G Model GACETA-2240; No. of Pages 3 ARTICLE IN PRESS Gac Sanit. 2022;xxx(xx):xxx–xxx Editorial Improving equity using dynamic geographic accessibility data for urban health services planning Mejorando la equidad usando datos dinámicos de accesibilidad geográfica para la planificación de servicios de salud urbanos Luis Gabriel Cuervo a,∗ , Eliana Martínez-Herrera b,c , Daniel Cuervo d , Ciro Jaramillo e a Biomedical Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain b Faculty at the National School of Public Health, Universidad de Antioquia, Medellín, Colombia c Research Group on Inequalities in Health, Environment and Employment Conditions (GREDS-EMCONET); Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain d Iquartil SAS, Bogotá, Colombia e School of Civil Engineering and Geomatics, Universidad del Valle, Cali, Colombia “Before big data, our analysis was usually limited to testing a small Place of residence is a spatial determinant of health and number of hypotheses that we defined well before we even collected health equity. It defines which populations can reach health ser- the data. When we let the data speak, we can make connections that vices in a timely and affordable manner by different means of we had never thought existed.” transportation.7–9 The inability to reach essential health services can harm people and cause financial hardship.10–12 Viktor Mayer-Schönberger and Kenneth Cukier. Common approaches for assessing accessibility to health ser- Big Data. HarperCollins, Kindle Edition. (2014) p. 14. vices study the shortest distance or time to the nearest facility.13,14 Equity in accessibility to health services is central to social jus- Traditionally, these assessments are proxy measures that rely on tice. It is also a key element of the Health in All Policies approach distance or fixed travel-time estimates.15 For example, actual travel to intersectoral action for achieving the Sustainable Development distances on road networks and travel times are often estimated Goals of the United Nations Agenda 2030.1 Geographical accessi- with traffic and transportation models from static data and on bility, a determinant of health that requires intersectoral action, is typical days captured with samples through surveys and field vital to achieving universal access to health care.2 However, urban gauging.16 These estimates are suboptimal as they use small sample planning has rarely incorporated relevant research that measures sizes, rarely focus on specific health services and do not account for and improves equity in geographical accessibility to health services. temporospatial variations of accessibility, such as those resulting Moreover, much of that research has used sampling techniques that from traffic congestion. offered limited practical value. Dynamic accessibility assessments are needed to account for the Despite high-level calls for intersectoral action, few imple- substantial traffic variations that are common in busy urban set- mentation strategies show how to shift the standard approach tings and emerging reports and preprints show that this approach to intersectoral collaborations that address the determinants of is being adopted.12,17–20 health.3,4 Community engagement, a driver for intersectoral action, These reports mostly follow sophisticated methods and use jar- requires involved stakeholders to communicate effectively, share gon and complex formulas that require advanced field expertise their understanding of issues, and agree how to use knowledge and to understand.10,21 Many stakeholders may thus find these reports metrics.5,6 difficult to access or understand and would struggle to communi- This editorial examines the emergence of studies that show cate their methods and findings to their peers and counterparts. the value of adopting accurate, dynamic travel times to assess These complications are an important limitation hindering the use equity in geographic accessibility to essential health services. and implementation of the knowledge such reports contribute.22 These studies are novel for using readily available data coupled They require access to specialized sources that many stakeholders with digital technologies and big data analytics to reveal new lack, and some are behind paywalls. The complexity of these reports data and correlations using metrics that stakeholders can under- and their lack of simple communication materials make them dif- stand and share. Emerging studies can thus spur intersectoral ficult for diverse stakeholders to use. Stakeholders need to grasp collaboration and democratic urban and health services plan- essential issues, communicate findings to others, and explore their ning. Using big data offers new insights into what is happening relevance in specific settings.22,23 and allows researchers and stakeholders to make predictions that Research that drives societal change must be accessible to would otherwise be impossible. Big data thus arms citizens, gov- stakeholders who shape decisions and plans for health services ernments, and consumers with new tools to address equity and that must consider land use, mobility, public health, and smart accessibility. cities.23,24 These stakeholders include representatives from the government (e.g., local authorities from different sectors, lawmak- ers), the community (e.g., watchdogs, academics), and service users ∗ Corresponding author. and providers (e.g., insurers, service providers, consumer represen- E-mail address: LuisGabriel.Cuervo@autonoma.cat (L.G. Cuervo). tatives, patients).23,25 https://doi.org/10.1016/j.gaceta.2022.05.001 0213-9111/© 2022 SESPAS. Published by Elsevier España, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Please cite this article in press as: Cuervo LG, et al. Improving equity using dynamic geographic accessibility data for urban health services planning. Gac Sanit. 