This repository contains data and codes which will be used in the project Mellon Grant
Health inequalities are disparities that lead to systematic differences in health outcomes (McCartney et al., 2019). The worst outcome occurs in the most vulnerable and poorest populations, who have barriers that impede them actual access to healthcare. A combination of barriers related to availability and accessibility constitute "spatial accessibility" (SA). Health inequity as a social problem in Peru could be overcome with public policies based on science contributions, however no study has incorporated spatial access to healthcare in vulnerable populations in Peruvian health system. Therefore, it is a necessity to know how easy or difficult spatial access is for peruvian vulnerable populations to know if this reality may be widening the gap and generating even more inequality. Here we have researched the spatial accessibility to healthcare of Peruvian populations.
Context and geography of each country is unique leading to a constant necessity to generate new methods, especially in highly heterogeneous countries like most LAC countries and Peru. we have focused in exploring gravity-model based methods and their newest adaptations like Floating Catchment Area (FCA) method, Two-step FCA (2SFCA), Enhanced 2SFCA (E2SFCA) and Three-step FCA (3SFCA) because they provide the most valid measures of SA for urban and rural areas. We explored ethnic inequalities in three main peruvian cities from three regions that have different landscape and demographic characteristics: Lima in the coastal region, Arequipa in the andean region and Iquitos in the Amazon.
Lima is the Peruvian capital and it is located on the central coast of the country. Lima is the only capital from LAC countries located in coastal areas. Metropolitan Lima has the largest population in the country with around 10 million people, that is one third of the full peruvian population. Lima is split up into 43 districts, some on the shores of the Pacific Ocean, others in the coastal desert or in the valleys areas. Migration from other regions is usual and the city has grown more than 1 million every 10 years during the last decades. Migrants come from all over the country, especially from Ancash, Junín, other provinces in Lima region and Ayacucho. Transportation through the city is by bus, by car or by Metro (with two lines) and the Metropolitan bus.
Arequipa is the largest Andean city in Peru with more that 1 million people. The city is located in southwest Peru and has grown continuously over the past six decades, sustained by migration, mostly from the countryside. A centrifugal urbanization gradient that differentiates urban and peri-urban areas can easily be observed in the urban landscape. There is also a geographical stratification of resources, including access to social services, health care, and educational opportunities. Arequipa city has 29 districts, usually with uneven terrain and some districts border the mountains. Transportation through the city is by bus or by car only and does not count with metro or other faster types of transport.
Iquitos is the main Amazon city and the sixth biggest city in Peru. Located in Northeast Peru, Iquitos has 500 000 people in 4 districts. It is surrounded by three rivers, including the Amazon river. Around 60% of the population is native and migration to other capitals has stopped the city's growth, so growth projection was not reached in the last census 2017. Migration from Iquitos occurs to Trujillo, Lima, Cajamarca, Piura or Chiclayo. Transport within the city is by bus, motorcycle or mototaxi, but to other areas usually can be accessed by long travels by boat or helicopter only. Due to Iquitos´s geography, the city is not connected with other regions by highways, with the exception of one route that connects Iquitos with Nauta and other northern small towns.