COVID-19 pandemic and access to healthcare in Brazil's largest cities

The Institute for Applied Economic Research (Ipea) published yesterday our study looking at 'Urban mobility and access to the healthcare system by patients with suspected and severe cases of COVID-19 in the 20 largest cities of Brazil'. The work is published in Portuguese but there is a Twitter thread with the main findings. In any case, I included a summary of the publication in English below.

obs. This is a by-product of the Access to Opportunities Project. I'm grateful for an amazing team of co-authors who helped me put this piece together in such a short time.

Summary:

The Covid-19 epidemic crisis is causing a rapid growth in the number of hospitalizations for severe acute respiratory syndrome (SARS) in Brazil. According to recent studies, this could soon overload the country's public health system (SUS). As of this writing, most of the confirmed cases of Covid-19 are concentrated in the country's largest cities, where the spread of the disease is at a rapid pace and affecting a growing number of people in disadvantaged communities.

In this policy report, we analyze accessibility to healthcare services in Brazil's 20 largest cities. The research focuses on how easily patients with suspected and severe cases of COVID-19 could reach public health facilities. The study has two purposes:

1. In the first half of the report we estimate how many vulnerable people (low-income above 50 years old) live in areas with poor access to healthcare facilities that could either screen suspected cases of Covid-19 or provide hospitalization of severe cases with the support of ICU beds and mechanical ventilators.
2. In the second half, we estimate the ratio between the number of ICU beds and mechanical ventilators available at each hospital and the population living withing its catchment area.

These two analyses combined provide actionable information to local authorities. The study puts disadvantaged communities with poor access to health services on the map, indicating in which neighborhoods local authorities could build makeshift hospitals or develop strategies via pre-hospital care with mobile units or through the work of health community agents. This research also helps local authorities identify which hospitals could more likely struggle with the rising demand for hospitalizations, and hence would need investments to expand capacity.

Six open positions in the Access to Opportunities Project

We are hiring six research assistants to work with me on the Access to Opportunities Project, at the Institute for Applied Economic Research (Ipea). Applications will be open until the 12th of March 2020. More details can be found here (info in Portuguese only).



We are looking for driven candidates with good data analysis skills in R and interested in evaluating policy impacts on issues of transport accessibility and urban inequalities.

Please, help spread us the word!

Why cities should focus on promoting accessibility, not mobility

Amit Bhatt (WRI) has written a very eloquent piece on why cities should focus on promoting accessibility, not mobility. Good read.

First results of Access to Opportunities Project are now online

Last week, we officialy launched the Access to Opportunities Project. In this first edition of the project (2019) we present accessibility estimates by active transport modes (walking and cycling) for the 20 largest cities in the Brazil, and by public transport for 7 major cities (São Paulo, Rio de Janeiro, Belo Horizonte, Recife, Fortaleza, Porto Alegre e Curitiba).

At the occasion of the event, we launched the website of the project where one can find:

1. a published report analyzing inequalities in access to opportunities in Brazil's largest cities (report only available in Portuguese)
2. an interactive map to explore the results
3. the data outputs of the project
4. the computational code used to process, analyze and visualize the data

Here is a quick demo of the interactive map but please go ahead and try it for yourself. The app scales fairly well despite the massive amount of data, thanks to Kauê Braga's work using in R to create a mapdeck application in shiny.

New paper out: Distributional effects of transport policies on inequalities in access to opportunities

Glad to share our paper on "Distributional effects of transport policies on inequalities in access to opportunities in Rio de Janeiro" is now out the Journal of Transport and Land Use. I summarize the paper findings and contributions in this short thread here, but please feel free to read the full paper. The journal is open access!

