发表机构
The Bartlett Centre for Advanced Spatial Analysis (CASA), University College London; School of Social Sciences, Birkbeck, University of London; Malaria Atlas Project, The Kids Research Institute Australia（伦敦大学学院巴特莱特高级空间分析中心; 伦敦大学伯贝克社会科学学院; 疟疾地图项目澳大利亚儿童研究所）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
本研究扩展渗流分歧树框架，结合街道可及性与道路层级连通性，多尺度分析加纳医疗可及性不平等，发现约四分之一人口距医疗设施超5公里，揭示单中心与多中心区域的不同结构形态，为跨尺度政策干预提供依据。
AI 中文摘要
实现可持续发展目标3.8中提出的全民健康覆盖，需要缩小医疗保健可及性方面持续存在的地理和社会经济差距，尤其是在非洲资源匮乏的环境中。医疗保健可及性不平等不仅受当地可及性差的影响，还受与城市和区域级服务及机会连通性有限的制约。传统的可及性分析可以识别可及性差的地区，但无法判断服务不足的地方是否在多个尺度上形成结构性脱节的区域。因此，本文在渗流分歧树框架的基础上进行扩展，开发了一种基于连通性的多尺度方法，用于考察加纳的医疗保健可及性不平等。该方法将街道级可及性制图与道路网络的层级结构相结合，以识别不平等与连通性断裂相吻合的尺度。结果首先显示出显著的不平等：约四分之一的人口居住在距离最近医疗设施超过5公里的地方。多尺度分析进一步揭示了可及性差的独特结构形式。在连通性较好、单中心的区域，尽管整体区域具有优势，但局部可及性差的区域出现在大都市边缘。在连通性较差、多中心的区域，可及性差的范围延伸至更大的子系统，局部区域嵌套在更广泛的服务不足区域中。这些发现表明，医疗保健可及性不平等既反映了当地条件，也反映了更广泛空间系统的层级连通性，这可能也限制了边缘化社区获取其他关键资源和服务的机会。该框架可为针对性的地方干预措施以及跨地方和区域尺度的政策协调提供信息。
英文摘要
Achieving universal health coverage, as set out in Sustainable Development Goal 3.8, requires closing persistent geographic and socioeconomic gaps in healthcare access, especially in under-resourced settings across Africa. Healthcare-access inequality is shaped not only by poor local access, but also by limited connectivity to city- and regional-level services and opportunities. Conventional accessibility analysis can identify where poor access occurs, but not whether poorly served places form structurally disconnected pockets across scales. This paper therefore builds on and extends the percolation divergence tree framework to develop a connectivity-based multiscale approach for examining healthcare-access inequality in Ghana. It combines street-level accessibility mapping with the hierarchical structure of the road network to identify the scales at which inequality coincides with connectivity breaks. The results first show substantial inequality: around one quarter of the population lives more than 5 km from the nearest healthcare facility. Multiscale analysis further reveals distinct structural forms of poor access. In relatively well-connected, monocentric regions, local poor-access pockets emerge around metropolitan fringes despite overall regional advantage. In less well-connected, polycentric regions, poor access extends across larger subsystems, with local pockets nested within broader poorly served areas. These findings show that healthcare-access inequality reflects both local conditions and the hierarchical connectivity of the wider spatial system, which may also constrain marginalised communities' access to other key resources and services. The framework can inform targeted local interventions and policy coordination across local and regional scales.
