Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods. This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations. The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs. The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.

This research examines geographical accessibility to primary care providers (PCPs) across urban and rural areas of Southwestern Ontario and examines variations in the distribution of PCPs in relation to the senior population (aged 65 years and older). Information about PCP practices was provided by the HealthForceOntario Marketing and Recruitment Agency. Population data were obtained from the 2016 Census of Canada. To calculate scores for accessibility to PCPs (i.e., PCPs/10,000 population), we applied the enhanced 2‐step floating catchment area method with distance decay effect within a global service catchment of 30‐minute drive time. A geospatial mapping approach revealed disparities in the distribution of PCPs with a pattern of higher spatial accessibility in or around major urban areas in Southwestern Ontario. Comparative analyses were performed in association with the seniors’ population to identify how accessibility scores were mismatched with the population needs. The outcome of this study will assist researchers and health service planners to better understand the distribution of existing PCPs to address inequalities, particularly in rural areas.

We examined location-related accessibility to healthy and unhealthy food sources for school going children in Saskatoon, Saskatchewan. We compared proximity to food sources from school sites and from small clusters of homes (i.e., dissemination blocks) as a proxy for home location. We found that (1) unhealthy food sources are more prevalent near schools in lower income than higher income neighbourhoods; (2) unhealthy compared to healthy food sources are more accessible from schools as well as from places of residence; and (3) while some characteristics of neighbourhood low socio-economic status are associated with less accessibility to healthy food sources, there is no consistent pattern of access. Greater access to unhealthy food sources from schools in low-income neighbourhoods is likely a reflection of the greater degree of commercialization. Our spatial examination provides a more nuanced understanding of accessibility through our approach of comparing place of residence and school access to food sources.

The process of geocoding, particularly the street address matching process, is a commonly used technique to obtain locational information for public health research. In health care accessibility research, geocoded locations of health care providers are an essential element for measuring potential access to health care. Our objective is to compare the geocoding match rates and positional variation of two geocoding procedures by using street network and postal code datasets to geocode primary health care services in 14 cities. The first procedure uses a manually built geocoding service using DMTI Spatial (DMTI) reference datasets while the second employs an online geocoding service provided as a built‐in tool in ArcGIS, with ESRI Tele Atlas reference datasets. Results for Tele Atlas postal code and DMTI multiple enhanced postal codes (MEP) reference datasets produce much higher match rates (99.4%; 98.0% respectively) than street reference datsasets; while results of Tele Atlas street dataset produce better match rates (96.5%) than the DMTI street dataset (90.0%). Geocoding methods using Tele Atlas and DMTI Street datasets produce more accurate locations than postal code and MEP reference datasets. Empirical comparison of the geocoding results based on manually built and online geocoding services highlight the need for integrated geocoding procedures for increasing match rates with reduced positional uncertainty.

Background: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services. Methods: Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013–2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population ‘need’ subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cut-off. Three classes: low (< − 0.5SD), moderate (− 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions. Results: A total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services. Conclusion: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to “supply” and “need” factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

Urban cyclists are exposed to many traffic-related air pollutants including particulate matter (PM) that may increase vulnerability to health effects. This study investigates second-by-second personal exposure to PM_2.5 (fine particulate matter that is 2.5 microns in diameter and less) along bicycle commuting paths, and assesses elements of the natural and built environment for the relative importance of these factors in understanding the variability in PM_2.5 personal exposure. Urban cyclists were carrying high resolution PM_2.5 monitors (placed in a backpack) in combination with portable GPS trackers to provide a spatial identity to each one-second pollutant measurement. The results of this study indicate that daily averages of PM_2.5 concentrations from all bicycle routes were weakly correlated with meteorological variables, however, a strong influence of regional levels of PM_2.5 was observed. Geospatial analysis of PM_2.5 personal exposure concentrations showed a considerable variation within routes, correlated with land use (with lower concentrations in parks and higher in industrial areas) and clustered at four areas: busiest bridge, heavily trafficked road segments, the downtown urban core, and two construction sites. This study has found many incidences of personal exposure to PM_2.5 exceeding the provincial guidelines for healthy activity (e.g., very poor (PM_2.5 > 91 μg/m³) pollution concentrations are clustered in three regions: approaching the bridge in the west part of the city; the downtown urban core; and two under construction spots), which suggests behavioural and infrastructure modifications in balancing the health benefits of cycling with the environmental exposure to air pollutants.