Urban-Rural Disparities in Access to Covid-19 Testing Sites: The Impact of Funding Cuts in the Capital Region of Florida

In this study I analyzed the relationship between access to COVID-19 testing sites and neighborhood characteristics before and after federal funding cuts to determine if socially vulnerable communities were more likely to be affected by testing site closures. This was studied across eight counties in Florida's panhandle: Leon, Wakulla, Taylor, Madison, Jefferson, Gulf, Gadsden, and Franklin. For the purpose of this study, the study area will be referred to as the Capital Region (as it includes Leon County, which hosts the capital of Florida, and all of Leon County's neighboring counties). This project has three objectives: (1) To create a Social Vulnerability Index (SoVI) that summarizes the social determinants of health in the region, (2) To investigate how levels of access to COVID-19 testing sites changed over time as a result of testing site closures, and (3) Lastly, to analyze access before and after federal funding cuts, and the change in access, in relation to social vulnerability factors. The geographic scale for these analyses is at the census tract level. To accomplish these objectives, I (1) generated SoVI to measure social vulnerability, (2) calculated the drive-times from the population-weighted centroids of each census tract to the closest, two closest, and five closest testing facilities to measure access; and calculated the difference in drive times before and after federal funding cuts, and (3) utilized Generalized Additive Models (GAMs) to analyze the relationship between drive times and social vulnerability. From the results, I detected which census tracts had the lowest access to COVID-19 testing sites and which were the most affected by testing site closures. I found that SoVI did not have a statistically significant relationship to access to testing facilities when accounting for spatial autocorrelation, which was counter to expectations. However, I found that there was a consistently significant relationship between rural census tracts and high drive times to COVID-19 testing facilities. Rural status was the only significant indicator of an increase in drive time as well. These findings highlight the need for more comprehensive strategies to address healthcare access disparities in rural areas. This study enriches the argument for the essentiality of public health federal funding and provides important insights on how federal funding cuts for COVID-19 mitigation efforts affect at-risk communities, specifically rural ones. The purpose of this research is to analyze how geographic accessibility changed as a result of closures to state-funded testing sites and to identify which communities are the most affected. These findings have important implications for policy makers and local planners because they can inform decisions related to the allocation of resources for public health services. Additionally, evaluating how changes in funding affect geographic access to testing can help guide future decisions regarding public health funding and resource allocation. The intellectual merit of this research lies in its assessment of urban-rural disparities in access to testing sites and social vulnerability at a finer geographic scale than the extant research. Whereas most COVID-19 studies analyze accessibility and vulnerability at the scale of county-level units (e.g., Tao, et. al, 2020; Kim, et. al, 2021; CDC, n.d.), I measured these variables at the scale of census tracts. The application of SoVI will provide local governments with an evidence-based understanding of relative vulnerability across census tracts in the Capital Region and their capacities to prepare for, respond to, and recover from COVID-19. Because there is no standard for the number of testing facilities to consider in the drive-time analysis, I compared the findings from the closest, two closest, and five closest testing facilities and analyzed how the results changed. Furthermore, there are very few studies that examine the relationship between access to testing sites and social vulnerability. One relevant study conducted by Mullachery and colleagues (2022) analyzed vulnerability and access in 30 US cities, but none were in Florida or in rural communities. My project contributes empirical findings on unstudied regions impacted by COVID-19. The broader impacts of my project are to demonstrate how critical COVID-19 federal funding is for disadvantaged communities. The findings of this study may help policymakers and healthcare providers better understand the needs of rural communities and develop targeted interventions to improve access to testing. The lack of a statistically significant relationship between access to COVID testing sites and SoVI suggests that other factors, such as rurality, may be more important in determining access to healthcare services, particularly for North Florida.

Grantor dc:publisher

Florida State University

Year dc:date

2023

Contributors dc:contributor

• Steele, Quinn (author)
• Mukherjee, Tathagata (professor co-directing thesis)
• Wong, Sandy (professor co-directing thesis)
• Uejio, Christopher K. (professor co-directing thesis)
• Horner, Mark W. (committee member)
• Florida State University (degree granting institution)
• College of Social Sciences and Public Policy (degree granting college)
• Department of Geography (degree granting department)

• Geography

Language dc:language

English

Identifier

fsu:928075
iid: Steele_fsu_0071N_18051

OAI identifier oai:identifier

oai:diginole.lib.fsu.edu:fsu_928075