تحلیل سطح توسعه خدمات بهداشتی - درمانی از منظر عدالت فضایی (مطالعه موردی: سکونتگاه‌های روستایی استان آذربایجان غربی)

محورهای موضوعی : مطالعات برنامه ریزی شهری و منطقه ای

شمسی صالح پور ¹ , حسن افراخته ²

1 - دانشجوی دکتری جغرافیا و برنامه‌ریزی روستایی، دانشگاه خوارزمی، تهران، ایران
2 - استاد گروه جغرافیا و برنامه‌ریزی روستایی، دانشگاه خوارزمی، تهران، ایران

تاریخ دریافت : 1394/12/04 تاریخ پذیرش : 1395/09/13 تاریخ انتشار : 1395/09/01

کلید واژه: سکونتگاه‌های روستایی, عدالت فضایی, استان آذربایجان غربی, خدمات بهداشتی- درمانی,

چکیده مقاله :

در هر جامعه‌ای، بهداشت و درمان به عنوان یکی از بخش‌های مهم اجتماعی نقش تعیین‌کننده‌ای در سلامت و تندرستی افراد جامعه دارد. از این رو به عنوان یکی از حقوق جهانی بشر، مورد تاکید تمام کشورها در زمینه تأمین رفاه اجتماعی است. مطالعه حاضر باهدف تحلیل سطحتوسعه خدمات بهداشتی - درمانی از منظر عدالت فضایی در سکونتگاه های روستایی استان آذربایجان غربی انجام شده است. روش تحقیق توصیفی- تحلیلی و نوع آن کاربردی است. جمع‌آوری داده‌ها در قالب 12 شاخص، به صورت اسنادی و کتابخانه‌ای بوده است. به منظور تحلیل داده ها از ضریب آنتروپی شانون و مدل‌های TOPSISو MORIS و به منظور رسیدن به نتیجه واحد از روش میانگین رتبه‌ها استفاده شد. بابکارگیری این مدل ها و آنالیز هریک از آن ها، سکونتگاه های روستایی شهرستان های آذربایجان غربی رتبه بندی و سطح بندی فضایی شدند. نتایج پژوهش نشان می‌دهد که سکونتگاه های روستایی شهرستان‌های ارومیه و خوی درهر دو مدل بارتبه 1و2 با وضعیت مطلوب در سطح اول و دوم قرارگرفته‌ و سکونتگاه های روستایی شهرستان‌های سلماس، مهاباد، تکاب، پیرانشهر، نقده، شاهین دژ، سردشت، اشنویه، چالدران با کسب رتبه‌های ششم تا چهاردهم در سطح چهارم جای گرفته‌اند. نتایج مشاهدات میدانی صورت گرفته نشان داد در نابرابری فضایی موجود، علاوه بر تعداد جمعیت، عامل فاصله نیز اثرگذار است. به طوری که با افزایش فاصله از مرکز شهر، از شدت برخورداری از امکانات و خدمات کاسته می شود. این امر حاصل نتایج سیاست های رشد قطبی است که در نتیجه آن تمام امکانات و قدرت در یک یا چند منطقه تمرکز می یابد و سایر مناطق به صورت حاشیه ای عمل می کنند. در نهایت با توجه به عدم تعادل فضایی موجود، پیشنهادهایی ارائه شده است.

چکیده انگلیسی:

In each community, health and remedy as the one of parts important social, decisive role in the persons health and wellbeing of the community. Present study with the aim of analysis the spatial distribution of health services from the perspective of spatial equity has been conducted in rural settlements Western Azerbaijan province. The research method is descriptive - analytical and Practical type. Data gathering in the form of 12 indicators, is documentary- Libraries method. In analyzing the data using models of Shannon entropy, TOPSIS, MORIS and in order to achieve the same result using method average ranks. Using these models and analyze each of them, rural settlements the county West Azerbaijan ranked and leveling space.  The results show that rural settlements of Urmia and Khoy countyes in both models with rank 1 and 2 with good condition have been in the first and second level. And rural settlements counties Salmas Mahabad, Takab, Piranshahr, Naqadeh, Shahindej, Sardasht, Oshnavieh, Chalderan With ranks sixth up fourteenth are the fourth level. Results conducted field observations showed that in existing spatial inequality, Addition to the number of population Operating distance is also effective. Even with increasing distance from the city center, will be reduced the intensity of the enjoyment of facilities and services. This results is of polar growth policies, Followed by that, all facilities and power is concentrated in one or several regions and other regions act marginally eventually, with regard to existing spatial inequality provided Suggestions.

