<p>Over the last few decades, household incomes have been rising steadily but the biggest share of that growth has been in the top income quintile. This unequitable growth is exacerbated by spatial factors, such as a household’s home location and the distribution of opportunities and resources around it. This thesis examines the effects of the distribution of places of employment and healthy food retailers on socioeconomic outcomes for households in the Phoenix Metropolitan Statistical Area (MSA). The main research objectives are to: i) calculate accessibility to employment and healthy food for public transit and automobile and identify low-access areas for the two modes; ii) determine the underlying reasons and recommend mitigation measures for the access gaps; and iii) investigate the associations between the calculated accessibility measures and socioeconomic outcomes for households. This is achieved by calculating healthy food accessibility, general job accessibility, industry job accessibility (i.e., access to jobs by the different North American Industry Classification System (NAICS) different industry sectors) and industry job mismatch (i.e., the difference in the general job accessibility and the industry job accessibility). We employ a modified Enhanced 2-step Floating Catchment Area (E2SFCA) method with continuously decaying weights using census data at the census block level, employment data from the Longitudinal Employer-Household Dynamics (LEHD) program in various North American Industry Classification System (NAICS) sectors, and locations of grocery stores from the Safegraph places dataset. Using spatial regression models, we estimate the associations between these calculated measures and socioeconomic outcomes. The analysis shows that there is a lack of transit access to healthy food and employment in the periphery of the MSA and that greater access is clustered around interstates and primary roads. The access by transit is worse than access by automobiles for most of the block groups. The spatial regression results show that renters find block groups with better access more attractive, and homeowners trade off that accessibility for better living conditions and other factors, such as school districts. People using the Supplemental Nutrition Assistance Program (SNAP) and people not high school educated have worse industry job accessibility; jobs that they are employed and qualified in are not accessible to these vulnerable populations. City planners and policy makers can use these findings to implement policies that can address the access gaps found and impact communities. </p>

L’objectif de la thèse était de développer un indicateur mesurant l’accessibilité spatiale des premiers soins (nommé Index of Spatial Accessibility : ISA) pour les femmes enceintes, à partir de sources de données collectant des informations en routine. Ce travail a pour vocation de mettre en évidence les limites des indicateurs existants tout en apportant des améliorations. Une attention particulière a consisté à étudier l’impact de l’effet des contours administratifs (ou effet de bord), la limite pointée dans de nombreuses études portant sur l’accès aux soins. L’indicateur d’accessibilité aux professionnels de santé que nous avons développé a pour objectif de mettre en évidence les disparités spatiales à une échelle géographique fine afin d’identifier les zones géographiques dans lesquelles il faudrait intervenir en priorité. Ce travail s’est concentré tout d’abord sur les professionnels de santé intervenant dans le suivi de la grossesse : médecins généralistes, sages-femmes et gynécologues. Les résultats mettent en évidence qu’en combinant la disponibilité avec la proximité des soins, les besoins en matière de santé et la mobilité, l’ISA permet de fournir une meilleure mesure d’accessibilité. L’ISA a été construit afin de pouvoir interroger l’accès aux soins pour d’autres pathologies ou d’autres populations. L’analyse de l’impact de l’effet de bord met en évidence que : 1) la moyenne et l'écart-type sont légèrement inférieurs avec effet de bord que sans, quel que soit le type des professionnels de santé ; 2) La variation d’ISA est plus marquée pour les sages-femmes et les gynécologues, et pour les zones rurales. Nous avons également menée une étude pilote sur le recours aux soins des femmes enceinte, à partir des données SNIIRAM afin d’étudier la relation entre le recours aux soins et l’indicateur ISA. / This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the census blocks level, and seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application. The indicator of accessibility to health professionals developed aims to highlight spatial disparities measured at a fine geographical scale and to identify area where actions are needed in priority. This work focused first of all on the health professionals involved in the follow-up of the pregnancy: general practitioners, midwives and gynecologists. The main finding is that by combining availability with proximity to services, health needs and mobility, and by calculating at the smallest feasible geographical scale, ISA provides a better measure of accessibility. ISA was conceived so that we could question the access to care for other pathologies and other populations. When we compare the variation of ISA with and without edge effect, we found that (1) mean and standard deviation are slightly below when offer and demand outside are taken in to account, whichever health professionals considered; 2) the variation of ISA is higher for midwives and gynecologists, and for rural areas. In addition, we also conducted a pilot study on the health use of pregnant women, using SNIIRAM data to examine the relationship between use of care and the ISA indicator.

Vi lever i en urbaniserad värld och mer än hälften av jordens befolkning bor i städer globalt. God tillgång och tillgänglighet till bostadsnära grönområden har påvisats öka vår psykiska och fysiska hälsa. Världshälsoorganisationen (WHO) och Förenta nationerna (FN) har båda antagit program med mål att öka och säkra tillgängligheten till grönområden. I detta examensarbete jämförs fyra olika metoder för att analysera nuläget av tillgång och tillgänglighet i Falkenberg. Analysen genomförs i tre steg. I steg 1 definieras de grönområden som ingår i analysen. I steg 2 jämförs buffert- och nätverksanalys och i steg 3 beräknas tillgängligheten med 2 modeller av Two-Step Floating Catchment Area metoden (2SFCA). De polygonbaserade beräkningar som sker med buffert- och nätverksanalys beräknar tillgången ensidigt och beräknar den spatiala tillgängligheten eller befolkningstrycket på ett grönområde. Med 2SFCA-metoderna kombineras tillgången och efterfrågan i samma analys. Analysen finner att cirka 90 % av invånarna i Falkenberg har tillgång till bostadsnära grönområden inom 300 meter, dock är både tillgång och tillgänglighet lägre i de centrala delarna av tätorten. I studien jämförs traditionella metoder för att beräkna den spatiala tillgängligheten så väl som nyare metoder. 2SFCA-metoderna beräknas med och utan avståndsviktning. I vidare studier vore det intressant att implementera en kvalitetsaspekt där så väl ett grönområdes kvalitet som dess avstånd avgör attraktionskraft. / More than half of the world population live in cities or urban areas today. Urban green spaces (UGS) have been found to have an impact on the mental and physical well-being of urban citizens. The World health organisation (WHO) and United Nations (UN) both have set goals to increase and secure the accessibility to UGS, especially for children and young people. The aim of the study is to measure the spatial accessibility to UGS in Falkenberg, Sweden. The work consists of three steps. Step 1 is to define what constitutes a green space. Step 2 aims to compare buffer and network analysis to determine which method is best suited for the third step. Step 3 is to measure the accessibility by using the Two-step Floating Catchment Area Method (2SFCA) and thereafter integrate a Gaussian distance decay to the function and conduct the measures with the Enhanced two-step floating catchment area method (E2SFCA).  Step 2 finds that there is no major difference in access to green space between the buffer and network analysis as approximately 90 % of the population have access to green space within 300 meters from their home. In step 3 the implementation of the 2SFCA Method finds that 13 % has no access to UGS and 41 % has a low accessibility score. By introducing the distance decay function the population with low-mid to high-mid accessibility score increases as well as the overall accessibility. This is due to the nature of E2SFCA which does not treat the distance threshold dichotomous. Further studies could benefit from implementing a probability function to the E2SFCA method to incorporate the attraction to a UGS by using the qualitative values in combination with the distance.