Spatial Justice and Implications for US Health Care

Abstract

The recognition that where people live matters to their health has deep roots, highlighted in the works of Hippocrates, W. E. B. Du Bois, and in contemporary research on environmental and placebased factors that shape health. 1,2 Although health systems have come to accept their role in helping change community conditions in support of health, their complex institutional, financial, and sociopolitical considerations can prevent positive change or lead to more harm. We suggest that the concept of spatial justice must be incorporated in health system actions to improve population health.Spatial justice 3 refers to the relationship between people and places as mediated by historical and current values, assumptions, beliefs, policies, investments, and practices. The National Academies of Sciences, Engineering, and Medicine Roundtable on Population Health Improvement recently hosted a workshop on spatial justice as a driver of health in the context of societal emergencies, including pandemics and climate change. Participants-planners, architects, social scientists, community organizers, residents, policy makers, and others-examined how space is organized, used, allocated, owned, and who is or is not included in decisions about design, building, and use of spaces.

Racial Disparities in Endovascular Thrombectomy: It’s More Than Just Access

“…But until we do all of these things and health systems consider their environment while holding themselves accountable to their communities, and advocate for change-we will continue to see studies like this one that suggest we need to improve our methods of caring for our patients. 10 The hyperacute, time-sensitive nature of acute ischemic stroke care means that patients are limited to what is offered to them. Accepting the status quo does not work when we are talking about access to the most effective disability-reducing intervention there is.…”

The relationship between stroke system organization and disparities in access to stroke center care in California

“…As spatial justice is increasingly recognized as a critical component of building equitable systems of care, it will be important to examine the role of transfer patterns and the structure of the hospital network created by interhospital transfers in reinforcing or perpetuating disparities in patient access to high‐quality acute stroke care. 28 Strategies from network science may prove valuable. 29 , 30 …”

“…As spatial justice is increasingly recognized as a critical component of building equitable systems of care, it will be important to examine the role of transfer patterns and the structure of the hospital network created by interhospital transfers in reinforcing or perpetuating disparities in patient access to high-quality acute stroke care. 28 Strategies from network science may prove valuable. 29,30 Our findings also reinforce prior literature, as we found that stroke patients from racial or ethnic minority groups in California had lower odds than White patients of receiving reperfusion interventions.…”

“…This finding may suggest that transfer patterns and the organization of the stroke system of care are configured in a way that reinforces differential access to high‐quality care based on relative privilege. As spatial justice is increasingly recognized as a critical component of building equitable systems of care, it will be important to examine the role of transfer patterns and the structure of the hospital network created by interhospital transfers in reinforcing or perpetuating disparities in patient access to high‐quality acute stroke care 28 . Strategies from network science may prove valuable 29,30 …”

Geographical Distribution and Social Justice of the COVID‐19 Pandemic: The Case of Palma (Balearic Islands)

“…Some authors suggest that the concept of spatial justice should necessarily be incorporated into the field of health to try to improve the health of the population (Baciu et al., 2021 ). Spatial justice is related to both the way territories face the pandemic and the typology and intensity of its effects on the population.…”