Division of Public Health, Michigan State University, USA.
Division of Public Health, Michigan State University, USA.
Soc Sci Med. 2019 Apr;227:63-75. doi: 10.1016/j.socscimed.2018.07.030. Epub 2018 Jul 19.
Addressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index. We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0-100 scale). Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that-even when controlling for individual-level factors-we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.
解决健康差异问题需要社区参与和对健康决定因素的理解。尽管建筑环境的元素可以影响公共卫生干预措施中的行为改变，但这些决定因素尚未通过参与式绘图明确揭示。现在有机会将社区声音纳入这些指标的制定中。为了填补这一空白，并为弗林特（美国）健康公平解决方案中心（FCHES）的公共卫生干预措施提供信息，我们创建了一种在地理信息系统（GIS）中评估空间变化的社区需求和资产的方法，我们称之为健康指数。我们通过多标准决策分析框架让社区和学术合作伙伴参与他们对弗林特建筑环境特征的专家意见，这些特征可能通过促进或抑制健康行为。专家们从 6 个类别（包括便利设施、环境、绿地、住房、基础设施和社会问题）中选择并对 29 个变量进行排名，使用层次分析法。专家意见的结果矩阵被聚合并附加为每个变量对应地图层的权重。通过地图代数组合，复合得分产生空间变化的健康指数，这些指数表明每个社区的相对促进健康的质量（在 0-100 范围内）。结果在弗林特市差异很大，中间地带得分最高，而东北部和市中心北部的旧社区得分最低。分数汇总到 38 个弗林特社区；对于两个特定项目的指数，每个指数的范围从最低的 38.7（希尔本公园）和 41.8（哥伦比亚高地）到最高的 52.9（学院文化）和 58.0（大学大道走廊）。我们假设，即使控制了个人层面的因素，我们也将在居住在健康指数较高的社区的参与者中测量到更好和更持续的行为改变。未来的工作将检验这一假设，并确定此类指数在其他类似社区中的重要性。
