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Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 35822

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Special Issue Editors

Prof. Dr. Florian Steger

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Guest Editor

Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
Interests: history of medicine; medical ethics; bioethics; research ethics; social diversity and access to healthcare; ethics of digitalization of healthcare; politicization of medicine
Special Issues, Collections and Topics in MDPI journals

Dr. Marcin Orzechowski

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Guest Editor

Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
Interests: ethical challenges of diversity in healthcare; ethics of digitalization of healthcare; history of medicine; research ethics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As the composition of societies changes, questions of social diversity and equal access to healthcare for vulnerable and minority populations are attracting increasing attention. In recent years, processes of international migration, globalization, aging of societies, widening income gaps, as well as increased sensibility concerning the healthcare needs of diverse social groups, have led to an increased focus on questions of discrimination in healthcare and equal access to healthcare services for all. Nevertheless, despite this greater engagement with the topic, empirical research on access to healthcare still remains insufficient.

Belonging to a vulnerable group can constitute a relevant obstacle to accessing healthcare. Limitation of access to healthcare for these populations raises medico–ethical considerations and has negative consequences on the health outcomes of individual patients. For example, non-heteronormative persons, such as gay, lesbian, bisexual, transgender, and non-binary individuals, report substantial discrimination and disparities regarding their access to healthcare as a result of healthcare providers’ moral convictions and attitudes; difficulties communicating with healthcare professionals; or institutional and internalized homophobia. Another vulnerable minority group that experiences barriers to healthcare is migrants, refugees, and asylum seekers, for whom obstacles can include inadequate legal entitlements, language barriers, or patients’ socioeconomic status.

Discrimination in access to healthcare can function on two levels: individual and structural. Individual discrimination occurs on the level of personal encounters, i.e., between a healthcare professional and an individual patient. Here, obstacles may have various contexts, e.g., they can stem from communication issues or the presence of racism or homophobia. In contrast, structural inequalities may arise through normative frameworks that disadvantage particular minority groups. In such cases, international institutions or states establish specific laws, regulations, or procedures that either permit or prohibit equal access to health services.

This Special Issue aims to collect research articles concerning the question of equal access to healthcare for various minority populations, including (but not limited to) ethnic, cultural, or religious minorities; sexual and gender minorities; children; older or disabled persons; prisoners, etc. The Guest Editors welcome contributions from across the globe that not only examine structural and individual barriers to access to healthcare for these vulnerable groups, but also provide best-practice examples of facilitating access to healthcare for them. The Special Issue aims to include papers from a wide range of academic perspectives including Public Health, Healthcare Ethics, Health Systems Research, and Global Health Research.

You may choose our Joint Special Issue in Healthcare.

Prof. Dr. Florian Steger
Dr. Marcin Orzechowski
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

healthcare access
healthcare disparities
equity
minority and vulnerable populations
ethics
public health
healthcare services

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Published Papers (7 papers)

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Research

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10 pages, 756 KiB

Open AccessArticle

Situation Analysis of a New Effort of Community-Based Health Planning and Services (CHPS) for Maternal Health in Upper West Region in Rural Ghana

by Chieko Matsubara, Maxwell Ayindenaba Dalaba, Laata Latif Danchaka and Paul Welaga

Int. J. Environ. Res. Public Health 2023, 20(16), 6595; https://doi.org/10.3390/ijerph20166595 - 18 Aug 2023

Cited by 2 | Viewed by 2221

Abstract

A free maternal health policy started in Ghana in 2008, however, health facility utilization is still low, and out-of-pocket payments (OOPPs) are putting households at risk of catastrophic expenditure. To improve this situation, some rural communities have assigned a midwife to a health post called community-based health planning and services (CHPS), where only assistant nurses are allocated. This study explored the effectiveness of the new approach in Upper West Region, Ghana. We conducted a cross-sectional study and interviewed women who gave birth in the last year. We systematically selected communities matched into four criteria: communities near CHPS (functional CHPS), communities near CHPS with a midwife (advanced CHPS), communities near a health centre, and communities without a health facility in their neighbourhood. In total, 534 women were interviewed: functional CHPS 104, advanced CHPS 131, near health centre 173, and no facility 126. About 78% of the women were 20 to 34 years old. About half of the women incurred OOPP, however, catastrophic payment (household spending > 5% of annual income) was significantly lower in advanced CHPS communities for normal delivery compared with the other three communities. The new local approach of assigning a midwife to CHPS functioned well, improving access to healthcare facilities for childbirth. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

