One of the great advantages that humans gain from living in a society, is having a way to get help if we are sick or injured, and to help each other to stay healthy. Those of us who live in or near a city are more likely to be close to hospitals and clinics, since they are built in more densely populated places so that most people can spend less time getting there.
In a large and populous city like Jacksonville, there is no scarcity of options when it comes to healthcare. Hospitals and clinics belonging to the St. Vincents and Baptist medical families are the most prominent among several others, including a military hospital at the naval base. Let's take a look at how the largest city landwise in the continental US gets covered in terms of the ready accessibility of healthcare facilities. Click to enlarge.
This map shows the locations of all of the major hospitals in Jacksonville as red dots. The concentric circles around each one show the approximate distance of a 5, 10, and 30 minute drive. There are a couple of these circles overhanging the edges of the map, representing the proximity of hospitals outside of Duval county that are further away. The circles are superimposed over one another to visualize the overall geographic coverage of the hospitals, the brightest areas being those that are quite close to multiple hospitals, and the darkest being more than a half-hour drive away from any hospital, like a complex Venn diagram. The brightness of concentric 'drive time' circles around each hospital increases as radius decreases, and the regions are brightest wherever multiple sets of proximity circles overlap.
This legend elaborates shows that yellow and blue lines indicate the major and minor roadways, which are important to have a sense of when considering the proximity of major destinations. County lines appear as a thin, dashed red line. Many of the clinics and primary care or physicians' offices in the city are shown in pink and green dots, providing a spatial sense of the care options available apart from a visit to a hospital, although these categories should not be considered exhaustive.
This map focuses less on the proximity of any one particular hospital as it does on the collective proximity of all the hospitals in the area, and particularly on which areas are superabundantly supplied by being situated within a short distance to multiple hospital options. This visualization of hospital proximity can tell us which areas can be considered quite close to a hospital landwise, but what can we know about the populations they serve? Some demographic data will bring this map to life. Click to enlarge.
This is the same map, superimposed with a choropleth layer visualizing the percentage of the population that is uninsured in and around Duval County, shown in census tract data from the American Community survey. We can use it to consider how much of the population nearest to hospitals is uninsured.
This legend is unchanged except for the addition of a gold gradient bar explaining the population data. The largest percentages of the population that are uninsured in any part of Jacksonville are between 25 and 30 %. There is no census tract in this area where more than 30% of the population is uninsured. The gradient bar breaks down the percentages under 30% in increments of 5%, where color opacity increases with the uninsured population. The portion under 5% is not included because no color opacity is applied tracts where the uninsured population is very low.
By comparing the brightness that indicates close proximity to hospitals, with the relative opacity or transparency of the gold color, we can get an idea of which highly insured or highly uninsured areas are close to hospitals. Bear in mind that census tracts were originally determined as areas of approximately equal population, so larger ones normally have about the same number of people spread out across a larger area, or lower population density, and smaller ones normally have greater population density. This map shows us that there are a lot of places in the central Jacksonville area where a fairly great proportion of the population in uninsured. There are also a few more far-flung regions where 20% or more of the population is uninsured. There don't appear to be any areas where there are a lot of uninsured people without at least one hospital pretty close to them.
It's important to understand that although uninsured people can still go to hospitals to receive care, they often experience the prohibitive risk of having to pay out of pocket for potentially expensive procedures. They are more likely to put off preventive exams and to only go to a hospital in an emergency, meaning they are more likely to have preventable health problems. It may help them to be in the vicinity of a hospital, but being uninsured means they often get sick despite the proximity of healthcare resources. It's important for hospital administration to be aware of which areas in their vicinity are the least insured, so they can do their best to meet the needs of their communities.
Let's also consider the how the largest racial populations are distributed throughout the city, and get a picture of how it compares to the proximity of hospitals. The majority of people in Jacksonville are white, the second largest group is Black, and the third is Hispanic. These maps visualize the percentages that each group represents in Jacksonville. Click to enlarge.
These iterations of the map show the percentage represented by White, Black, and Hispanic racial groups in the census tracts within Duval County, according to the most recent data from the American Community Survey. Superimposed over the hospital proximity circles, we can see how well covered the various racial groups are, and understand the racial distribution of people in the city. The data has been limited to Duval county for simplicity, because all of the census tracts outside of Duval county within the scope of the map have a strong white majority.
The pink gradient bar in the legend in broken down into increments of 20%, where opacity increases to indicate a higher percentage. The legend is drawn from the map about the Black population, but the gradient bar reads exactly the same for all of them. Wherever the pink color is very bright, there is a strong racial majority of whichever race is shown by the map. The places with a moderate pink shade are more thoroughly integrated. We can compare these maps to each other, and to the map about the uninsured population from earlier.
By comparing the maps, we can see that most parts of the city have either a White majority or at least a significant portion of the population made up by white people. The northwestern region of Jacksonville from downtown upward has a distinct Black majority, although Black people make up much of the population in other areas too. Hispanic people, the third most populous group, are not in a majority in any tract but we can see a few tracts in the southern and eastern portions of the city where they make up a greater proportion of the total population, than in most areas. The uninsured population does not appear to correlate consistently with tracts where there is a majority of any of the three racial groups, although further research is needed to determine whether any racial group is significantly more likely to be uninsured in Duval County.
While it's true that people of all races experience more obstacles to receiving quality care than only being relatively far from a hospital, it's worthwhile to know who might have to travel a further distance. A comparison of the hospital proximity layer with the racial data tells us that no one racial group tends to live within significantly less proximity to a hospital than any other. However, most of the furthest-out tracts on the edges of the county are majority White, and as described earlier, most other regions within the scope of the map but outside the county are also majority White. These are more rural, less populous areas which, as indicated on the map, can be 30 min or more away from a hospital. That being said, no part of Duval County appears to be particularly neglected by the healthcare system with regard to geography, with most people of all races being within about half an hour's drive to at least one, and the most populous areas near more than one.
These maps indicate a healthy and fair distribution of hospitals in the Jacksonville area, and present insurance and race data that could be of interest to hospital administration. Hospital leadership has the opportunity to see which areas in their vicinity experience the greatest financial obstacles, the demographic makeup of who is near them versus who is actually coming there, and for which areas they are the closest option but perhaps not close enough.
Research of this kind can help healthcare providers understand where the gaps are that need to be filled, and consider how they can make themselves available in new ways. Perhaps a rural clinic or a medical transit system can help bring care to a far-flung area. A mobile clinic option can help provide preventive exams to neighborhoods where there are many uninsured people avoiding going to hospitals until they have to. The nearness of a hospital may not mean that everyone nearby is getting the care they need, but it does mean that with enough awareness of surroundings, and a little creativity, everyone could.
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