Connecting the Dots Between Health, Poverty and Place in Accra, Ghana

Abstract

West Africa has a rapidly growing population, an increasing fraction of which lives in urban informal settlements characterized by inadequate infrastructure and relatively high health risks. Little is known, however, about the spatial or health characteristics of cities in this region or about the spatial inequalities in health within them. In this article we show how we have been creating a data-rich field laboratory in Accra, Ghana, to connect the dots between health, poverty, and place in a large city in West Africa. Our overarching goal is to test the hypothesis that satellite imagery, in combination with census and limited survey data, such as that found in demographic and health surveys (DHSs), can provide clues to the spatial distribution of health inequalities in cities where fewer data exist than those we have collected for Accra. To this end, we have created the first digital boundary file of the city, obtained high spatial resolution satellite imagery for two dates, collected data from a longitudinal panel of 3,200 women spatially distributed throughout Accra, and obtained microlevel data from the census. We have also acquired water, sewerage, and elevation layers and then coupled all of these data with extensive field research on the neighborhood structure of Accra. We show that the proportional abundance of vegetation in a neighborhood serves as a key indicator of local levels of health and well-being and that local perceptions of health risk are not always consistent with objective measures.

África Occidental cuenta con una población en rápido crecimiento, una creciente fracción de la cual vive en asentamientos urbanos informales caracterizados por su infraestructura inadecuada y riesgos contra la salud relativamente altos. Sin embargo, muy poco se sabe de las características espaciales o sanitarias de las ciudades de esta región, ni de las desigualdades espaciales en salud existentes en las mismas. En este artículo mostramos lo que estamos haciendo en Accra, Ghana, buscando crear un laboratorio de campo bien surtido de datos, para tratar de unir los puntos entre salud, pobreza y lugar en una ciudad grande del África Occidental. Nuestro principal objetivo es poner a prueba la hipótesis de que las imágenes satelitales, combinadas con datos censales y los limitados datos de campo, como los que se encuentran en los estudios demográficos y de salubridad (DHSs), pueden generar indicios sobre la distribución espacial de desigualdades de la salud en ciudades donde existen menos datos de los que nosotros logramos conseguir para Accra. Con tal propósito, creamos el primer archivo de límites digitales de la ciudad, obtuvimos un conjunto de imágenes satelitales de alta resolución espacial de dos fechas de observación, recogimos datos entre un panel longitudinal de 3.200 mujeres distribuidas espacialmente a través de Accra, y obtuvimos datos del censo a nivel micro. Obtuvimos también datos sobre agua, alcantarillado y elevaciones, para luego cotejar toda esta información con un amplio estudio de campo sobre la estructura barrial de Accra. Mostramos que la abundancia proporcional de vegetación en un vecindario sirve de indicador clave de los niveles locales de salud y bienestar y que las percepciones locales sobre riesgos de la salud no son siempre consistentes con las mediciones objetivas.

Key Words:

• Africa
• Ghana
• health
• neighborhood
• remote sensing.

关键词:

• 非洲
• 加纳
• 健康
• 邻里
• 遥感

Palabras clave:

• África
• Ghana
• salud
• vecindario
• percepción remota

Acknowledgments

This research was funded in part by grant number R01 HD054906 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (“Health, Poverty and Place in Accra, Ghana,” John R. Weeks, Project Director/Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health. Additional funding was provided by Hewlett/PRB (“Reproductive and Overall Health Outcomes and Their Economic Consequences for Households in Accra, Ghana,” Allan G. Hill, Project Director/Principal Investigator). The 2003 Women's Health Study of Accra was funded by the World Health Organization, the U.S. Agency for International Development, and the Fulbright New Century Scholars Award (Allan G. Hill, Principal Investigator). The generous support received during all phases of this study from the Institute for Statistical, Social and Economic Research (Director Ernest Aryeetey); the School of Public Health (Richard Adanu); and the Medical School (Rudolph Darko and Richard Biritwum), University of Ghana, is gratefully acknowledged. Thanks to Deanna Weeks for expert manuscript editing.