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Addressing Disparities in Health and Healthcare Globally

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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".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 4176

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Special Issue Editors

Dr. Toni Wright

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Guest Editor

Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury CT1 1QU, UK
Interests: public health; health inequities; health policy; arts for health and wellbeing; mental health; and older people’s health and wellbeing

Dr. Rajeeb Kumar Sah

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Guest Editor

School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
Interests: global health inequalities; mental health and wellbeing; maternal and child health; sexual and reproductive health; adolescent health; social determinants of health; sustainable development goals; global public health

Special Issue Information

Dear Colleagues,

Whilst many are living for longer and, generally, overall health might be improving, health and healthcare disparities remain urgent public health concerns and continue to require rigorous evidence-based scholarly attention. The COVID-19 pandemic disproportionately affected marginalised populations and exacerbated existing health and healthcare disparities, and although research on health and healthcare disparities has been plentiful before and after COVID-19, substantial gaps in the access, quality, and outcomes of health and healthcare persist and are growing for vulnerable and marginalised groups. A complex set of structural inequities, systemic barriers, and social determinants of health continue to mean that there are significantly poorer health outcomes for certain populations.

This Special Issue draws together a range of original research and review contributions reflecting the latest evidence and perspectives on the multifaceted nature of health and healthcare disparities for vulnerable and marginalised communities globally. It includes both the documenting of disparities and proposals for informing solutions to entrenched health and healthcare inequities. We hope this collection of papers will spark dialogue and inspire new lines of research inquiry as contributions to ongoing efforts towards making health and healthcare equity a reality for all.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Structural racism in health and health care;
Innovations in culturally responsive and/or socially just health care;
The impact of health policy reforms on vulnerable and marginalised communities;
Creative approaches for sustained efforts to tackle health disparities and health care inequities for vulnerable and marginalised populations;
The critical role of vulnerable and marginalised community-based participatory research;
The importance of intersectionality and how mutually constitutive identities such as race, gender, sexual orientation, disability, and immigration status shape health and access to health care;
Mental health in vulnerable and marginalised populations;
Women’s maternal and child health in vulnerable and marginalised populations;
Addressing health and health care disparities among migrant populations;
Health and health care disparities in LGBTQIA+ populations;
Health and health care disparities for vulnerable and marginalised older people;
Advancing health and health care equity for disabled people.

We look forward to receiving your contributions.

Dr. Toni Wright
Dr. Rajeeb Kumar Sah
Guest Editors

Manuscript Submission Information

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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

health disparities
health inequities
social determinants of health
intersectionality
vulnerable and marginalised populations
underserved populations
socially just health and health care

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Published Papers (5 papers)

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Research

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16 pages, 1628 KB

Open AccessArticle

Inequalities in Enrollment in Nepal’s National Health Insurance Program: An Intersectional Analysis of Nepal Demographic and Health Survey 2022

by Geha Nath Khanal and Kiran Acharya

Int. J. Environ. Res. Public Health 2026, 23(4), 521; https://doi.org/10.3390/ijerph23040521 - 17 Apr 2026

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Abstract

Nepal’s National Health Insurance Program (NHIP), launched in 2016, continues to show low enrollment rates and substantial socio-economic and geographical inequalities hinder the progress towards universal health coverage (UHC). This study uses a composite indicator of intersectional disadvantages to examine how multiple equity markers (wealth quintile, education status and ethnicity) interact to shape inequalities in NHIP coverage. Data were drawn from the nationally representative 2022 Nepal Demographic and Health Survey. Key predictors are wealth status, education, ethnicity, residence, province, ecological zone and marginalization status. A composite measure of intersectional disadvantage was constructed using three socioeconomic dimensions: wealth, education, and ethnicity. Binary logistic regression, concentration indices, and concentration curves were used to assess the patterns of inequality in NHIP coverage. Results show that only 10.2% of men and 10.8% of women were enrolled in the NHIP. Enrollment varied markedly by province, with highest in Koshi (21.8% for men and 22.9% for women) and lowest in Madhesh (3.1% for men and 2.7% for women). Enrollment was disproportionately higher among wealthier, more educated, and ethnically advantaged groups. This disparity is starkest for those with an intersection of triple disadvantage (poor, illiterate, and disadvantaged ethnicity) and had substantially lower coverage (3.0% for men and 3.4% for women) compared to those facing no disadvantage (18.4% for men and 22.9% women). The concentration curve analysis confirmed that wealthier women and men had greater access to NHIP. Multivariable analysis showed that women and men with no disadvantages were more likely to be enrolled in NHIP than individuals in triple-disadvantage groups. These findings highlight persistent inequities in NHIP, which undermine its contribution to financial risk protection. Targeted interventions are urgently required, including effective implementation of existing subsidies for poor households, expansion of health facility networks in underserved provinces like Madhesh, and tailored outreach programs that address the intersection of ethnicity, wealth, and education in both genders to accelerate equitable progress towards UHC. Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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16 pages, 413 KB

Open AccessArticle

From Village to Clinic: Structural Barriers and Intersecting Challenges in Maternal Healthcare Access in Rural Nepal

by Lalita Kumari Sah, Eleni Hatzidimitriadou and Prabhu Sah

Int. J. Environ. Res. Public Health 2026, 23(4), 454; https://doi.org/10.3390/ijerph23040454 - 1 Apr 2026

