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ObjectivesTo test a new approach to characterise accessibility to tertiary care emergency health services in urban Cali and assess the links between accessibility and sociodemographic factors relevant to health equity.DesignThe impact of traffic congestion on accessibility to tertiary care emergency departments was studied with an equity perspective, using a web-based digital platform that integrated publicly available digital data, including sociodemographic characteristics of the population and places of residence with travel times.Setting and participantsCali, Colombia (population 2.258 million in 2020) using geographic and sociodemographic data. The study used predicted travel times downloaded for a week in July 2020 and a week in November 2020.Primary and secondary outcomesThe share of the population within a 15 min journey by car from the place of residence to the tertiary care emergency department with the shortest journey (ie, 15 min accessibility rate (15mAR)) at peak-traffic congestion hours. Sociodemographic characteristics were disaggregated for equity analyses. A time-series bivariate analysis explored accessibility rates versus housing stratification.ResultsTraffic congestion sharply reduces accessibility to tertiary emergency care (eg, 15mAR was 36.8% during peak-traffic hours vs 84.4% during free-flow hours for the week of 6–12 July 2020). Traffic congestion sharply reduces accessibility to tertiary emergency care. The greatest impact fell on specific ethnic groups, people with less educational attainment and those living in low-income households or on the periphery of Cali (15mAR: 8.1% peak traffic vs 51% free-flow traffic). These populations face longer average travel times to health services than the average population.ConclusionsThese findings suggest that health services and land use planning should prioritise travel times over travel distance and integrate them into urban planning. Existing technology and data can reveal inequities by integrating sociodemographic data with accurate travel times to health services estimates, providing the basis for valuable indicators.

This protocol proposes an approach to assessing the place of residence as a spatial determinant of health in cities where traffic congestion might impact health services accessibility. The study provides dynamic travel times presenting data in ways that help shape decisions and spur action by diverse stakeholders and sectors.  Equity assessments in geographical accessibility to health services typically rely on static metrics, such as distance or average travel times. This new approach uses dynamic spatial accessibility measures providing travel times from the place of residence to the health service with the shortest journey time. It will show the interplay between traffic congestion, accessibility, and health equity and should be used to inform urban and health services monitoring and planning. Available digitised data enable efficient and accurate accessibility measurements for urban areas using publicly available sources and provide disaggregated sociodemographic information and an equity perspective. Test cases are done for urgent and frequent care (i.e., repeated ambulatory care). Situational analyses will be done with cross-sectional urban assessments; estimated potential improvements will be made for one or two new services, and findings will inform recommendations and future studies. This study will use visualisations and descriptive statistics to allow non-specialized stakeholders to understand the effects of accessibility on populations and health equity. This includes “time-to-destination” metrics or the proportion of the people that can reach a service by car within a given travel time threshold from the place of residence. The study is part of the AMORE Collaborative Project, in which a diverse group of stakeholders seeks to address equity for accessibility to essential health services, including health service users and providers, authorities, and community members, including academia.

Addressing accessibility to health services requires intersectoral multi-stakeholder action. There is not a lot of knowledge about the effects of traffic congestion on accessibility. The availability of new data allows putting forward simple metrics that all stakeholders can manage. This proof-of-concept reveals accessibility using a platform with intuitive heatmaps/choropleths, dials, and graphs. It uses filters and shows accessibility according to socio-demographic characteristics. It is dynamic, reflecting the impact of changes in traffic congestion. The platform (AMORE Platform) provides a situational analysis that can be updated as conditions or data changes. The Platform reveals and quantifies inequities of accessibility and allows maximizing accessibility by optimizing the location for new services. The proof-of-concept uses two scenarios (1) urgent care in a tertiary hospital; and (2) frequent care (hemodialysis and radiotherapy). The data generation component will be complemented with a participatory action research assessment with project collaborators involving different stakeholders (e.g., authorities, service providers and users, organized civil society and academia) who will use the platform and could determine its value and potential in service planning, urbanism, and intersectoral and multistakeholder collaboration. The platform can be updated and modified to cover other services within and beyond the health sector. The proof-of-concept is done in Cali, Colombia's third most populous city, with inputs from a broad range of stakeholders.

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