The cost of driving in the city sick: data models aim to solve this problem

Ciro Jaramillo Molina, researcher, professor at the School of Civil and Geomatic Engineering and co-director of the doctoral thesis that resulted in the AMORE Project. Credit: Édgar Bejarano, Communications Office, Faculty of Engineering.

 

The location of health care providers in Cali brings with it an additional difficulty for patients, especially those with chronic diseases who require frequent outpatient services, as in the case of hemodialysis, and are forced to make long and costly trips to seek such services. This has implications for both the quality of life and finances of patients and their families. In a segregated city like Cali, the concentration of services away from the most populated areas amplifies health and social justice inequalities. More so in neighborhoods with poor accessibility. This was documented in the Comuna 18 by the Laboratorio de Barrios Populares - Populab in 2023, and resolving it requires concerted action by the municipal government. A joint work with national and international researchers, whose results were published in the journal "The Lancet Regional Health - Americas", shows how inequity in terms of accessibility in this area is amplified by traffic congestion, in addition to the need to rethink the relationship between the location of such service providers and the places where they are most needed.

Lea este artículo en español aquí.

The view of experts from around the world 

In 2020, physician and researcher Luis Gabriel Cuervo, doctoral candidate at the Autonomous University of Barcelona and corresponding member of the National Academy of Medicine of Colombia, decided to use his national and international contacts and networks, product of his extensive experience in scientific research for health, to put them at the service of a clear purpose: pointing to solutions that highlight the inequities which traffic congestion amplifies, aiming at solutions that put services within reach of users, especially in the global South.  

Thus was born the AMORE project (Analysis with Macrodata to Orient Equity Results), an initiative of his doctoral research in Biomedical Research Methodology and Public Health, under the direction of professor and researcher of the School of Civil Engineering and Geomatics of the Universidad del Valle, Ciro Jaramillo Molina, with the co-direction of professor and researcher Eliana Martínez-Herrera, of the School of Public Health of the Universidad de Antioquia. The project involved researchers and academics from Spain, the United States, Peru, Canada and Colombia. Cali became the place where the study was carried out, due to the availability of open data and the proximity Luis Gabriel Cuervo felt to the place, as he studied there for his specialization in Family Medicine and his certification in the Advanced Program in Health Administration. 

The project was based on the co-creation with information users and beneficiaries of a platform for data visualization. It had a precedent from 2020, when another collaborative project was a finalist in the Data Science for All (DS4A) call of the Ministry of Information Technology and Communications (MinTic), together with IQuartil SAS, a data analytics company. The result convinced Luis Gabriel Cuervo that his doctoral thesis could be developed along the same lines, focusing on three essential health services: highly complex emergency services (level 3 hospitals), hemodialysis and radiotherapy. 

The project involved the actors related to the problem, from patients to people in charge of formulating and implementing public policies, as well as academics, researchers, users and service providers. "This global vision is very interesting, because in the published article there are many people, from very different sectors and very different perspectives, and a collective construction was achieved to be able to assess a problem which apparently would only be of the health sector," says Professor Ciro Jaramillo Molina. 

Databases and their application to the DSTAM model 

The research took advantage of open data from the 2018 national census and measured travel times for two weeks, in the months of July and November 2020, when Colombia was experiencing the consequences of the pandemic produced by COVID-19 and the corresponding confinement. The AMORE project considered new ways of approaching the information. Instead of using the geographical unit of analysis directly related to the city's neighborhoods, it used Traffic Analysis Zones (TAZ), a data engineering concept, in order to work with much more accurate figures, since the number of TAZ is much greater than the number of neighborhoods in the territory.  

Another of the particularities with which this study was approached was to relocate the geographic centroid of the spatial unit (the point where the area to be analyzed is concentrated), so that it would not only correspond to the geographic location, but would also reflect the site where the highest density of inhabitants was concentrated.  

After this, the model worked with measures of accessibility and cumulative opportunity contours, based on isochrons (lines on a map describing the areas and time equality of a specific trip within a territory).  

