The Effects of Transit Corridor Developments on the Healthcare Access of Medically Fragile Vulnerable Populations

The Effects of Transit Corridor Developments on the Healthcare Access of Medically Fragile Vulnerable Populations

Rafael Diaz (Eastern Virginia Medical School, Norfolk, VA, USA), Joshua Behr (Virginia Modeling, Analysis and Simulation Center (VMASC), Old Dominion University, Suffolk, VA, USA), ManWo Ng (Department of Modeling, Simulation and Visualization Engineering, Old Dominion University, Norfolk, VA, USA), Anna Jeng (School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA) and Bridget Giles (Virginia Modeling, Analysis and Simulation Center (VMASC), Old Dominion University, Suffolk, VA, USA)
DOI: 10.4018/ijphim.2013070105
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Transportation has been identified as a major barrier to healthcare access, particularly, within vulnerable population groups. The level of healthcare access that most population segments have in traditional transit systems may be increased with new initiatives that involve complex and large investments in transit oriented developments (TOD) projects. However, the increasing attractiveness of neighborhoods affected by TOD initiatives may result in the gentrification of vulnerable population segments. These vulnerable segments are likely to be relocated into less attractive neighborhoods characterized by inadequate transit systems. This relocation increases the probabilities of reducing healthcare access for these underserved groups leading to an increase in health disparities. The present discussion calls for research to explore relevant factors that affects these dynamics. A framework that enables the identification of individual factors that affect gentrification processes under TOD initiatives as well as quantifying the effects from these processes is suggested in this paper. A system dynamics framework that allows the understanding of the dynamics associated with this system is suggested in this paper. Critical areas for empirical research are highlighted. These are prerequisites for the effective deployment of initiatives that ensure the mitigation of possible negative impacts on vulnerable populations.
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1. Introduction

Transportation has been cited one of the most critical barrier to access to healthcare (Institute of Medicine, 1993). A large number of studies indicate the negative impacts of transportation barrier towards access to healthcare, predominantly, for vulnerable population. Rittner and Kirk (1995) report that a majority of low income old people in poor health condition depended on public transit as their only means of accessing healthcare services. Okoro et al. (2005) report ‘lack of transportation’ and a possible dependence on public transportation as one of critical barriers to healthcare, especially for women, in a study of overcoming the barriers to preventive care among older population. Similar results are reported by Fitzpatrick et al. (2004). Flores et al. (1998) found that transportation problem was cited by 21% of the parents as the reason for lack of access to healthcare when studying the barriers to healthcare access among Latino children. Ahmed et al. (2001) report comparable results from studying barriers for non-elderly, poor Americans segments in urban settings. In a study conducted in a community health center settings, Shook (2005) reports that 32% of the patients reported a transportation barrier within the last year, with most problems related to transit. Consistently, this author finds that this barrier affects the vulnerable populations more severely than the rest. From the discussion above it is evident that transportation remains to be a major barrier to healthcare and that transit is a possibly inefficient but the only (and hence important) means of accessing healthcare especially for the most vulnerable populations.

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