Easy access health facilities is assumed if you live in a big city. Local researchers say most people are not so lucky. Dr Karl Gruber (PhD) reports.
When you or a loved one is sick, reaching the nearest hospital is all that matters. But, for many people in the world, the nearest hospital may be out of reach.
Researchers at the Telethon Kids Institute and Curtin University have created the first global map of access to healthcare facilities. The map shows who can quickly reach a hospital or healthcare clinic and who might need extra help trying to get there.
This is the first map of its kind, identifying major healthcare facilities from every corner of the world and making global estimates of how long it would take people to reach their closest health care facility.
The study, led by Telethon Kids’ Dr Daniel Weiss, builds on a previous study he published in 2018, showing global access to cities. The 2018 study showed that, worldwide, only 50% of people living in low-income settings were more than one hour away from a city, compared to 91% of people living in high-income settings. This study showed significant disparities in terms of wealth and accessibility but did not go into detail about important factors such as access to healthcare.
In this new study, Dr Weiss shows just how far away some people are from a healthcare facility.
A major finding of this study is that most people around the world have quick access to a hospital or healthcare facility – as long as they can hop into a motorised vehicle. If this is the case, 60.3% of world’s population can reach a healthcare facility within 10 minutes, and 91.1% within about 60 minutes or less.
However, when you remove the motor vehicle from the picture, things change dramatically.
“For people who are only able to walk to their nearest healthcare facility, our map shows that just 16.3% of people around the globe can reach a healthcare facility within 10 minutes, and for 43.3% it will take them one hour or more,” Dr Weiss said.
For a substantial number of people, it can take much longer than an hour.
“For example, if there is access to a motor vehicle, about 300 million people live in a place where it would take them more than two hours to reach a hospital or clinic. If there is no access to a motor vehicle, the number of people living two or more hours away from a healthcare facility rises to 1.8 billion.
“The reality is somewhere between these numbers, meaning hundreds of millions of people around the world require a long journey to reach a healthcare facility. This is critically important from a public health perspective because we know that the longer people must travel to receive care, the less likely they are to do so.”
The story is not much different in Australia. People in rural areas are generally further from major hospitals and major healthcare facilities.
How was this map done?
The global map was built by a process of amalgamating multiple global and publicly available datasets, including data from OpenStreetMap, and Google Maps. Data included information on road locations around the world, as well as location of healthcare facilities.
“We took our methodology (from our 2018 paper) and built on it to make it a travel map to healthcare services. The motivation behind our research was that we know from other research that people who live farther away from healthcare facilities are less likely to seek care when needed. We wanted to quantify this,” he said.
“It was quite the undertaking but one of the marvels of living in this era where there are powerful global datasets available. It becomes our job to capitalise on them and turn the data into useful information.
One potential limitation of the study concerns the definition of healthcare facilities.
“We relied on other people’s definition of what a hospital or clinic was and one country’s definition of a clinic might be slightly different from another country’s definition,” Dr Weiss said.
“Also, these maps are only as good as the inventories of healthcare facility locations. The quality and completeness of these data varies between countries, and data also change through time as facilities open and close.
“Another important caveat is that the time it takes to reach healthcare is only the first hurdle people face. Other factors, such as cost or how busy a facility is, can also limit people’s ability to receive care.”
Why these findings matter?
While these global maps are reassuring for many, they also show that significant numbers of people are likely to struggle to reach a hospital or other major healthcare provider when they need it.
“These inequities are understandable because facilities are placed in areas where most people live and therefore are in most demand, but people living far from facilities still need care,” he said.
“The maps may help policy makers direct resources to underserved communities, perhaps through programs such as mobile clinics, community healthcare workers, or telemedicine.”
The maps are free to download and use and Dr Weiss has also created an online tool, accessible to anyone with internet.
“We didn’t just make a set of maps, but also an online map-making system that enables users to upload facility locations and generate custom travel time maps. In doing so, we allow anyone to make maps using the most up-to-date facility lists they have,” he said.
The road ahead
Now, Dr Weiss is looking at making more detailed maps that show the transportation services which are available for people needing to reach a healthcare facility.
Beyond mapping access to healthcare, Dr Weiss has also used his mapping skills to track the burden of malaria around the world, with the Malaria Atlas Project (MAP). Malaria is still a major healthcare problem in many countries, affecting 218 million people and killing more than 400,000 in 2018, mostly children. The largest burden of malaria is disproportionally allocated in the African continent. The WHO African region has more than 93% of all malaria cases.
With help from the MAP project, researchers have been able to obtain global data on malaria incidence, prevalence and mortality since 2000.
“The Malaria Atlas Project has been able to track the success of malaria reduction in key countries where this disease is a major problem,” he said.