Spatial analysis of areas with high ratings for children's health: Case study, Tehran city

A B S T R A C T
Social Determinants of Health (SDH), within political and socio-economic contexts, are recognized as a key framework for analyzing health inequalities. These determinants encompass economic, cultural, and structural dimensions and are closely associated with indicators such as income, educational attainment, occupational status, social class, and quality of the living environment, all of which directly influence children’s health. Children living in deteriorated urban fabrics or in low-quality housing are more exposed to illnesses and negative health outcomes. This study aims to identify and evaluate environmental factors influencing children’s health in Tehran using Geographic Information Systems (GIS). To this end, SDH were examined across three main dimensions: the political dimension (quality and quantity of healthcare services), the structural dimension (quality of and access to educational and social services), and the intermediary dimension (physical environment, housing quality, and socio-spatial characteristics of neighborhoods). Based on surveys conducted among urban health experts and households with children, six key indicators were identified: air pollution, distribution and density of pediatric specialty hospitals, quality and per capita availability of green spaces, traffic volume and intensity, population density, and the proportion of children in the population. Field data from 10 selected households were used for validation. Analysis using the fuzzy product model revealed that more affluent areas, due to higher welfare levels and stricter urban regulations, demonstrated more favorable conditions in children’s health indicators.
Extended Abstract
Introduction
Children’s health represents a multidimensional phenomenon shaped not only by biological factors but also by the interplay of social, economic, and environmental determinants. Within the framework of Social Determinants of Health (SDH), elements such as income, housing quality, educational access, employment status, and social class critically influence individual and community health outcomes. Urban children, particularly those residing in deprived neighborhoods and substandard housing, face heightened vulnerability to respiratory diseases, developmental delays, and psychosocial risks. In Tehran, one of the largest and most densely populated metropolises in the Middle East, these inequalities manifest spatially, reflecting uneven distributions of healthcare facilities, green spaces, traffic congestion, and environmental quality. The significance of this research lies in its dual focus: first, to empirically measure how political, structural, and intermediary dimensions of SDH influence child health in Tehran; and second, to highlight spatial inequalities that exacerbate risks for children in disadvantaged neighborhoods. This study pursues two guiding research questions: (1) Which environmental and social factors exert the strongest influence on children’s health in Tehran? (2) How are spatial patterns of child health vulnerability distributed across the city’s northern, central, and southern districts? By answering these questions, the study contributes to urban health planning and the broader agenda of reducing spatial inequalities in child well-being.
 
Methodology
The research employed a mixed-methods design integrating secondary data, expert consultation, household surveys, and spatial analysis. Six primary indicators were selected following literature review, expert judgment, and participatory surveys with households raising children. These included: (1) air pollution levels, (2) distribution and accessibility of pediatric hospitals, (3) quality and per capita supply of urban green spaces, (4) traffic volume and intensity, (5) population density, and (6) proportion of children within the total population.Spatial data were obtained from Tehran Municipality’s Geographic Information System (GIS) platform, the Ministry of Health and Medical Education, the Tehran Traffic Control Company, and the Statistical Yearbook of Tehran (2022–2023). Layers were standardized through Min–Max normalization and processed using ArcGIS tools, including distance analysis and overlay functions. Household-level validation was achieved by interviewing 10 families in selected neighborhoods, who reported their lived experiences of environmental health risks and service accessibility. The analytical core of the study employed a fuzzy product model, a multi-criteria decision-making method designed to handle uncertainty and imprecision in urban health assessments. Each indicator was fuzzified using Gaussian membership functions, and composite maps were generated through product operators to highlight zones of low, medium, high, and very high vulnerability. Spatial interpolation was further applied to incorporate household survey data into the GIS outputs, providing a more citizen-oriented validation of results.
 
Results and discussion
Findings reveal a stark north–south divide in children’s health conditions across Tehran. Northern and northeastern districts (e.g., Districts 1, 2, 3, and 6) exhibited favorable indicators, including greater accessibility to pediatric hospitals (average travel time 2–5 minutes), abundant green spaces (35–45 m² per capita), and relatively lower air pollution (average AQI 80–95). These areas benefit from higher socioeconomic status, stricter urban regulations, and better-maintained infrastructure. Conversely, southern and southwestern districts (e.g., Districts 15, 18, 19, and 20) displayed severe vulnerabilities. Travel time to pediatric hospitals often exceeded 15 minutes, green space availability dropped to less than 3 m² per capita, and air pollution levels frequently reached 150–180 AQI, well above health standards. Population density in these districts averaged 23–25 children per hectare, creating additional pressure on schools, clinics, and recreational spaces. Traffic congestion further exacerbated air and noise pollution, elevating risks of respiratory illness, accidents, and mental stress among children. The fuzzy product analysis confirmed that areas with overlapping disadvantages limited healthcare access, poor air quality, high density, and inadequate green spacesconstituted “very high vulnerability zones.” These were concentrated in southern Tehran, particularly in Districts 11, 15, 18, 19, and 20. Household survey results aligned with GIS outputs: families in disadvantaged neighborhoods reported dissatisfaction with healthcare availability, overcrowded schools, and unsafe play environments. By contrast, families in affluent northern districts emphasized the benefits of green spaces, faster emergency services, and overall higher quality of life. These findings echo international research highlighting spatial inequalities in child health across major global cities such as London, Madrid, Seoul, and New York. They also reaffirm the notion that healthcare alone cannot close the health gap; structural and intermediary factors including housing, environmental quality, and social services are equally critical. From a theoretical perspective, the results resonate with both the Health Ecosystem Theory, which emphasizes child–environment interactions, and the Social Health Inequality Model, which links structural inequities to spatial health disparities.
 
Conclusion
This study underscores the critical importance of spatial analysis in understanding and addressing inequalities in children’s health within Tehran. By employing GIS and fuzzy product modeling, it identified vulnerable neighborhoods where environmental and social disadvantages converge to produce elevated health risks for children. The results confirm that northern districts offer more supportive conditions for child health, while southern and southwestern districts face acute challenges.
Several policy implications emerge:

Strengthening healthcare infrastructure by expanding pediatric hospitals and clinics in underserved southern districts to reduce emergency response times.
Expanding and preserving green spaces in high-density neighborhoods to promote physical and mental health among children.
Implementing stricter air pollution controls and traffic management policies, including promoting public transport, cycling, and pedestrian-friendly infrastructure.
Balancing educational and social services with population growth, ensuring equitable access to schools, kindergartens, and community centers.
Institutionalizing GIS-based monitoring systems at municipal and national levels to continuously track environmental risks and child health outcomes. Limitations include reliance on available municipal and ministerial data, as well as a relatively small household validation sample. Future research should expand participatory data collection, integrate longitudinal health statistics, and explore alternative fuzzy operators (e.g., gamma operator) to refine vulnerability.Ultimately, the study demonstrates that citizen-oriented GIS analysis, when combined with robust spatial modeling, offers a powerful evidence base for reducing health inequalities and ensuring healthier urban futures for children.

 
Funding
There is no funding support.
 
Authors’ Contribution
Authors contributed equally to the conceptualization and writing of the article. All of the authors approved the content of the manuscript and agreed on all aspects of the work declaration of competing interest none.
 
Conflict of Interest
Authors declared no conflict of interest.
 
Acknowledgments
We are grateful to all the scientific consultants of this paper.