منابع و مأخذ:

Ahadnejad Roshti, M., Golamhoseini. R., & Zolfi, A. (2012). Evaluation of Mazandaran province Counties in terms of access to health infrastructures using the model MORIS and TOPSIS. Geography and Urban Planning Zagros landscape, 1, 53-68. (in Persian)
Amini, D., & Mokhtari Malekabadi, R. (2013). The analysis of health indicators East Azerbaijan Province The analysis of health indicators East AzerbaijanProvince Through numerical taxonomy. Geography and Environmental Studies, 5, 7-19. (in Persian)
Asayesh, H., & estelaji, A.R. (2003). Principles and methods of regional planning models, Methods and techniques. Islamic Azad University Press of Shahr-e Rey, Tehran. (in Persian)
Bahrami, R. (2015). Analytical level of development the health sector in Kurdistan province Counties with Using TOPSIS Method linear. Geographical Information (sphere), 24, (96), 49-39. (in Persian)
Chen, C.-T. (2000). Extensions of the TOPSIS for group decision-making under fuzzy environment. Fuzzy Sets and Systems, 114 (1), PP 1-9.
Cho, Ch. M. (2003). Study on effects of resident-perceived neighborhood boundaries on public services: Accessibility & its relation to utilization: Using Geographic Information System focusing on the case of public parks in Austin, Texas: Texas A&M University.
Cuadras-Morato'a pinto, X., & Pinto j.L. (2005). Prades Equity Consideration in Health Care: The Relevance Claims. Health Economics Health econ, 10, 187-205.
Delbosc, A., & Graham. C. (2011). Using Lorenz curves to assess public transport equity. Journal of Transport Geography, 19 (6), 1252-1259.
Distaso, A. (2007). Well-being and/or quality of life in EU countries through a multidimensional index of sustainability. Ecological Economics, 64, 1-163.
Gulliford, M., & Morgan, M. (2003). Access to Health Care: Rutledge. London: New fetler LAN.
Hataminezhad, H., Fahodi, R., & Mohammadpour jabery, M. (2008). Analysis of social inequality in the enjoyment of Analysis of social inequality in the enjoyment of Landes city services Case Study: City esfaraien. Human Geography Research, 65, 71-85. (in Persian)
Hataminezhad, H., Mahdian Behnamiri, M., & Mahdi. A. (2012). Investigation and analysis of spatial justice enjoyment of Health Services Using models the Topsis, Morris and Taxonomy, Case Study: Mazandaran province. Geographical space planning, 5, 75-97. (in Persian)
Hendryx, M., Ahern, M., & Lovrich, N. (2002). Mc Curdy A. Access to Health Care and Community Social Capital. Health Serve, 37 (1), 85 -101.
Heydari Chaîne, R., Alizadeh Zonouzi, Sh., Qlyky Milan, B & imanitabar, H. (2014). Analytical socio-economic inequalities   VIKOR and SAW-based models in East Azerbaijan Case study: health services. Research and Urban Planning, 21, 19-34. (in Persian)
Horev T., Pesis-Katz, I., & Mukamel, Db. (2004). Trends in Geographic Disparities in Allocation of Health Care Resources in the US. Health Policy, 68 (2), 32-223.
Hwang, C. L., & Yoon, K. (1981). Multiple Attributes Decision Making Methods and Applications, Berlin: Springer.