Pereira, R. H. M., Banister, D., Schwanen, T., & Wessel, N. (2019). Distributional effects of transport policies on inequalities in access to opportunities in Rio de Janeiro. Journal of Transport and Land Use, 12(1). doi:10.5198/jtlu.2019.1523

Abstract:

The evaluation of social impacts of transport policies has been attracting growing attention in recent years. Yet studies thus far have predominately focused on developed countries and overlooked whether equity assessment of transport projects is sensitive to the modifiable areal unit problem (MAUP). This paper investigates how investments in public transport can reshape socio-spatial inequalities in access to opportunities, and it examines how MAUP can influence the distributional effects of transport project evaluations. The study looks at Rio de Janeiro (Brazil) and the transformations carried out in the city in preparation for the 2014 World Cup and the 2016 Olympics, which involved substantial expansion in public transport infrastructure followed by cuts in service levels. The paper uses before-and-after comparison of Rio's transport network (2014-2017) and quasi-counterfactual analysis to examine how those policies affect access to schools and jobs for different income groups and whether the results are robust when the data is analyzed at different spatial scales and zoning schemes. Results show that subsequent cuts in service levels have offset the accessibility benefits of transport investments in a way that particularly penalizes the poor, and that those investments alone would still have generated larger accessibility gains for higher-income groups. These findings suggest that, contrary to Brazil’s official discourse of transport legacy, recent policies in Rio have exacerbated rather than reduced socio-spatial inequalities in access to opportunities. The study also shows that MAUP can influence the equity assessment of transport projects, suggesting that this issue should be addressed in future research.

City walkability and upward social mobility

Here is a recent paper with some interesting findings suggesting that more walkable cities can facilitate upward social mobility (Thanks Pedro Nery for the pointer). The results are rather consistent with the studies by Raj Chetty and colleagues at Opportunity Insights, but it extends previous research by exploring how walkability can have positive effects on social mobility via both accessibility and psychological channels.

Oishi, S., Koo, M., & Buttrick, N. R. (2018). The Socioecological Psychology of Upward Social Mobility. American Psychologist. http://dx.doi.org/10.1037/amp0000422

Abstract

Intergenerational upward economic mobility—the opportunity for children from poorer households to pull themselves up the economic ladder in adulthood—is a hallmark of a just society. In the United States, there are large regional differences in upward social mobility. The present research examined why it is easier to get ahead in some cities and harder in others. We identified the “walkability” of a city, how easy it is to get things done without a car, as a key factor in determining the upward social mobility of its residents. We 1st identified the relationship between walkability and upward mobility using tax data from approximately 10 million Americans born between 1980 and 1982. We found that this relationship is linked to both economic and psychological factors. Using data from the American Community Survey from over 3.66 million Americans, we showed that residents of walkable cities are less reliant on car ownership for employment and wages, significantly reducing 1 barrier to upward mobility. Additionally, in 2 studies, including 1 preregistered study (1,827 Americans; 1,466 Koreans), we found that people living in more walkable neighborhoods felt a greater sense of belonging to their communities, which is associated with actual changes in individual social class.

obs. image credit: Virginia Suburbs, by La Citta Vita

The Access to Opportunities Project, live webinar with preliminary results

This week, on Sept 18 at 7pm (GMT), we will be broadcasting a live webinar to present some of the preliminary results of the Access to Opportunities Project. The webinar will be broadcast in Portuguese on this link and we will also be answering questions about the project.

Here is a quick summary about the project:

How many jobs can one access in less than an hour using public transport? How long does it take to get to your nearest healthcare facility or school? The answers to these questions are a direct result of the urban and transport policies implemented in our cities. These policies largely determine the ease with which people from different social groups and income levels can access employment opportunities, health and education services. These policies play a key role in building more just and inclusive cities and reducing inequalities in access to opportunities. Although the issue of transport accessibility has been widely studied in cities in the Global North, this topic has received much less attention in the global South and particularly in Brazil.

My team and I at the Institute for Applied Economic Research (Ipea) are launching the Access to Opportunities Project to map and analyze urban accessibility in Brazilian cities. The purpose of the project is to estimate accessibility to job opportunities, schools and health services by public transport, walking, cycling and driving at high spatial resolution for all of the largest urban areas in the country. This year, the project will include public transport accessibility estimates for 6 major cities (São Paulo, Rio de Janeiro, Belo Horizonte, Fortaleza, Porto Alegre and Curitiba), as well as walking and cycling accessibility estimates for the 20 largest cities in Brazil. We are planning to expand the project soon to include other urban areas.

