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8.10: Geography of Care

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    212718
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    Geography of Care

    New York Times: Where A re the Hardest Places to Live in the US?

    A mapped Index of Health and Poverty:

    The geographical variation in death and disease can also be attributed to the geography of health care. Wealth explains most of the variation in access to quality health care globally and nationally. The health of poor people everywhere suffers from multiple burdens, many of which begin well before a person is born. Impoverished pregnant women may be malnourished and unable to afford the costs associated with proper pre-natal childcare, especially where the government does not provide health care. Poor women also tend to have babies born prematurely, and premature babies often suffer from low birth weight, which in turn invites a number of additional ill-health outcomes, most notably infant death. Poor children often continue to suffer from poor diets and an inability to access regular, high-quality health care throughout their lives which shortens their lives and reduces their capacity to be productive citizens. Many of the poorest areas in the United States have high percentages of physically or mentally disabled citizens.

    Medically underserved regions and populations U.S.png

    Figure US County Map: Orange indicates medically underserved regions, blue indicates medically underserved populations. Source: HRSA – Interactive Map *or* ArcGIS Online Interactive Map

    Access to Medical Facilities

    Poor people are not attractive customers for profit-driven health care providers. Poor people, especially prior to the Affordable Care Act (Obamacare), frequently had little means to obtain health insurance outside of the government-run Medicaid program. This fact limits health care options for millions of people in the United States. As a result, uninsured people tend to wait until they are very ill to see a doctor, often requiring a visit to a hospital’s emergency room where federal law requires provision of medical care, regardless of the patient’s ability to pay. The government partially reimburses hospitals for the costs of emergency room care, but much of the cost of caring for the indigent is paid for by charities and/or passed on to those with insurance – another example of an economic externality. Hospitals that serve too many indigent patients risk going out of business. As a result, doctors and hospitals avoid many of the poorest areas of the United States, favoring places where well-insured patients generate bigger profits.

    Geographers sometimes call regions without medical facilities medical deserts. Most medical deserts are in poor rural areas, but a few inner-city areas in America’s largest cities also suffer from limited access to health care provision. The passage of the Affordable Care Act was intended to shrink or halt the expansion of medical deserts in most of the US, but expansion of medical deserts continues in states where politically conservative politicians opposed to Obamacare prevented their state from funding expansion of Medicaid programs for those who were both too poor to afford private insurance, but not poor enough to qualify for Medicaid. Multiple challenges to Obamacare, especially since the election of Donald Trump have reversed some of the gains made from 2010-2019. An estimated 10-15 million additional uninsured people, largely living in poor, and politically conservative regions, has expanded the threat of medical desertification.

    Find Your Local Trauma Center

    American Trauma Society:

    Interactive Map of Trauma Centers in the US

    Map of trauma centers in U.S.png

    Figure Maps. On the left is a US map showing one-hour transport distances to trauma centers. Los Angeles area trauma centers and a 45 minute ambulance ride are mapped (right). Source: Traumamaps.org

    Geographers also analyze health care access at very local scales. Perhaps the most closely scrutinized region has been Los Angeles’ “South Central'' neighborhood. As far back as the 1965 Watts Riots, black residents of Los Angeles have complained about poor access to doctors and hospitals. Government officials, in an attempt to shorten the distance residents of South Central LA had to travel for medical care, opened the King-Drew Medical Center in the early 1970s. However, after years of shoddy health care provision by the staff at King Drew, the facility was closed 2007, including its very busy trauma center. The closure angered local residents who would have to be transported to more distant emergency rooms for emergency treatment. Although it was controversial, most residents of South LA have reasonably good access to trauma care compared to residents of many areas of the US. In fact, all Los Angelenos have reasonably good access to trauma centers and hospitals.

    Regional Variations in Health Care

    In addition to regional variations in access to health care, there are significant variations in the style of healthcare both within and beyond the borders of the United States. How often people are diagnosed with specific illnesses varies greatly across time and space as do the strategies doctors use to treat conditions. Geography is exceptionally useful in highlighting and addressing these discrepancies. For example, in South Korea, there has been a startling rise in the incidence of thyroid cancer in the last 20 years. The rate is fifteen times higher than it was a generation ago, and it appears at first blush to be an epidemic. But, upon closer study, it turns out that changes in Korea’s health care system simply encouraged doctors to look for thyroid cancer more often than before. Because doctors were looking for the disease more aggressively, they found it far more often. As it turns out, quite few people have thyroid cancer and live with it for many years. Unfortunately, many Koreans chose to have the cancerous thyroid gland removed and as a result suffered more complications than they would have, had not just left it alone.

    Similar situations occur in the United States. The rate of diagnosis of specific diseases as well as the preferred treatment strategy depends a great deal on where you live. For example, If you live in the Southeastern United States, and you get a cold, there’s a much better chance you’ll be prescribed an antibiotic drug than if you live in California, Vermont or Colorado. If you and a cousin are both diagnosed with bad tonsils, where you live may dictate what your doctor suggests as an ideal treatment. You might have them surgically removed, and your cousin may simply get some pain-pills and a note to stay home from school.

    Cool Map:

    An interactive web mapping application addressing a variety of health care issues.

    Dartmouth Atlas of HealthCare

    Healthcare issues within U.S.png

    Figure : Map - Significant variation in the rate of tonsillectomies exists across parts of New England suggesting inconsistent treatment practices. Spatial Autocorrelation is evident.

    Source: Dartmouth Atlas of HealthCare.

    These variations in care are troubling because it suggests that geography may be influencing doctors more than accepted medical protocols. Geographers would investigate mapping treatments first, and then conduct a statistical test for spatial autocorrelation to determine if the spatial pattern of treatment is random or clustered. If the pattern of some disease does not mimic the pattern of treatment for that disease, then serious questions about the quality of health care should be raised.


    8.10: Geography of Care is shared under a CC BY-NC 4.0 license and was authored, remixed, and/or curated by LibreTexts.

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