Jabareen, Y. (2008). A new conceptual framework for sustainable development. Journal of Environment, Development and Sustainabilit, 10 (2), 179-192.
Javan, J., & Abdollahi, A. (2008). Spatial Justice in double spaces city of Mashhad (Explanation of geopolitical patterns of inequality in Mashhad metropolitan margin). Geopolitics, 2, 157-175. (in Persian)
Kandakoglu, A., Celik M., & Akgun, I. (2009). A multi - method ological approach for shipping registry selection in maritime transportation industry. Mathematical and Computer Modelling, 49, 586-597.
Keykha, N. (2004). The concept and mechanisms of the social justice, political science. 8, (26), 163-186. (in Persian)
Kreng, VB., & Yang, C-T. (2011). the Equality of Resource Allocation in Health Care under the National Health Insurance System in Taiwan. Health Policy, 100 (2-3), 203-210.
Kunzmann, K. R. (1998). Planning for spatial equity in Europe. International Planning Studies, 3 (1), 91-108.
Liao, C-H., Hsueh-Sheng, C., & Tsou, K-W. (2009). Explore the spatial equity of urban public facility allocation based on sustainable development. Real Corp, 137-145. (22-25 April 2009, Sitges. http://www.corp.at /)
Liu, M., Zhang, Q., Lu, M., Kwon, CS., & Quan, H. (2007). Rural and urban disparity in health services utilization in China. Med Care, 45(8), 767-774.
Lotfi, S., & Shabani, M. (2013). Presenting a model combined ranked for Regional Development, Case Study: Health Sector Mazandaran province. Applied Research Geographic Sciences, 13 (2), 7-30. (in Persian)
M.-T. Chu., Shyu, j., Tzeng, G-H., & Khosla, R. (2006). Comparison among three analytical methods for knowledge community’s group-decision analysis. Expert Systems with Applications, 33, 1011-1024.
Marsousi, N. (2003). Spatial analysis of social justice in Tehran. Ph.D. thesis, Geography and Urban Planning, Tarbiat Modarres University, Tehran. (in Persian)
Moeain, M. (1993). Moeain Culture. Volume 2, Eighth Edition, published by Amir Kabir, Tehran. (in Persian)
Mohammadi, Z., shukri, M., & Eftekhari, H.R. (2013). Measurement the degree development of Golestan province Countries in health Sector indicatores using the method numerical taxonomy. The fifth Conference of planning and urban management. (in Persian)
Mousavi, MN., & Hekmatnia, H. (2015). Factor analysis and Combining indicators in determining factors affecting human development areas of Iran. Geography and Development, 6, 55-70. (in Persian)
Mousavi, S.M., Anjam, shoa M., Rajabi Vasookalaei, Gh., Ezati asar, M., & Varehzardi, M. (2015). Evaluation West Azarbaijan province Counties in the field of enjoying of health services development indicators. School of Urmia Nursing and Midwifery, 13 (3), Sequential 68, 234-245. (in Persian)
Nicholls, S. (2001). Measuring the accessibility and equity of public parks: a case study using GIS. Managing Le isure, 6, 201-219. (http://www.tandf.co.uk/journals).
Nickpour, B. (2006). Health in the villages of Chahar Mahal and Bakhtiari. Tehran University Press, Tehran. (in Persian)
Oladipo, J. A. (2014). Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems. African Health Sciences, 14, (2), 322-333.