The Access to Opportunities Project is carried out in collaboration with the Institute for Transportation and Development Policy (ITDP - Brazil), and it will bring annual updates on the accessibility landscape of Brazilian cities. One of the expected results of the project is to generate a wealth of data that will be made publicly available to policy makers and researchers, with whom we will be able to collaborate to analzye particular case studies and conduct international comparative research.

My interview for the Caos Planejado podcast

Today is the 5th anniversary of Caos Planejado, a great Brazilian blog focused on urban planning, economics and innovation. Long live! Anthony Ling (the head of Caos Planejado) interviewed me for their podcast a few months ago, when we talked about my PhD research, my ongoing work on the Access to Opportunities Project and other topics related to innovation, data and equity in urban mobility. The interview was recorded in Portuguese and you can listen to it here.

A spatial database of health facilities in sub Saharan Africa

Interesting new paper analyzing accessibility to emergency hospital care in sub-Saharan Africa in 2015. The authors have done a laborious work to map public health facilities and the data is openly available here. HT Moritz Kraemer.

Ouma, P. O., et al. (2018). Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. The Lancet Global Health, 6(3), e342-e350.

Abstract:

Background

Timely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complete a geocoded inventory of hospital services in Africa in relation to how populations might access these services in 2015, with focus on women of child bearing age.

Methods

We assembled a geocoded inventory of public hospitals across 48 countries and islands of sub-Saharan Africa, including Zanzibar, using data from various sources. We only included public hospitals with emergency services that were managed by governments at national or local levels and faith-based or non-governmental organisations. For hospital listings without geographical coordinates, we geocoded each facility using Microsoft Encarta (version 2009), Google Earth (version 7.3), Geonames, Fallingrain, OpenStreetMap, and other national digital gazetteers. We obtained estimates for total population and women of child bearing age (15–49 years) at a 1 km2 spatial resolution from the WorldPop database for 2015. Additionally, we assembled road network data from Google Map Maker Project and OpenStreetMap using ArcMap (version 10.5). We then combined the road network and the population locations to form a travel impedance surface. Subsequently, we formulated a cost distance algorithm based on the location of public hospitals and the travel impedance surface in AccessMod (version 5) to compute the proportion of populations living within a combined walking and motorised travel time of 2 h to emergency hospital services.

Findings

We consulted 100 databases from 48 sub-Saharan countries and islands, including Zanzibar, and identified 4908 public hospitals. 2701 hospitals had either full or partial information about their geographical coordinates. We estimated that 287 282 013 (29·0%) people and 64 495 526 (28·2%) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital.

Interpretation

Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa.

The winners and losers of the transport legacy of megaevents

Summarizing the core elements of one's research to communicate with a wide audience is among the most challenging and yet important aspects of what researchers do. Here's my best attempt so far to summarize my PhD research to a broad audience, published in my favorite online newspaper Nexo. The text is in Portuguese.

image credit: Nexo

My presentation at the 2019 ITF Summit

shameless self-promotion post  again 

Last week I was attending the 2019 International Transport Forum Summit, where I presented a paper on estimating the future accessibility impacts of transport project scenarios. The study also discusses the equity implications of travel-time threshold choice in cumulative opportunity metrics. Such a sexy topic, ah.

My presentation was recorded and you can watch it here (in case you really need to procrastinate on the work you should be doing now).

Biographical note: ITF/OECD award

Hi all. I am so glad to share that I have been honored with the 2019 Young Researcher of the Year Award, by the International Transport Forum (ITF/OECD). As I've said many times, this award speaks volumes about the generous guidance and support I have received from supervisors and colleagues at both Oxford and Ipea to conduct my research. Special thanks to my incredibly  demanding  supportive supervisors Tim Schwanen and David Banister. Thanks!

This is the award-winning paper, where I investigate the future impacts that different scenarios of a major BRT in Rio de Janeiro could have on access to employment opportunities for different income groups. The study also shows that the the equity assessment of transport projects based on accessibility estimates using cumulative opportunity measures with a single time threshold (the most common practice adopted by academic studies and transport agencies) can lead to misleading or partial conclusions. The preprint of the study is available for download here (it includes a spatial regression analysis that didn't make it into the paper because or reviewer #2).