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15 pages, 596 KiB

Open AccessArticle

A Cluster-Randomised Stepped-Wedge Impact Evaluation of a Pragmatic Implementation Process for Improving the Cultural Responsiveness of Non-Aboriginal Alcohol and Other Drug Treatment Services: A Pilot Study

by Sara Farnbach, Alexandra Henderson, Julaine Allan, Raechel Wallace and Anthony Shakeshaft

Int. J. Environ. Res. Public Health 2023, 20(5), 4223; https://doi.org/10.3390/ijerph20054223 - 27 Feb 2023

Cited by 3 | Viewed by 2116

Abstract

There is limited evidence regarding implementing organisational improvements in the cultural responsiveness of non-Aboriginal services. Using a pragmatic implementation process to promote organisational change around cultural responsiveness, we aimed to (i) identify its impact on the cultural responsiveness of participating services; (ii) identify areas with the most improvement; and (iii) present a program logic to guide cultural responsiveness. A best-evidence guideline for culturally responsive service delivery in non-Aboriginal Alcohol and other Drug (AoD) treatment services was co-designed. Services were grouped geographically and randomised to start dates using a stepped wedge design, then baseline audits were completed (operationalization of the guideline). After receiving feedback, the services attended guideline implementation workshops and selected three key action areas; they then completed follow-up audits. A two-sample Wilcoxon rank-sum (Mann–Whitney) test was used to analyse differences between baseline and follow-up audits on three key action areas and all other action areas. Improvements occurred across guideline themes, with significant increases between median baseline and follow-up audit scores on three key action areas (median increase = 2.0; Interquartile Range (IQR) = 1.0–3.0) and all other action areas (median increase = 7.5; IQR = 5.0–11.0). All services completing the implementation process had increased audit scores, reflecting improved cultural responsiveness. The implementation process appeared to be feasible for improving culturally responsive practice in AoD services and may be applicable elsewhere. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

15 pages, 647 KiB

Open AccessArticle

Caring for Transgender People in Healthcare: A Qualitative Study with Hospital Staff in Croatia

by Ivana Tutić Grokša, Robert Doričić, Vanja Branica and Amir Muzur

Int. J. Environ. Res. Public Health 2022, 19(24), 16529; https://doi.org/10.3390/ijerph192416529 - 9 Dec 2022

Cited by 3 | Viewed by 1853

Abstract

Transgender and gender-diverse people have greater health risks due to increased social stress and face a disadvantaged position in the healthcare system as a result of the stigma associated with their gender identity. Due to the lack of research in Croatia on the position of transgender people in the healthcare system, this research was intended to supplement the knowledge about the experiences of hospital staff in the Croatian healthcare system when caring for patients with transgender identities. Qualitative research was conducted using an interview method. The participants (n = 10) were healthcare managers or hospital care team members. The collected data were processed through thematic analysis. The results show that some participants had had no encounters with transgender patients and those who had described them as unproblematic or had only encountered them at a level of basic healthcare. They also described how they perceive transgender people and their life circumstances. The participants described how they envision potential encounters with this group of patients and what they consider necessary to improve the position of this group within the healthcare system. In the discussion part of the article, we assess the need for additional training regarding hospital staff, especially in terms of diversity competence, and for an increase in the visibility of transgender patients. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

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24 pages, 594 KiB

Open AccessArticle

Victimization of Applicants for International Protection Residing in Belgium: Sexual Violence and Help-Seeking Behavior

by Lotte De Schrijver, Anne Nobels, Jonathan Harb, Laurent Nisen, Kristien Roelens, Tom Vander Beken, Christophe Vandeviver and Ines Keygnaert

Int. J. Environ. Res. Public Health 2022, 19(19), 12889; https://doi.org/10.3390/ijerph191912889 - 8 Oct 2022

