RESUMO
This Health Impact Assessment (HIA) informed the decision of expanding public transportation services to rural, low income communities of southern Doña Ana County, New Mexico on the U.S./Mexico border. The HIA focused on impacts of access to health care services, education, and economic development opportunities. Qualitative and quantitative data were collected from surveys of community members, key informant interviews, a focus group with community health workers, and passenger surveys during an initial introduction of the transit system. Results from the survey showed that a high percentage of respondents would use the bus system to access the following: (1) 84% for health services; (2) 83% for formal and informal education opportunities; and (3) 81% for economic opportunities. Results from interviews and the focus group supported the benefits of access to services but many were concerned with the high costs of providing bus service in a rural area. We conclude that implementing the bus system would have major impacts on resident's health through improved access to: (1) health services, and fresh foods, especially for older adults; (2) education opportunities, such as community colleges, universities, and adult learning, especially for young adults; and (3) economic opportunities, especially jobs, job training, and consumer goods and services. We highlight the challenges associated with public transportation in rural areas where there are: (1) long distances to travel; (2) difficulties in scheduling to meet all needs; and (3) poor road and walking conditions for bus stops. The results are applicable to low income and fairly disconnected rural areas, where access to health, education, and economic opportunities are limited.
Assuntos
Avaliação do Impacto na Saúde , População Rural , Meios de Transporte , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico , Adulto JovemRESUMO
We conducted a Health Impact Assessment (HIA) focused on water and sanitation in Vinton, TX, a small rural town on the U.S./Mexico Border. We present the Vinton HIA as a case study to inform the practice of HIA in rural limited resource communities with higher than average levels of unemployment and poverty, and limited infrastructure. Household surveys, focus groups, and interviews provided quantitative and qualitative data on water sources and quality, sanitation practices, and community health. We found that some of the current water sources in Vinton did not meet drinking water standards for total dissolved solids and arsenic; the majority of septic tanks were not managed properly; and there was a short-term risk of water scarcity due to prolonged drought in the region. Prevalent ailments reported by participants included stomach problems, diarrhea, and skin problems. These ailments can be related to arsenic and/or biological organisms in water. The positive direct and indirect health impacts of improved water and sanitation in Vinton included: reduced gastrointestinal illnesses and skin disorders; improved water quality, quantity, and pressure; reduced risks from failing septic systems; increased property value; potential economic growth; and enhanced quality of life. The negative direct and indirect impacts included: residents' initial and monthly costs; increased property taxes; increased debt by local government; and the need for ongoing support from changing elected decision makers. The unique challenges in completing this HIA included: (a) limited available data; (b) a culture of fear and distrust among residents; (c) residents' lack of education, awareness, and civic discourse regarding water and sanitation issues and their impact on public health; and (d) lack of civic discourse and participation in the democratic process. An important outcome of the HIA was the characterization of local water supplies, which motivated and empowered the community members to become more involved in civic discourse concerning their water supplies. Results are transferable to similar low-income rural communities worldwide where residents are lacking in information about their water supplies and in political "voice".