Thanks to the award, I'll be attending the 2019 International Transport Forum Summit in Leipzig next week. The team at ITF will be Twitting about the Summit. I'll be presenting the paper on May 23rd at  5:15pm (local time). Apparently, it will be webcasted on Facebook Live.

Biographical note: AAG PhD thesis award

I am very pleased to share that my PhD thesis was awarded the best 2019 thesis award by the Transportation Geography Specialty Group of the American Association of Geographers (AAG). I am also very honoured that I was nominated a board member of the specialty group. If it could be of interest, my thesis is available for download here and I've created a GitHub repository with the R code used in the data wrangling, mapping and analysis in the thesis. Some of the chapters in the dissertation have been published as papers here, here and here (+ this other one currently under review).

I am very grateful for the the support from my partner Fabiana, from the Institute for Applied Economic Research (Ipea) and to the invaluable guidance from my  demanding  tireless supervisors Tim Schwanen and David Banister. 

ps. the blog has been less active than usual in the past weeks because I was away attending the AAG annual meeting to receive the award and to present this paper here.

Travel time to closest healthcare facility in Rio de Janeiro

The map shows how long it takes (in minutes) to travel by public transport and walking to the closest healthcare facility across the city of Rio de Janeiro. The analysis is disaggregated for facilities providing low-, medium- and high-complexity services. 

The first thing to note here is that physical accessibility to public health is relatively high in Rio. Approximately 94% of Rio`s population could reach at least one facility providing low-complexity services under 30 minutes. Under the same time, medium- and high-complexity services could be reached by 81% and 72% of the population, respectively. This is explained to some extent by the spatial planning of healthcare in the region, which has been relatively successful in spreading low- and medium-complexity facilities across the city. The map also gives a good sense of how the distribution of healthcare facilities vis-à-vis the public transport network varies across space, and how access to public health tend to be much lower in the west and particularly in the urban fringes of the city.

ps. This is a map I created for my PhD research but I didn't include it in the thesis in the end . To create this map I used a 2015 dataset of healthcare facilities and the GTFS of Rio's public transport network from March 2017. The dataviz and data wrangling were done in R. In case you're interested in doing similar analyses, I've created a simple tutorial with reproducible example on how to use OpenTripPlanner (OTP) to estimate travel times.

[click on the image to enlarge it]

New paper out: Future accessibility impacts of transport policy scenarios: equity and sensitivity to travel time thresholds

I'm glad to share that the 3rd paper of my thesis is now published. The study (1) illustrates how one can measure the future accessibility impacts of transport project scenarios; (2) discusses how accessibility analyses can be influenced by the little-known issue of the modifiable temporal unit problem (MTUP); and (3) shows that equity assessments of transport policies based on cumulative opportunity metrics depend on the time threshold chosen for accessibility analysis. One thing in particular I like about this paper is that its findings demonstrate that the most common practice adopted by academic studies and transport agencies when evaluating the accessibility impacts of transportation projects can lead to misleading or partial conclusions if this methodological choice is made uncritically.

The paper will remain open access for the next 40 days or so. Downloaded it here [ungated preprint]. The R scripts used to write this paper and my PhD thesis are available in this GitHub repo.

Pereira, R. H. M. (2019). Future accessibility impacts of transport policy scenarios: equity and sensitivity to travel time thresholds for Bus Rapid Transit expansion in Rio de Janeiro. Journal of Transport Geography, 74, 321-332.

