Spatial Justice in Healthcare: A GIS Approach Toward European Cohesion. The Case of the Province of Nuoro, Sardinia

The 1989 Structural Funds reform reshaped the European Union's priorities, placing the objective of cohesion at the heart of its policy. Cohesion Policy's current objective is to reduce disparities in the level of development across European regions. Specific measures are in place to support areas suffering from serious and permanent natural and demographic disadvantages, such as islands and mountainous regions. In this framework, reducing disparities in accessibility to healthcare services is a priority of the EU. The aim of this study is to explore the Emergency Care System (ECS), with a particular focus on the Advance Life Support (ALS) stations coverage in the province of Nuoro (Sardinia, Italy). The study will assess the accessibility of the ALS system and, where necessary, identify a suitable location for the establishment of an additional ALS station, to be implemented by using European Structural Funds. The province of Nuoro is an ideal target for this type of analysis as it is a mountainous area, situated within a broader context of insularity, which faces a critical demographic challenge. This research is based on a network analysis carried out with geographical information system approach (e.g. using QGIS). Specifically, two methodologies are employed: the fastest path analysis and the isochronous analysis. Finally, a non-automated location-allocation analysis was carried out, based on demographic and dasymetric criteria. In this context, an accessibility analysis was conducted considering its two stages: realised accessibility, which refers to the current use of ALS service by the population; and potential accessibility, which refers to the number of potential users of this service. The analysis revealed an actual shortfall in the ALS service coverage in the study area, but also enabled the identification of a strategic location for implementing a new ALS station. In this regard, in light of the 2021–2027 ERDF and ESF+ Regional Programmes, the financial sustainability of the proposed implementation project was assessed. Thus, after determining that the social value derived from a measure of this kind justifies the economic costs, it was also concluded that, within the framework of Cohesion Policy and through the Structural Funds, the proposal is financially sustainable for the public purse. In conclusion, accessibility, insofar as it links the spatial dimension with the individual one, must be a guiding principle during the planning phase. In this regard, GIS tools, by enabling the combination of spatial and non-spatial data, are a valuable resource for making informed assessments in policy-making. Thus, this study provides a model of integrated planning, from problem analysis to strategy implementation, which can be easily replicated in future research.