters published:

The Role Of Geographical Context

Alec Holt   ( 28 March 2008 )

The Role Of Geographical Context 28 March 2008
Alec Holt, Director of the Health Informatics University of Otago Send letter to journal: Re: The Role Of Geographical Context aholt{at}infoscience.otago.ac.nz Alec Holt	It is assumed that there is a correlation between neighborhoods and health and well-being of residents within that neighborhood -- a measure of public health. This could also stand true for the health and well-being of children. The article by Acevedo-Garcia et al. analysed racial/ethnic disparities in children’s access to opportunity neighborhoods. I am continually astounded that this article and others mention geographic issues such as access and yet they never complete the appropriate spatial analysis for the neighborhoods. This study and others would be advantaged by using spatial statistics and Geographic Information Systems (GIS) analysis. These systems are now widely utilised in public health issues concerning neighborhood analysis. It would be illuminating to see the geographic clusters of poverty rates, rentership, adults without a diploma, and unemployment rates, rather than just display the percentages in tables. It is acknowledged that “access to” is more that just travel time; in fact, sometimes access to some neighborhood resources is better in the more deprived areas. Hence, it is important to take a holistic view of neighborhoods by factoring in the quality of the neighborhood resources with “access to”. Acevedo-Garcia et al. focused on comparable access to opportunity neighborhoods and access to opportunity neighborhoods for minority children. They also discussed residential segregation and postulated about place-based interventions -- for example, healthy eating concepts, for which one measure is convenience food outlets. I would give more credit to their research if they used appropriate spatial tools. When researching neighborhoods and health, there is a role for a geographical context to the data. GIS methods could be utilised to measure access to a range of neighborhood resources and determine the association with various health outcomes and health-related behaviors. Residents of a neighborhood, for example, might have great access to shopping malls, but they might not have access to primary health care, green space, and educational institutions and too much geographic access to convenience food outlets. Clusters of mulitvariates and even the influence of adjacent neighborhoods do have an impact. Therefore, with neighborhoods and health, there is a real role for a geographical context.