2022. https://doi.org/10.1016/j.gaceta.2022.05.001 G Model GACETA-2240; No. of Pages 3 ARTICLE IN PRESS 2 L.G. Cuervo et al. / Gac Sanit. 2022;xxx(xx):xxx–xxx Stakeholders can spur collaborations and knowledge uptake by COVID-19 pandemic travel restrictions) merits further assessment contributing to the research process and to deliberations that shape and is already being explored.19 It is possible to, for example, iden- the implementation of policies, plans, and programs.5,26,27 . tify the areas where new services would reach the most people under new traffic conditions.30 How then to approach the challenges presented here in a Importantly, these approaches are adaptable to and scalable in way that promotes equitable accessibility and is scalable? many high-, middle-, and low-income settings where essential data is publicly available. These data include inputs such as georefer- Adopting these technologies paired with data science is a dra- enced population data with sociodemographic characteristics, the matic step forward. These technologies simplify assessments of location of health services, and travel-time big data. Integrating accessibility by using metrics that all stakeholders understand, such these data make it possible to deliver clear statistics and visual- as time to destination. Simplified assessments generate action- izations (e.g., choropleth maps and frequency tables and graphs) oriented data that lets stakeholders explore variations in the that reveal equity in accessibility to or from health services that assessments under different assumptions and reveals equity impli- stakeholders and decision makers can quantify, understand and cations. Emerging reports present these benefits.12,19 share.12,19,22 When data is available in simple interactive platforms, knowl- These data are game-changing and can be further refined if more edge users can quickly adopt and adapt these data to deliver elaborate analyses were needed to account for insurance, prefer- accurate estimates of travel times and equity analyses while explor- ence, means and direction of transportation, service capacity and ing different assumptions and scenarios. The essential value of quality. these data is that they expose the interactions between traffic con- Similar technologies have transformed the hospitality and com- gestion, the sociodemographic characteristics of the population, modities sectors. It is time to adopt them to reveal and address the and travel to (or from) health services. This perspective has been needs of citizens as we move towards a healthier and fairer soci- missing in urban and health services planning. It is relevant to land ety that meets the Sustainable Development Goals of the United use, urbanism, mobility, smart cities, and health services. This per- Nations Agenda 2030. spective also benefits service providers and users, advocacy groups and researchers seeking to address social justice issues through Authorship contributions intersectoral approaches.12,18,19 LGC conceived the editorial, and CJ, EMH, and DC provided sub- stantive inputs. All authors approved the final version. What if these data were combined with the location of health services and sociodemographic population data to reveal equity and accessibility measurements Funding that inform health services planning and land use? No funding has been received for this editorial. These digital technologies’ superior accuracy, speed, and afford- ability distinguishes them from traditional origin-destination study Conflicts of interest methods. The data these digital technologies generate is thus more likely to be available in time to challenge current thinking and The authors contribute to the unfunded AMORE Collaborative inform plans, increasing the value of these data.10,12,20,22 Project that uses big data, dynamic geospatial analysis, and ana- While traditional studies rely on few measurements, widely lytics, to measure and enhance geographical accessibility to health available technologies use millions of travel time measurements services. This project is part of the doctoral work of Luis Gabriel (big data) accumulated from mobile phone apps to promptly deliver Cuervo. His contributions are made in his personal capacity and detailed data that constantly improves in accuracy.12,17,19,20,22,28 time; the views expressed in this article do not necessarily repre- This is an important advantage over one-time assessments. sent the decisions or policies of his employer the Pan American Frequent users of ambulatory care services incur costs to access Health Organization (PAHO/WHO). Reproductions of this article those services. These costs can become barriers to access and should not include any suggestion that PAHO/WHO endorsed this force tough choices between risking health or suffering financial research or is endorsing any specific organization, services, or prod- hardship.10,15,21 Assessments of equity in accessibility to health ucts. services help to identify and address the social injustice harming the most vulnerable populations, who pay a greater share of their References income to reach adequate essential health services.29 1. 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