چکیده:
با توجه به رشد بیماریها، سیر صعودی آلودگیها و ناهنجاریهای مرتبط با شهرنشینی، خدمات درمانی از جمله مهمترین خدماتی است که باید متناسب با نیاز و جمعیت شهرها مورد توجه مدیران و برنامهریزان شهری واقع شود. بر این اساس این پژوهش به سنجش نابرابری فضایی در توزیع خدمات درمانی در محلات شهر اصفهان میپردازد. هدف پژوهش، کاربردی و از نظر ماهیت و روش توصیفی- تحلیلی است. از روش کتابخانهای برای گردآوری دادهها و اطلاعات لازم بهره گرفته شد. توابع تحلیل نزدیکترین همسایگی، شاخص موران محلی، موران جهانی و تحلیل لکههای داغ برای تجزیه و تحلیل چگونگی الگوی توزیع فضایی خدمات درمانی ، روش عضویت فازی برای بررسی مطلوبیت شعاع عملکردی این خدمات و شاخص دو متغیره موران در محیط نرمافزاری Geo Da، جهت تحلیل خودهمبستگی فضایی متغیر جمعیت در ارتباط با پراکنش و مساحت خدمات درمانی در سطح محلات شهر اصفهان به کار گرفته شدند. یافتههای پژوهش نشان میدهند الگوی پراکنش خدمات درمانی به صورت خوشهای است. همچنین کمبود شدید خدمات درمانی در محلات پیرامون شهر را نشان میدهد. ارزیابی تاثیرگذاری الگوی توزیع فضایی این خدمات بر میزان مطلوبیت شعاع عملکردی بیانگر مطلوبیت شعاع عملکردی مناطق مرکزی و نامطلوبی مناطق پیرامون شهری میباشد. سنجش ارتباط بین توزیع خدمات درمانی و میزان جمعیت محلات نیز ارتباط بسیار ضعیف این دو متغیر را تایید میکند و عدم توجه به عامل جمعیت و نیاز شهروندان در راستای توزیع خدمات درمانی را نشان میدهد. درنتیجه نابرابری فضایی شدیدی در توزیع خدمات درمانی در سطح مناطق و محلات شهر اصفهان برقرار است.
Introduction: Urban services are a tool in management of urban development and a major factor in the continuity of urban life without which lives of citizens lose activeness and reduction in its efficiency causes reduced welfare of citizens. In fact, following the extension of cities and the growth of urban population, demand to use Urban services also increases. Considering the rising trend of pollution, the growth of diseases and anomalies related to urbanization, medical services is one of the most important services that should be considered in proportion to the needs and population of cities. Accordingly, this study measures spatial inequality in the distribution of medical services in the neighborhoods of Isfahan. Isfahan is one of the cities located in the arid region of Iran and due to many constraints, problems with transportation network, poor urban environment, lack of spaces and cultural sites and so on. Finds more and provides for the creation of inequality and unhealthy competition for access to city-wide amenities. The purpose of this paper is to evaluate the spatial pattern of medical in Isfahan city, to obtain the effect of spatial distribution pattern of medical on utility radius of this land use and to measure the relationship between spatial distribution of medical and the amount of population corresponding to their location. Isfahan is a city. Methodology: This study is applied in terms of purpose and descriptive-analytical in nature and method. To analyze the results, the basic graphical methods used in Arc GIS and Geo Da software are used. The method of data collection was library and after gathering basic statistics and information such as maps related to Isfahan Master Plan studies, location of medical services was determined and extracted. Then, using nearest-neighbor function, local mooring index, global mooring index and hot spots analysis of spatial distribution pattern of medical services were determined and their functional radius desirability was evaluated by fuzzy membership method. Finally, by overlapping the location information of urban services and urban neighborhoods of Isfahan, the medical services available in each specific neighborhood and considering the population of each neighborhood based on the data extracted from the results of the census results of Isfahan urban blocks in 2016, there is a significant relationship between population number variables. Isfahan was characterized by the spatial distribution of these services and the existence of spatial autocorrelation among the mentioned variables.Results and Discussion: Nearest neighbor tool showed that medical services are clustered in Isfahan city. But according to the Moran Global index calculations, medical distributions, with 99% confidence, are distributed random across neighborhoods. By calculating the local Moran for Isfahan's neighborhoods, it was determined that a neighborhood from region 4, a neighborhood from region 5, and a neighborhood from region 10 at the High-Low clustering level had formed a single clumsy formation. These neighborhoods have a large number of health services, but with neighbors with less records, they have not been able to form a cluster. Also, a High-High neighborhood in region 6 has formed an unhealthy formation. This means that the neighborhood and its neighboring neighborhoods have the highest per capita therapeutic use. According to hot spot analysis maps, neighborhoods and central areas, especially areas 3, 8, 10 and 14, form hot spots due to the high establishment of medical services. Moving to the suburbs of the city, the amount of Z-Score is reduced and they move towards the formation of cold spots. This situation is well evident in the northern, western and southern parts of the city, especially in region 7, and shows the severe shortage of medical services in these neighborhoods.Conclusion: The results indicate that the spatial distribution of medical services in the neighborhoods of Isfahan is inappropriate, so that the desirability of access to this use in the central areas is high and citizens in the surrounding neighborhoods and suburbs are denied access. Therefore, in order to eliminate this major space gap, it is necessary to consider programs and policies in order to establish spatial justice in the neighborhoods of Isfahan, and finally social justice will cover the city. For this purpose, in order to achieve justice in the field of distribution of medical facilities and services and to eliminate the gap in health care in Isfahan, it is necessary to pay more attention to less privileged areas around the city and these neighborhoods should be given priority in infrastructure investments. More attention should be paid to the demographic threshold of different urban areas and the optimal provision of health care services according to the population capacity and needs of these areas. There should also be a favorable interaction between the various bodies that lead to unity of procedure in the development of justice, welfare, comfort and public health.