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Exploring and Addressing Healthcare Inequalities in Marginalized Communities

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Dr. Anaïs Tuepker

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Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA
Interests: participatory health system redesign; medical education; primary care access and equity; planetary health; health professions sustainability

Special Issue Information

Dear Colleagues,

In the widely differing healthcare systems across the globe, inequalities in care contribute to unequal health outcomes. Often, the negative impact of these inequalities is seen most clearly within communities that are marginalized either by the healthcare system specifically or at a broader societal level. While marginalization carries an implication of harm and exclusion, healthcare “at the margins” can be a place of innovation towards more effective care and a more promising future.

This Special Issue invites contributions to advance our collective understanding of how marginalization manifests in real-world health(care) contexts, as well as what can be implemented to mitigate its harms and advance new forms of care that better meet humanity’s needs. The issue will adopt an inclusive interpretation of factors that may drive marginalization, such as lack of geographic or financial access to care, societal discrimination against specific groups, the ongoing influence of historical context or trauma, and/or misalignment between system services and population or ecosystem priorities, including presumptive norms of what healthcare can or should provide. Papers reporting interventions that effectively address or transform the negative outcomes of marginalization from health(care), and the lessons learned from such efforts, are especially welcome. Possible topics of interest include, but are not limited to, the following: enhanced participation of marginalized communities in health service design; changes to payment models or services with the goal of decreasing exclusion; redefinitions of the scope of healthcare to align with marginalized value systems or self-care practices; and/or identification of novel factors contributing to marginalization (for example, the role of new technologies or medical treatments in improving or worsening marginalization).

Dr. Anaïs Tuepker
Guest Editor

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Research

8 pages, 218 KB

Open AccessArticle

Food Alliance’s Mobile Food Community Kitchen and Pop-Up Pantry Model

by Margaret Henning, Magdalynn Graul and Kate McAvoy

Int. J. Environ. Res. Public Health 2026, 23(5), 550; https://doi.org/10.3390/ijerph23050550 - 24 Apr 2026

Viewed by 326

Abstract

This research, funded by the National Science Foundation (Award #2412054) as part of the NH-LIFT project, provides a critical analysis of a successful public health initiative addressing food insecurity in New Hampshire, which affects nearly 10% of residents and 13.4% of children. The study’s primary objective was to analyze the effectiveness, unique characteristics, and replicability of The Community Kitchen’s Mobile Food Pantry program in collaboration with the Healthy Monadnock Alliance and Cheshire Medical Center. Methods: A survey design was employed over a four-week period (July–August 2025) to collect qualitative data from n = 97 voluntary participants attending mobile pantry events in four rural southwest New Hampshire towns, Gilsum, Richmond, Winchester, and Fitzwilliam, during the period of May-June of 2025. The anonymous, 25-question instrument gathered information on program benefits and needed improvements. Results indicate the model is highly effective in mitigating increased financial stressors and overcoming transportation barriers, which are critical challenges for families and aging adults in this rural region. While demonstrating success in promoting local health and well-being, the research also highlights factors crucial for long-term sustainability. This study contributes to an evidence-based public health model suitable for replication in other food-insecure rural communities. Full article

(This article belongs to the Special Issue Exploring and Addressing Healthcare Inequalities in Marginalized Communities)

12 pages, 582 KB

Open AccessArticle

Preliminary Findings of a Chronic Disease Management Program in Medicare Advantage Enrollees with Mild to Moderate Kidney Disease

by Trevon Morales, Rubette Harford, Dulcie Kermah, Jose Flaque, Michelle Camacho, Damaris Vasquez, Vanessa Schmidt, Inés Hernández-Roses, James P. O’Drobinak and Keith C. Norris

Int. J. Environ. Res. Public Health 2026, 23(2), 237; https://doi.org/10.3390/ijerph23020237 - 13 Feb 2026

Viewed by 511

Abstract

Background: Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that of the overall United States (US). To address the disproportionately high rate of CKD in Puerto Rico, we created a multidisciplinary chronic disease management (CDM) program targeting CKD and diabetes mellitus (DM), the leading CKD risk factor. Methods: Over 7200 eligible enrollees in a Puerto Rico-Managed Medicare Program participated in a CDM program targeting individuals with CKD or DM as determined by administrative review. Evaluations were conducted on 4068 program participants with baseline glomerular filtration rate (eGFR) and codifying CKD stage by eGFR. A dietitian/nurse team provided dietary and lifestyle recommendations to the patient/family and a nephrologist/endocrinologist made diabetes and CKD recommendations to the primary care provider. Findings on 2095 participants with Stages 1–3 CKD with follow-up eGFR at least 6 months but less than 2 years after baseline are presented. Results: At baseline, the mean age was 74 years (range 30–101), 59% of patients were female and mean duration of follow-up from initial evaluation to second evaluation was 407 days (±159 days SD). Most participants had Stage 2 CKD (34.8%), followed by CKD Stage 1 and 3 (33.5 and 31.7%). During the follow-up period, 55.9% of participants with Stage 1 CKD remained in Stage 1, 84.9% of patients with Stage 2 remained in Stage 2 or regressed to Stage 1, while 96.1% of patients with Stage 3 remained in Stage 3 or regressed to Stage 2. Only 15.1% of patients in Stage 2 progressed to Stage 3 and 3.9% of patients in Stage 3 progressed to Stage 4 or 5. A secondary analysis comparing all 665 CDM Stage 3 participants to 117,249 historical controls found CDM participants demonstrated a higher rate of regression (20.3% vs. 15.2%; absolute difference +5.1 percentage points; p = <0.01) and a lower rate of progression (3.9% vs. 15.3%; absolute difference −11.4 percentage points; p < 0.001). Conclusions: Early findings of a multidisciplinary CDM intervention indicate that 79% of participants with CKD Stages 1–3 by eGFR had stabilized or improved CKD status. Comparison to a randomized control group to better assess for causality and longer-term CDM program follow-up on CKD status and clinical outcomes is warranted. Full article

(This article belongs to the Special Issue Exploring and Addressing Healthcare Inequalities in Marginalized Communities)

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