Cited by 5 | Viewed by 2349

Abstract

Background: Sexual violence (SV) literature on applicants for international protection (AIPs) shows that they are at high risk of victimization. The study objectives are to provide an exploratory overview of the occurrence of SV in AIPs in Belgium and their help-seeking behavior (HSB). This overview is crucial to develop prevention strategies and care paths focusing on providing adequate care to AIP SV victims in Belgium. Methods: Quantitative data from structured interviews with AIPs (n = 62) triangulated with qualitative data from in-depth interviews with AIP SV victims (n = 11) served to explore the nature and impact of SV in AIPs in Belgium and their HSB. Results: A total of 83.9% of respondents have experienced SV. A total of 61.3% were victimized within the past year. Victimization seems more gender-balanced than in the general population. AIPs link SV to their legal status and their associated vulnerable situation. HSB upon SV was very limited in this sample. Help-seeking barriers interfering with the decision-making process to consult (in)formal resources were identified. Conclusions: AIPs in Belgium are at high risk of SV. Despite the impact of SV on AIPs’ lives, HSB upon SV is rare. The provision of age-appropriate sexual education and development of policies that will reduce help-seeking barriers is needed. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

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18 pages, 524 KiB

Open AccessSystematic Review

First Nations, Inuit and Métis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review

by Simon Graham, Nicole M. Muir, Jocelyn W. Formsma and Janet Smylie

Int. J. Environ. Res. Public Health 2023, 20(11), 5956; https://doi.org/10.3390/ijerph20115956 - 25 May 2023

Cited by 10 | Viewed by 6845

Abstract

In Canada, approximately 52% of First Nations, Inuit and Métis (Indigenous) peoples live in urban areas. Although urban areas have some of the best health services in the world, little is known about the barriers or facilitators Indigenous peoples face when accessing these services. This review aims to fill these gaps in knowledge. Embase, Medline and Web of Science were searched from 1 January 1981 to 30 April 2020. A total of 41 studies identified barriers or facilitators of health service access for Indigenous peoples in urban areas. Barriers included difficult communication with health professionals, medication issues, dismissal by healthcare staff, wait times, mistrust and avoidance of healthcare, racial discrimination, poverty and transportation issues. Facilitators included access to culture, traditional healing, Indigenous-led health services and cultural safety. Policies and programs that remove barriers and implement the facilitators could improve health service access for Indigenous peoples living in urban and related homelands in Canada. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

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11 pages, 635 KiB

Open AccessPerspective

Twelve Tips for Inclusive Practice in Healthcare Settings

by Brahmaputra Marjadi, Joanne Flavel, Kirsten Baker, Kristen Glenister, Melissa Morns, Mel Triantafyllou, Penelope Strauss, Brittany Wolff, Alexandra Marie Procter, Zelalem Mengesha, Scott Walsberger, Xiaoxi Qiao and Paul A. Gardiner

Int. J. Environ. Res. Public Health 2023, 20(5), 4657; https://doi.org/10.3390/ijerph20054657 - 6 Mar 2023

Cited by 14 | Viewed by 17047

Abstract

This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association’s diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

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9 pages, 1056 KiB

Open AccessOpinion

The Increasing Population Movements in the 21st Century: A Call for the E-Register of Health-Related Data Integrating Health Care Systems in Europe

by Arkadiusz Dziedzic, Abanoub Riad, Marta Tanasiewicz and Sameh Attia

Int. J. Environ. Res. Public Health 2022, 19(21), 13720; https://doi.org/10.3390/ijerph192113720 - 22 Oct 2022

Cited by 2 | Viewed by 2133

Abstract

The escalating mass influx of people to Europe in the 21st century due to geopolitical and economic reasons as well as food crises ignites significant challenges for national health care services. The lack or disruption of cross-border, e-transferred, health-related data negatively affects the health outcome and continuous care, particularly in medically compromised individuals with an unsettled status. Proposal: The urgent need of a structured database, in the form of a health-related data register funded by the European Union that allows a swift exchange of crucial medical data, was discussed to flag ever-increasing migrants’ health problems, with a primary aim to support an adequate health care provision for underserved people who are at risk of deteriorating health. The data security information technology aspects, with a proposed and drafted structure of an e-health register, were succinctly highlighted. Conclusions: Focusing on long-term benefits and considering future waves of mass relocation, an investment in a health-related data register in Europe could vastly reduce health care disparities between minority groups and improve epidemiological situations with regard to major illnesses, including common, communicable diseases as well as oncological and infectious conditions. Commissioners, policymakers, and stakeholders are urged to continue a collective action to ensure vulnerable people can access health services by responding to the ongoing global migration crisis. Full article

(This article belongs to the Special Issue Access to Healthcare for Vulnerable and Minority Populations: A Global Perspective)

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