Abstract: 

The accessibility impacts of transport projects ex-post implementation are generally evaluated using cumulative opportunity measures based on a single travel time threshold. Fewer studies have explored how accessibility appraisal of transport plans can be used to evaluate policy scenarios and their impacts for different social groups or examined whether the results of project appraisals are sensitive to the time threshold of choice. This paper analyzes how different scenarios of full and partial implementation of the TransBrasil BRT project in Rio de Janeiro (Brazil) will likely impact the number of jobs accessible to the population of different income levels. The analysis is conducted under various travel time thresholds of 30, 60, 90 and 120 min to test whether the results are sensitive to the boundary effect of the modifiable temporal unit problem (MTUP). Compared to a partial operation scenario, the full implementation of TransBrasil that extends this corridor into the city center would lead to higher accessibility gains due to network effects of connecting this BRT to other transport modes. Nonetheless, the size of the accessibility impacts of the proposed BRT as well as its distribution across income classes would significantly change depending on the time threshold chosen for the accessibility analysis. Considering cut-off times of 30 or 60 min, both scenarios of TransBrasil would lead to higher accessibility impacts in general and particularly for low-income groups, moving Rio towards a more equitable transportation system. However, under longer thresholds of 90 and 120 min, an evaluation of this project would find much smaller accessibility gains more evenly distributed by income levels. The paper highlights how time threshold choice in cumulative opportunity measures can have important but overlooked implications for policy evaluation and it calls for further research on the MTUP in future transport and mobility studies.

Call for a research assistant in the Access to Opportunities Project at Ipea, Brazil

This is just a reminder that I am hiring a research assistant for the Access to Opportunities Project, at the Institute for Applied Economic Research (Ipea). The researcher will be based in Brasilia (Brazil). We are looking for someone with advanced skills in R. Applications will be open until the 20th of January 2019. More details can be found here (info in Portuguese only). Please, help spread us the word.

More info about the Access to Opportunities Project: The aim of the project is to estimate accessibility to employment opportunities as well as education and health services in the largest urban areas in Brazil. The project focuses on how social and spatial inequalities in access to opportunities relate to urban transportation, housing and land use policies. We are estimating accessibility by public transport, walking and cycling at a high spatial resolution for all of the Brazilian major cities. The project will generate a massive amount of data each year. My plan is to make the data outputs and results publicly available to policy makers and researchers, with whom we will be able to collaborate in the future to analzye particular case studies in Brazil but also to conduct comparative studies involving cities in Brazil and other countries.

Open position for a research assistant in the Access to Opportunities Project at Ipea, Brazil

This post will probably be of interest to only a small share of readers living in Brazil.

We have an open position for a research assistant to work with me in the Access to Opportunities Project at the Institute for Applied Economic Research (Ipea). The aim of the project is to estimate accessibility to employment opportunities as well as education and health services in the largest urban areas in Brazil. The project focuses on how social and spatial inequalities in access to opportunities relate to urban transportation, housing and land use policies. We are estimating accessibility by public transport, walking and cycling at a high spatial resolution for all of the Brazilian major cities, what will generate a massive amount of data each year. My plan is to make the data outputs and results publicly available to policy makers and researchers, with whom we will be able to collaborate in the future to analzye particular case studies in Brazil but also to conduct comparative studies involving cities in Brazil and other countries.

The research assistant will be based in Brasilia (Brazil) and we are looking for someone with advanced skills in R. Applications will be open until the 20th of January 2019. More details can be found here (info in Portuguese only). Please, help spread us the word.

PhD thesis officially deposited and available for download

PhD thesis officially deposited! You can download the thesis here and check the R code I used in the data wrangling, mapping and analysis in this GitHub repo.*

ps. Special thanks to my friend Christine Moore for making the deposit.

* If you find any mistakes, let me know and I'll try to find someone to blame for.

Future access to essential services in a growing smart city

Warning of  shameless  self-promotion:

I'm glad to share that some colleagues at UBC (Jerome, Martino and Nuttall) and I have a new paper published. In this paper we analyze how projected population change could affect future accessibility demand to education and healthcare services and transportation equity, looking at the case of Surrey in Canada. One thing in particular I like about this paper is that it looks at how transport accessibility is affected by changes in population growth and spatial distribution while most studies in the literature have traditionally looked at how accessibility levels change due to modifications in the transport network or in the spatial allocation of schools, healthcare facilities etc. The paper will remain open access for the next 50 days. Download it here or send me an email and I'll be glad to share it to you. 

