Investigating spatial inequality and inequity in health status and its social determinants in Iran
Subject Areas :
Regional Planning
mohammad reza rezvani
1
,
siamak tahmasbi
2
,
bahram hajari
3
1 - Professor, Department of Geography and Rural Planning, Faculty of Geography, University of Tehran, Tehran, Iran.
2 - MSc. Student, Department of RS & GIS, Center for Remote Sensing & GIS Research, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran.
3 - PhD Candidate in Geography and Rural Planning, Faculty of Geography, University of Tehran.
Received: 2020-04-28
Accepted : 2021-04-19
Published : 2022-12-22
Keywords:
"Health Inequality",
" Social Health Determinants",
" Spatial Inequality",
" Spatial Analysis",
" Provinces of Iran",
Abstract :
Health is a vital component of human well-being. Health justice is one of the political priorities of governments. Most region of the Iran are facing the problem of improving the level of health, which is a major obstacle to sustainable development in these regions. Recognizing and analyzing spatial health inequalities and their determinants at different scales (national, regional, local) is an effective step in policy making. The main purpose of this study is to analyze the spatial inequality in health status and its social determinants in the provinces of Iran. The required data collected through statistical yearbooks of Iran Statistics Center and medical universities. To measure the spatial pattern and spatial clustering, the global Moran’s I and Getis-Ord G statistics are used. Also, the two-variable Moran statistic was used to measure the relationship between health status and independent research variables. Findings show that health status and its determinants are distributed unequally among the provinces. In the health stats, the border provinces, especially in the east and southeast of the country are in an unfavorable situation. The provinces of Tehran, Alborz, Kurdistan and Ardabil achieved the highest values. In other words, they can be said to be in a good position. In contrast, the provinces of North Khorasan, Khuzestan, South Khorasan and Sistan and Baluchestan had the lowest scores, which they had poor condition. Health status and independent variables of the study showed significantly positive relationship with health status in the provinces. Highest coefficient values for health prediction status respectively are socio-economic status 0.222 (p = 0.000) physical 0.147 (p <0.001), human resources 0.142 (p <0.001) and environmental quality 0.135 (p <0.001). However, these relations are changing among the provinces, and not all provinces follow the same pattern. The influencing factors of research varies among provinces, which is higher in the southeastern and northwestern provinces of the country.
References:
Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: the challenge of the gradient. American psychologist, 49(1), 15.
Afrakhteh,Hassan;Afkar, Abolhassan (2012), Factors Affecting Rural Health Level, Journal of Rural Research and Planning, No. 1, pp. 44-25. In Persian.
Ahmadi, Sajjad; Saburikhah, Hamid; Darvishi, Hedayatullah; Jabbari, Habib (2014), Spatial Analysis of Iran's Provinces in Health Indicators, Regional Planning Quarterly, Fourth Year, No. 14, pp. 44-31. In Persian.
Ali Akbar Anabestani; Behzadi, Sedigheh (2013), Assessing the level of rural health and individual factors affecting it in Meybod-Yazd city, third year, first issue, pp. 18-18. In Persian.
Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015). Inequalities in health: definitions, concepts, and theories. Revista Panamericana de Salud Pública, 38 (4), 261-271.
Asthana, S., & Gibson, A. (2008). Health care equity, health equity and resource allocation: towards a normative approach to achieving the core principles of the NHS. Radical Statistics, 96, 6.
Ataguba, J. E. O., Day, C., & McIntyre, D. (2015). Explaining the role of the social determinants of health-on-health inequality in South Africa. Global health action, 8(1), 28865.
Azar, Adel; Andalib Ardakani, Davood; Shah Tahmasbi, Ismail (2010), Evaluating the efficiency of provinces in rural health and treatment in the third program and the early years of the fourth development program, Health Management Quarterly, No. 13, pp. 65-87. In Persian.
Bernard, P., Charafeddine, R., Frohlich, K. L., Daniel, M., Kestens, Y., & Potvin, L. (2007). Health inequalities and place: a theoretical conception of neighbourhood. Social science & medicine, 65(9), 1839-1852.
Braveman, P. A. (2003). Monitoring equity in health and healthcare: a conceptual framework. Journal of health, population and nutrition, 181-192.
Braveman, P. A., Cubbin, C., Egerter, S., Chideya, S., Marchi, K. S., Metzler, M., & Posner, S. (2005). Socioeconomic status in health research: one size does not fit all. Jama, 294(22), 2879-2888.
Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: coming of age. Annual review of public health, 32, 381-398
Campbell, M. H. (2011). Exploring the social and spatial inequalities of ill-health in Scotland: A spatial microsimulation approach. (Doctoral dissertation, University of Sheffield).
DOHC (2001), Quality and Fairness: A Health System for You, Dublin: Stationery Office.
Fang, P., Dong, S., Xiao, J., Liu, C., Feng, X., & Wang, Y. (2010). Regional inequality in health and its determinants: evidence from China. Health Policy, 94(1), 14-25.
Hewko, J. N. (2003). Spatial equity in the urban environment: Assessing neighbourhood accessibility to public amenities (Alberta).