Opricovic, G.-H. Tzeng. (2004). Compromise solution by MCDM methods: A comparative analysis of VIKOR and TOPSIS. European, Journal of Operational Research, 156, 445–455.
Pong RW1, DesMeules, M., Heng, D., Lagacé, C., Guernsey, JR., Kazanjian, A., Manuel, D., Pitblado, JR., Bollman, R., Koren, I., Dressler, MP., Wang, F., Luo, W. (2011). Patterns of health services utilization in rural Canada. Chronic Dis Inj Can, 31 (Suppl), 1-36.
Rahnama, M.R., & Zabihi, J. (2011). The analysis distribution urban public facilities from the perspective of spatial equity with integrated access model in Mashhad. Geography and Development, 23, 5-26. (in Persian)
Rice, N., & Smith, P. (2001). Ethics and Geographical Equity in Health Care Utilization of New York.  journal of Medical Ethics, 27, 256-261.
Sadeghifar, J., Sydein, S.H., Anjam, shoa M., Rajabi Vasookalaei, Gh., Mosavi, S.M., & Armon, B. (2014). The Determine degree of development determine the degree of development counties Bushehr Province in terms of health indicators using the numerical taxonomy. Medical Sciences Razi, 21 (118), 81-91. (in Persian)
Sayehmiri, A., & Sayehmiri, C. (2001). The ranking healthcare status Ilam counties with the use of numerical taxonomy techniques and principal components analysis. Medical Sciences, 9 and 8, 91-104. (in Persian)
Shannon, C., Weaver, W. (1964). The Mathematical Theory of Communication. the University of Illinois Press. Urbana, (Copyright 1949 by the Board of Trustees of the University of Illinois. Manufactured in the United States of America. Library of Congress Catalog Card No. 49-11922).
Shin, H. (2003). Income related inequity in health care access and delivery. PhD thesis, University of South Carolina.
Sibley, L.M., & Weiner, JP. (2011). an evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Serv Res, 31, 11-20.
Smith, D., & M. (1994). Geography and Social justice. Oxford: Blackwell.
Streeten, P. (1999). Economic Development in Third World. Boston University, towards an Effective Urban Environmentalism for the 21s, Boston University.
Talen, E., & Anselin, L. (1998). Assessing Spatial Equity: An Evaluation of Measures of Accessibility to Public Playgrounds. Environment and Planning, 30 (1), 595-613.
Tavakoli, J. (2014). Assessment of socio-economic sustainability of rural settlements north and south Khave villages in Lorestan province. Applied ResearchGeographical Sciences, o 32, 71-92. (in Persian)
Tsou, Ko-Wan., Yu-Ting, H., & Yao-Lin, Ch. (2005). An Accessibility-Based Integrated Measure of Relative Spatial Equity in Urban Public Facilities. Cities, 22 (6), 424-435
Zarabi, A.A., & Sheykhbeglu, R. (2011). The leveling Health development indicators provinces of Iran. Social Welfare, 11 (42), 107-128. (in Persian)
Zere, E., Mandlhate, C., Mbeeli, T., Shangula, K., Mutirua, K., & Kapenambili, W. (2007). Equity in health care in Namibia: developing a needs-based resource allocation formula using principal components analysis. Int J Equity Health, 6(1), 1-7. (Http: //www. Equity healthj.

