Bridging the accessibility gap to healthcare: The role of urban transport for low-income communities in São Paulo, Brazil

Accessibility, generally understood as the ease to get to activity places, is recognised as an essential component of access to healthcare and a requirement for service utilisation. Accessibility gaps may underpin the burden often born by socially disadvantaged groups who make less use of health services, experience higher levels of disease and have shorter lives. This thesis contributes to clarifying the role of transport as an enabler of access to healthcare services in particular by those who suffer from health inequalities. Drawing on theories of human needs and perspectives of transport disadvantage and social exclusion, I construe accessibility as “the easiness for people to reach key services, opportunities and activities able to contribute to the satisfaction of their needs”. Under this conceptualisation, accessibility is integrally related to the attractiveness of potential destinations in terms of their qualities, and not just to their geographical locations. Guided by this conceptual framework, the qualitative approach was designed to get an in-depth understanding of how people living in low-income neighbourhoods in the city of São Paulo (Brazil) gain access to healthcare services. Fifteen focus group conversations, involving 114 residents of twelve distinct neighbourhoods, uncovered a range of accessibility barriers as well as strategies adopted to overcome them. Participants’ difficulties in gaining access to healthcare lay beyond issues such as location and distance. A variety of inter-related, multidimensional factors, including the waiting time for appointments and the quality of consultations, shapes the accessibility to healthcare in São Paulo. Even under severe financial and time constraints, residents of low-income neighbourhoods travel longer to obtain access to facilities perceived as adequate to respond to their health needs. The research has important policy implications. Tackling health inequalities requires planners to design integrated transport and health policies, taking into consideration the adequacy and quality of transport and healthcare services