Hekmatnia, H., Givehchi, S., Heidary Noshahr, N., Heidary Noshahr, M.(2011). Analysis Distribution of Urban Public Services with Data Standardization, Taxonomy and Specification Coefficient Model (Case Study: Ardakan Town). Human Geography Research Quarterly, Volume: 43 Issue: 77,
Irwin, A., Valentine, N., Brown, C., Loewenson, R., Solar, O., Brown, H.. & Vega, J. (2006). The commission on social determinants of health: tackling the social roots of health inequities. PLoS medicine, 3(6), e106.
Irwin, Alk; Scully, Elena (2005), Measures related to social factors affecting health: derived from previous experiences. Translated by Mohammad Hossein Niknam. Tehran: Wefaq. In Persian.
Kawachi, I., Subramanian, S. V., & Almeida-Filho, N. (2002). A glossary for health inequalities. Journal of Epidemiology & Community Health, 56(9), 647-652.
Khakpour, Baratali and Bavan Poori, Alireza. (2012). Investigation and analysis of inequality in developmental areas of Mashhad city. Journal of Knowledge and Development, 16 (27), 182-202. (In Persian).
Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104.
Marmot, M. (2007). Achieving health equity: from root causes to fair outcomes. The Lancet, 370(9593), 1153-1163.
McCartney, G., Collins, C., & Mackenzie, M. (2013). What (or who) causes health inequalities: theories, evidence and implications? Health Policy, 113(3), 221-227.
McGaugh, M. (2009). The utility of Self-Organizing Maps in the analysis of social determinants of health. Oklahoma State University.
McNeill, L. H., Kreuter, M. W., & Subramanian, S. V. (2006). Social environment and physical activity: a review of concepts and evidence. Social science & medicine, 63(4), 1011-1022.
Mousavi, Seyed Meysam; Anjum Shoaa, Mina; Rajabi Vasuklaei, Qasem; Ezzati Asar, Mohammad; Vareh Razdi, Ramin; (2015), Evaluation of West Azarbaijan Province in the field of benefiting from the indicators of development of health services, Journal of the School of Nursing And Midwifery of Urmia, Volume 13, Number 3, pp. 234-245.(In Persian).
Olabimpe, O. K. (2009). Analysis of equity in the pattern of health care utilization in South Africa (Doctoral dissertation, University of Cape Town).
Pourrshano, Firooz; Mohammad, Shiva; Pourzamani, Hamidreza (2012), A Study and Comparison of the Developmental Degree of Health and Health Services in Iran's Provinces in 2008, Journal of Health System Research, Volume 8, Number 7, pp. 1330-1322. In Persian.
Raphael, D. (2006). Social determinants of health: present status, unanswered questions, and future directions. International Journal of Health Services, 36(4), 651-677.
Rezaei, Mohmmadreza, and Akbari, Mahmood (2018), Survey of Health Indicator Inequalities in the township of Fars, Journal of Regional Planning, Volume 8, Number 31, pp. 19-31. In Persian.
Seidaei, Seyed Eskandar; Jamini, Davood; Jamshidi, Alireza (2014) Fourth year, first issue, (consecutive 12), pp. 64-43. (In Persian).
Sepehrdost, Hamid (2010), The role of government in the distribution of health and medical facilities in Hamadan province, Quarterly Journal of Social Welfare, No. 37, pp. 307-326. In Persian.
Sheikhi, Davood; Rezvani, Mohammad Reza; Mahdavi, Masoud (2012), Assessment and Analysis of Health Level in Rural Areas Based on the Healthy Village Approach: A Case Study of Khandab County, Markazi Province, Rural and Development Quarterly, Year 15, No. 2, Pp. 109-138. In Persian.
Sun, S., Chen, J., Johannesson, M., Kind, P., Xu, L., Zhang, Y., & Burström, K. (2011). Regional differences in health status in China: Population health-related quality of life results from the National Health Services Survey 2008. Health & Place, 17(2), 671-680.
Tahmasbi, Siamak; Gharghani, Masoumeh (2014), Evaluation of the country's rural health services, Proceedings of the National Conference on Sustainable Rural Development in the Sixth Development Plan.(In Persian).
Tyrrell, O. C. (2017). Analysis of Social Determinants of Health in Justice-Involved Youth: Relevance in the Context of Poverty.
Whitehead, M. (1991). The concepts and principles of equity and health. Health Promotion International, 6(3), 217-228.
Zangiabadi, Ali; Bahari, Issa; Ghaderi, Reza (2013), Spatial Analysis and Leveling of Health-Medical Indicators Using GIS (Case Study: Cities of East Azarbaijan Province), Geographical Research, No. 108, pp. 75-106. (In Persian).
Zarabi, Asghar; Sheikh Biglou, Rana (2011), Leveling of Health Development Indicators of Iranian Provinces, Social Welfare Quarterly, Volume 11, Number 42, pp. 128-107. (In Persian).
Zatonski, W. (2007). The east-west health gap in Europe—what are the causes? The European Journal of Public Health, 17(2), 121-121.
_||_