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Ahadnejad Roshti, M., Golamhoseini. R., & Zolfi, A. (2012). Evaluation of Mazandaran province Counties in terms of access to health infrastructures using the model MORIS and TOPSIS. Geography and Urban Planning Zagros landscape, 1, 53-68. (in Persian)
Amini, D., & Mokhtari Malekabadi, R. (2013). The analysis of health indicators East Azerbaijan Province The analysis of health indicators East AzerbaijanProvince Through numerical taxonomy. Geography and Environmental Studies, 5, 7-19. (in Persian)
Asayesh, H., & estelaji, A.R. (2003). Principles and methods of regional planning models, Methods and techniques. Islamic Azad University Press of Shahr-e Rey, Tehran. (in Persian)
Bahrami, R. (2015). Analytical level of development the health sector in Kurdistan province Counties with Using TOPSIS Method linear. Geographical Information (sphere), 24, (96), 49-39. (in Persian)
Chen, C.-T. (2000). Extensions of the TOPSIS for group decision-making under fuzzy environment. Fuzzy Sets and Systems, 114 (1), PP 1-9.
Cho, Ch. M. (2003). Study on effects of resident-perceived neighborhood boundaries on public services: Accessibility & its relation to utilization: Using Geographic Information System focusing on the case of public parks in Austin, Texas: Texas A&M University.
Cuadras-Morato'a pinto, X., & Pinto j.L. (2005). Prades Equity Consideration in Health Care: The Relevance Claims. Health Economics Health econ, 10, 187-205.
Delbosc, A., & Graham. C. (2011). Using Lorenz curves to assess public transport equity. Journal of Transport Geography, 19 (6), 1252-1259.
Distaso, A. (2007). Well-being and/or quality of life in EU countries through a multidimensional index of sustainability. Ecological Economics, 64, 1-163.
Gulliford, M., & Morgan, M. (2003). Access to Health Care: Rutledge. London: New fetler LAN.
Hataminezhad, H., Fahodi, R., & Mohammadpour jabery, M. (2008). Analysis of social inequality in the enjoyment of Analysis of social inequality in the enjoyment of Landes city services Case Study: City esfaraien. Human Geography Research, 65, 71-85. (in Persian)
Hataminezhad, H., Mahdian Behnamiri, M., & Mahdi. A. (2012). Investigation and analysis of spatial justice enjoyment of Health Services Using models the Topsis, Morris and Taxonomy, Case Study: Mazandaran province. Geographical space planning, 5, 75-97. (in Persian)
Hendryx, M., Ahern, M., & Lovrich, N. (2002). Mc Curdy A. Access to Health Care and Community Social Capital. Health Serve, 37 (1), 85 -101.
Heydari Chaîne, R., Alizadeh Zonouzi, Sh., Qlyky Milan, B & imanitabar, H. (2014). Analytical socio-economic inequalities   VIKOR and SAW-based models in East Azerbaijan Case study: health services. Research and Urban Planning, 21, 19-34. (in Persian)
Horev T., Pesis-Katz, I., & Mukamel, Db. (2004). Trends in Geographic Disparities in Allocation of Health Care Resources in the US. Health Policy, 68 (2), 32-223.
Hwang, C. L., & Yoon, K. (1981). Multiple Attributes Decision Making Methods and Applications, Berlin: Springer.
Jabareen, Y. (2008). A new conceptual framework for sustainable development. Journal of Environment, Development and Sustainabilit, 10 (2), 179-192.
Javan, J., & Abdollahi, A. (2008). Spatial Justice in double spaces city of Mashhad (Explanation of geopolitical patterns of inequality in Mashhad metropolitan margin). Geopolitics, 2, 157-175. (in Persian)
Kandakoglu, A., Celik M., & Akgun, I. (2009). A multi - method ological approach for shipping registry selection in maritime transportation industry. Mathematical and Computer Modelling, 49, 586-597.
Keykha, N. (2004). The concept and mechanisms of the social justice, political science. 8, (26), 163-186. (in Persian)
Kreng, VB., & Yang, C-T. (2011). the Equality of Resource Allocation in Health Care under the National Health Insurance System in Taiwan. Health Policy, 100 (2-3), 203-210.
Kunzmann, K. R. (1998). Planning for spatial equity in Europe. International Planning Studies, 3 (1), 91-108.
Liao, C-H., Hsueh-Sheng, C., & Tsou, K-W. (2009). Explore the spatial equity of urban public facility allocation based on sustainable development. Real Corp, 137-145. (22-25 April 2009, Sitges. http://www.corp.at /)
Liu, M., Zhang, Q., Lu, M., Kwon, CS., & Quan, H. (2007). Rural and urban disparity in health services utilization in China. Med Care, 45(8), 767-774.
Lotfi, S., & Shabani, M. (2013). Presenting a model combined ranked for Regional Development, Case Study: Health Sector Mazandaran province. Applied Research Geographic Sciences, 13 (2), 7-30. (in Persian)