Mayaud, J. R., Tran, M., Pereira, R. H. M., & Nuttall, R. (2018). Future access to essential services in a growing smart city: The case of Surrey, British Columbia. Computers, Environment and Urban Systems. doi:10.1016/j.compenvurbsys.2018.07.005

Abstract:

The concept of accessibility – the ease with which people can reach places or opportunities –lies at the heart of what makes cities livable, workable and sustainable. As urban populations shift over time, predicting the changes to accessibility demand for certain services becomes crucial for responsible and ‘smart’ urban planning and infrastructure investment. In this study, we investigate how projected population change could affect accessibility to essential services in the City of Surrey, one of the fastest growing cities in Canada. Our objectives are two-fold: first, to quantify the additional pressure that Surrey's growing population will have on existing facilities; second, to investigate how changes in the spatial distribution of different age and income groups will impact accessibility equity across the city. We evaluated accessibility levels to healthcare facilities and schools across Surrey's multimodal transport network using origin-destination matrices, and combined this information with high-resolution longitudinal census data. Paying close attention to two vulnerable population groups – children and youth (0–19 years of age) and seniors (65+ years of age) – we analyzed shifts in accessibility demand from 2016 to 2022. The results show that population growth both within and outside the catchments of existing facilities will have varying implications for future accessibility demand in different areas of the city. By 2022, the city's hospitals and walk-in clinics will be accessible to ~9000 and ~124,000 more people (respectively) within a predefined threshold of 30 min by public transport. Schools will also face increased demand, as ~8000 additional children/youth in 2022 will move to areas with access to at least half of the city's schools. Conversely, over 27,000 more people – almost half of them seniors – will not be able to access a hospital in under 30 min by 2022. Since low-income and senior residents moving into poorly connected areas tend to be more reliant on public transport, accessibility equity may decline in some rural communities. Our study highlights how open-source data and code can be leveraged to conduct in-depth analysis of accessibility demand across a city, which is key for ensuring inclusive and ‘smart’ urban investment strategies.

New paper out: Transport legacy of mega-events and the redistribution of accessibility to urban destinations

I'm glad to share that the 2nd paper of my thesis is now published. It will remain open access for the next 50 days. Downloaded it here.

This is the 1st empirical paper of my doctoral research. Two other empirical papers are currently under review, but you can read their preprints here and here. My theoretical paper is available here, in case you are looking to have some fun over the weekend.

Pereira, R. H. M. (2018). Transport legacy of mega-events and the redistribution of accessibility to urban destinations. Cities, 81, 45–60. doi:10.1016/j.cities.2018.03.013

Abstract:

Local governments increasingly justify the hosting of mega-events because of their legacy value, assuming that all local residents benefit from those events. Yet, little attention has been paid to the distributive question of who benefits from the transport legacy left by those events. This paper reflects on the delimitation of transport legacies and its social impacts in terms of how such developments can reshape urban accessibility to opportunities. It analyses the transformation in the transport system of Rio de Janeiro (Brazil) in preparation for the 2014 World Cup and the 2016 Olympic Games. That transformation involved substantial expansion in public transport infrastructure, followed by cuts in service levels and a reorganization of many bus lines to streamline the transport system. The paper examines whether those recent changes have increased the number of people from different income levels who could access Olympic sports venues and healthcare facilities by public transport within 15, 30, 60 and 90 min. The analysis uses a before-and-after comparison of Rio's transport network (2014–2017) and a quasi-counterfactual scenario to separate the effects of newly added infrastructure from the reorganization and cuts of transport services. The results show that the infrastructure expansion alone would have increased the number of people who could access the Olympic sports venues, but it would have only marginally improved people's access to healthcare facilities. Nonetheless, the findings indicate that the streamlined bus system have offset the benefits of infrastructure investments in a way that particularly penalizes the poor. The analysis of both the implemented changes to the public transport network and the counterfactual scenario show that the accessibility benefits from the recent cycle of investments and disinvestments in Rio generally accrued to middle- and higher-income groups, reinforcing existing patterns of urban inequality.