Zhang Lihong, Liu Yan, Jin Lu, Hou Xiang-Yu, Diminic Sandra, Zhou Xiaoyun, Suetani Shuichi, Nelson Carmel, Bainbridge Roxanne
School of the Environment, The University of Queensland, Brisbane, QLD, Australia.
Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Int J Health Geogr. 2025 Sep 26;24(1):24. doi: 10.1186/s12942-025-00415-9.
Mental disorders significantly burden Indigenous communities, worsened by limited culturally appropriate services. Spatial inequalities in access further disadvantage Indigenous peoples, especially in socio-economically challenged areas. This paper measures the spatial accessibility of Indigenous community-controlled mental health services in South East Queensland, Australia and examines its social inequalities across the region.
We considered both population and health service providers' capacity to maximise service coverage in measuring potential access to the services. Using Geographical Information Systems (GIS) technologies, a Gaussian-based two-step floating catchment area (G2SFCA) method was applied to quantify accessibility under four driving time thresholds ranging from 15 to 60 minutes. Bivariate global and local Moran's I statistics were used to analyse social inequalities in accessibility across various geographical areas.
Accessibility was higher in urban areas than those towards the peri-urban and rural areas; the overall spatial coverage was relatively limited for service access within the 15- or 30-minute driving time threshold, compared with the 45- or 60-minute driving time threshold. Lower levels of accessibility were identified in areas with a concentration of Indigenous and socio-economically disadvantaged populations.
This study advances a socially informed spatial inequality assessment framework. Unlike previous research exploring accessibility qualitatively, our framework innovatively integrates spatial analysis, Indigenous-specific population data and culturally sensitive provider capacity metrics within an advanced G2SFCA model. This approach uniquely exposes the compounded socio-spatial barriers to mental health services for Indigenous populations across South East Queensland's urban-rural continuum. The resulting accessibility and inequality maps, combined with a summary of focus areas and their associated socio-demographic profiles, provide a direct policy lever to prioritise intervention for Indigenous communities experiencing the greatest disadvantage. By bridging spatial analysis with Indigenous cultural contexts, this work offers a replicable model for equitable, community-driven healthcare resource allocation for Indigenous peoples globally.
精神障碍给原住民社区带来了沉重负担，而文化上适宜的服务有限使情况更加恶化。获得服务方面的空间不平等进一步加剧了原住民的不利处境，尤其是在社会经济条件较差的地区。本文衡量了澳大利亚昆士兰州东南部原住民社区控制的心理健康服务的空间可达性，并考察了该地区的社会不平等情况。
在衡量服务的潜在可及性时，我们考虑了人口因素以及医疗服务提供者最大化服务覆盖范围的能力。利用地理信息系统（GIS）技术，应用基于高斯的两步浮动集水区（G2SFCA）方法，在15至60分钟的四个驾车时间阈值下量化可达性。使用双变量全局和局部莫兰指数统计分析不同地理区域可达性的社会不平等情况。
城市地区的可达性高于城郊和农村地区；与45分钟或60分钟驾车时间阈值相比，在15分钟或30分钟驾车时间阈值内，服务获取的总体空间覆盖相对有限。在原住民和社会经济弱势群体集中的地区，可达性水平较低。
本研究提出了一个基于社会信息的空间不平等评估框架。与以往定性探索可达性的研究不同，我们的框架在先进的G2SFCA模型中创新性地整合了空间分析、特定原住民人口数据和文化敏感的提供者能力指标。这种方法独特地揭示了昆士兰州东南部城乡连续体中原住民获得心理健康服务所面临的复合社会空间障碍。由此产生的可达性和不平等地图，结合重点区域及其相关社会人口概况的总结，提供了一个直接的政策杠杆，以便对处于最不利地位的原住民社区进行优先干预。通过将空间分析与原住民文化背景相结合，这项工作为全球范围内公平的、社区驱动的原住民医疗资源分配提供了一个可复制的模型。