M.-T. Chu., Shyu, j., Tzeng, G-H., & Khosla, R. (2006). Comparison among three analytical methods for knowledge community’s group-decision analysis. Expert Systems with Applications, 33, 1011-1024.
Marsousi, N. (2003). Spatial analysis of social justice in Tehran. Ph.D. thesis, Geography and Urban Planning, Tarbiat Modarres University, Tehran. (in Persian)
Moeain, M. (1993). Moeain Culture. Volume 2, Eighth Edition, published by Amir Kabir, Tehran. (in Persian)
Mohammadi, Z., shukri, M., & Eftekhari, H.R. (2013). Measurement the degree development of Golestan province Countries in health Sector indicatores using the method numerical taxonomy. The fifth Conference of planning and urban management. (in Persian)
Mousavi, MN., & Hekmatnia, H. (2015). Factor analysis and Combining indicators in determining factors affecting human development areas of Iran. Geography and Development, 6, 55-70. (in Persian)
Mousavi, S.M., Anjam, shoa M., Rajabi Vasookalaei, Gh., Ezati asar, M., & Varehzardi, M. (2015). Evaluation West Azarbaijan province Counties in the field of enjoying of health services development indicators. School of Urmia Nursing and Midwifery, 13 (3), Sequential 68, 234-245. (in Persian)
Nicholls, S. (2001). Measuring the accessibility and equity of public parks: a case study using GIS. Managing Le isure, 6, 201-219. (http://www.tandf.co.uk/journals).
Nickpour, B. (2006). Health in the villages of Chahar Mahal and Bakhtiari. Tehran University Press, Tehran. (in Persian)
Oladipo, J. A. (2014). Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems. African Health Sciences, 14, (2), 322-333.
Opricovic, G.-H. Tzeng. (2004). Compromise solution by MCDM methods: A comparative analysis of VIKOR and TOPSIS. European, Journal of Operational Research, 156, 445–455.
Pong RW1, DesMeules, M., Heng, D., Lagacé, C., Guernsey, JR., Kazanjian, A., Manuel, D., Pitblado, JR., Bollman, R., Koren, I., Dressler, MP., Wang, F., Luo, W. (2011). Patterns of health services utilization in rural Canada. Chronic Dis Inj Can, 31 (Suppl), 1-36.
Rahnama, M.R., & Zabihi, J. (2011). The analysis distribution urban public facilities from the perspective of spatial equity with integrated access model in Mashhad. Geography and Development, 23, 5-26. (in Persian)
Rice, N., & Smith, P. (2001). Ethics and Geographical Equity in Health Care Utilization of New York.  journal of Medical Ethics, 27, 256-261.
Sadeghifar, J., Sydein, S.H., Anjam, shoa M., Rajabi Vasookalaei, Gh., Mosavi, S.M., & Armon, B. (2014). The Determine degree of development determine the degree of development counties Bushehr Province in terms of health indicators using the numerical taxonomy. Medical Sciences Razi, 21 (118), 81-91. (in Persian)
Sayehmiri, A., & Sayehmiri, C. (2001). The ranking healthcare status Ilam counties with the use of numerical taxonomy techniques and principal components analysis. Medical Sciences, 9 and 8, 91-104. (in Persian)
Shannon, C., Weaver, W. (1964). The Mathematical Theory of Communication. the University of Illinois Press. Urbana, (Copyright 1949 by the Board of Trustees of the University of Illinois. Manufactured in the United States of America. Library of Congress Catalog Card No. 49-11922).
Shin, H. (2003). Income related inequity in health care access and delivery. PhD thesis, University of South Carolina.
Sibley, L.M., & Weiner, JP. (2011). an evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Serv Res, 31, 11-20.
Smith, D., & M. (1994). Geography and Social justice. Oxford: Blackwell.
Streeten, P. (1999). Economic Development in Third World. Boston University, towards an Effective Urban Environmentalism for the 21s, Boston University.
Talen, E., & Anselin, L. (1998). Assessing Spatial Equity: An Evaluation of Measures of Accessibility to Public Playgrounds. Environment and Planning, 30 (1), 595-613.
Tavakoli, J. (2014). Assessment of socio-economic sustainability of rural settlements north and south Khave villages in Lorestan province. Applied ResearchGeographical Sciences, o 32, 71-92. (in Persian)
Tsou, Ko-Wan., Yu-Ting, H., & Yao-Lin, Ch. (2005). An Accessibility-Based Integrated Measure of Relative Spatial Equity in Urban Public Facilities. Cities, 22 (6), 424-435
Zarabi, A.A., & Sheykhbeglu, R. (2011). The leveling Health development indicators provinces of Iran. Social Welfare, 11 (42), 107-128. (in Persian)
Zere, E., Mandlhate, C., Mbeeli, T., Shangula, K., Mutirua, K., & Kapenambili, W. (2007). Equity in health care in Namibia: developing a needs-based resource allocation formula using principal components analysis. Int J Equity Health, 6(1), 1-7. (Http: //www. Equity healthj.