Population and service data were cross-referenced with travel time data obtained from Google's "Distant Matrix" API supported by IQuartil. This allowed leveraging macro data (Big Data) to simulate travel times, dynamically arranged in nine levels of traffic congestion, from free flow to peak congestion. The simulation was intended to measure travel times from the TAZs of residence to those of hemodialysis services, at any time of the day, under an ideal basis of up to 20 minutes of travel. This type of information analysis, technically known as "dynamic spatiotemporal accessibility measurements" (DSTAM), allowed the research team a level of dynamism such that it was possible to evaluate any time of the day - not only during peak hours - opening the possibility to consider a diversity of scenarios on issues related to travel speeds, congestion levels, coverage and equity levels when accessing hemodialysis services in Cali. Thus, it was revealed that for most of the population, trips are prolonged when there is traffic, and that congestion affects populations differentially according to their sociodemographic characteristics. For example, congestion reduces much more the accessibility of residents in low-income housing (1 and 2).

Accessibility to hemodialysis as measured July 6-12, 2020. Source: Cuervo et al. Lancet Regional Health Americas. 2024.

Another novelty is that the study targeted the sectors of the city where the installation of new hemodialysis services would optimize accessibility, measuring the impact they would have on the community. The locations revealed by the analysis were relatively consistent. In the July measurement, the ideal site was the "Alirio Mora Beltrán" neighborhood, in the Aguablanca District, and "Parcelaciones del Pance", in the extreme south of the city; when the measurements were repeated in November, with less congestion, the optimal sites migrated slightly towards "Marroquín III", in the Aguablanca District, and "San Joaquín", in the south of Cali. The optimal sectors were relatively stable. The study indicated that installing hemodialysis services that can be used by residents of these sectors would significantly increase accessibility, allowing many more users to reach a hemodialysis service by car, in a trip of less than 20 minutes, and greatly reducing inequities.

Location sugested to optimize accessibility to hemodialysis. Source: Cuervo et al. Lancet Regional Health Americas. 2024.

A praxis close to the community 

The research process, despite being carried out in times of pandemic, sought to be close to the community. As an example of such closeness, and of the awareness of the complexities that hemodialysis treatments imply for renal failure patients, there was a member of the team who had experienced first-hand the difficulties derived from this procedure, the lawyer and legal advisor Felipe Piquero, which allowed them to understand the complexity of the problem. This commitment to a praxis close to the community meant that, during the research, bridges of communication were built with other members of civil society, such as multinational companies in charge of supplying medicines and services, patient networks, members of the Health and Planning Secretaries of Cali, and epidemiologists and health specialists, in order to receive comments from them that would allow them to improve the way the research was carried out. 

This collaborative and community-based work is evidenced in the way the research article was written, as there is a greater emphasis on the implications of the study for society, and not so much on the equations and technical aspects, which helps anyone, even without formal education in the subject, to understand it. "He told me that no one understood the formulas. Technicians understood them, but if what we wanted to do was to impact a decisive actor, it was not going to work. For him, the important thing is what is shown and how it will be shown, what impact it can have on the ruling and decision-making classes", says Professor Ciro Jaramillo Molina about the decision taken by Luis Gabriel Cuervo, as leader of the AMORE project. 

Uses derived from the DSTAM model and the potential impact on public policy 

According to the perspective of professor and researcher Ciro Jaramillo Molina, although this model was used to address problems related to public health, it has the advantage of being used in areas such as education, employment, sports and recreation, and emergency response, among others, given the importance for these areas of analyzing spatial accessibility and its impact on the equity of cities.  

"This type of work, which is now booming worldwide, allows the city to be in tune with what is really being sought, which is to measure equity, if this type of studies and strategies are adopted," he says, adding that the publication of such studies, which highlight the inequities in the provision of hemodialysis services for the population of Cali, could lead the administration to consider "the possibility of building a new hospital, or upgrading one that is very close, providing such services. These are policies that one thinks would be interesting, not only with new equipment, but with the improvement of services, because there are facilities that already exist, but the service is not provided. Accessibility allows us to measure that." 

The study leaves a note of optimism by demonstrating that, with determined action by local government and service providers, it is possible to transform the accessibility of hemodialysis services by locating services that are open to the needy population, especially in the eastern part of the city of Cali. This would greatly improve accessibility and social justice.

If interested in being in touch with the researchers or any further information about the AMORE project, please write the Faculty of Engineering Communications Office: comunicaingenieria@correounivalle.edu.co