Viewed by 500

Abstract

This study explores the lived experiences of pregnant women in rural Nepal navigating maternal healthcare amidst intersecting structural barriers. Using the Social Determinants of Health framework and intersectionality, we examine how geographic isolation, inadequate infrastructure, and economic hardship compound risks to timely and safe maternal care. Twenty in-depth interviews were conducted at a district hospital in the eastern region of Koshi Province, Nepal. Four major themes were identified through inductive thematic analysis. These are: geographic vulnerability and transport challenges; gaps in rural maternal health provision; accommodation and institutional support deficits; and economic vulnerability and hidden costs of care. Findings reveal that poor road conditions, unreliable transport, and limited diagnostic services force women to undertake long, costly journeys, often requiring temporary relocation without institutional accommodation support. Despite policies such as the Safe Motherhood Programme, implementation gaps persist, leaving women to bear significant financial and emotional burdens. These experiences underscore systemic inequities in resource distribution and highlight the compounded disadvantage faced by women from rural and marginalised communities. To ensure equitable maternal healthcare, this study advocates for the decentralisation of health services and the implementation of inclusive financial protection policies tailored to the needs of women from rural and marginalised communities. To promote equitable maternal healthcare, we recommend strengthening rural health infrastructure, implementing maternity waiting homes, and expanding financial protection schemes tailored to vulnerable populations. This research offers critical insights for policymakers to address maternal health inequalities and advance Nepal’s progress toward Universal Health Coverage and Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages). Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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16 pages, 523 KB

Open AccessArticle

Perspectives of Community Health Center Employees on Public Bus Transportation in Rural Hawai‘i County

by L. Brooke Keliikoa, Claudia Hartz, Ansley Pontalti, Ke’ōpūlaulani Reelitz, Heidi Hansen Smith, Kiana Otsuka, Lance K. Ching and Meghan D. McGurk

Int. J. Environ. Res. Public Health 2026, 23(1), 78; https://doi.org/10.3390/ijerph23010078 - 6 Jan 2026

Viewed by 754

Abstract

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable transportation system. This qualitative study gathered the perspectives of community health center employees about the public bus system for Hawai‘i Island, a rural county in the United States. Using a community-engaged research approach, the evaluation team interviewed 10 employees through either in-person small group interviews or online individual interviews between April and July 2023. Transcripts were coded and analyzed using a thematic analysis approach. While all study participants were selected for their interest in commuting to work by bus, most believed the bus was not a reliable or convenient option. Participants shared their experiences about not being able to rely on the bus schedule, feeling unsafe while walking to bus stops or waiting for the bus, and other barriers to using the bus system. Participants also shared their insights about how a reliable bus system would benefit community health center patients who needed transportation to more than just their medical appointments, but also to places like pharmacies, laboratory services, and grocery stores. These findings can be used to initiate discussions around the ways that community health centers can further address transportation as a social determinant of health and inform transportation providers about how to best plan and invest in transportation infrastructure and services to meet the needs of rural populations. Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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14 pages, 672 KB

Open AccessArticle

Socioeconomic Factors and Depressive Symptoms Among Caregivers of Visually Impaired Individuals in South Africa

by Dimakatso Given Mashala, Hlupheka Lawrence Sithole and Eric Maimela

Int. J. Environ. Res. Public Health 2026, 23(1), 57; https://doi.org/10.3390/ijerph23010057 - 31 Dec 2025

Viewed by 503

Abstract

Caregiving for visually impaired individuals imposes substantial psychological, social, and financial burdens. This study examined depressive symptoms among family caregivers in rural Limpopo, South Africa, and their associations with sociodemographic and socioeconomic factors. A cross-sectional survey was conducted among 253 informal caregivers (response rate: 85.5%). Data on age, gender, marital status, education, employment, income, and socioeconomic status were collected. Depressive symptoms were assessed using the full 20-item Centre for Epidemiologic Studies Depression Scale (CES-D), and associations were analysed using chi-square tests, Cramer’s V, and logistic regression. Moderate-to-severe depressive symptoms were reported by 29.2% of caregivers, with 28.1% experiencing mild-to-moderate symptoms. Male caregivers were less likely to report minimal symptoms (OR = 0.3; 95% CI: 0.12–0.65). Caregivers aged 50–59 years were more likely to report lower depressive symptoms (OR = 1.3). Unmarried caregivers had higher odds of depressive symptoms compared with married caregivers (OR = 2.3). Education was protective: secondary education was associated with lower odds of severe symptoms, while primary education significantly increased risk (OR = 18.1). Lower-income caregivers tended to report higher depressive symptoms. Depressive symptoms among caregivers are influenced by gender, age, marital status, education, and income. Interventions such as psychosocial support, financial assistance, and community-based respite services are essential to reduce caregiver burden. Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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22 pages, 488 KB

Open AccessSystematic Review

The Impact of COVID-19 on Racialised Minority Populations: A Systematic Review of Experiences and Perspectives

by Toni Wright, Raymond Smith, Rajeeb Kumar Sah, Clare Keys, Harshad Keval and Chisa Onyejekwe

Int. J. Environ. Res. Public Health 2025, 22(12), 1767; https://doi.org/10.3390/ijerph22121767 - 21 Nov 2025

Viewed by 1111

Abstract

Racialised minority populations were disproportionately affected by COVID-19 and saw the highest rate of COVID-19 infections and mortality. Low socioeconomic status, working as frontline workers, temporary employment, precarious immigration status and pre-existing medical conditions were factors that contributed to disadvantaged experiences. This systematic review looked at the impact of COVID-19 on racialised minority populations globally, recognising their experiences, perspectives and the effects on their physical and mental health. Eight electronic databases were searched (MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Social Sciences Citation Index (SSCI), Social Policy and Practice (SPP), Applied Social Sciences Index and Abstracts (ASSIA), MedRxiv and Research Square) for English language qualitative studies. Reference lists of relevant literature reviews and reference lists of articles were hand-searched for additional potentially relevant articles. Duplicates were removed, and articles were screened for titles and abstracts, followed by full-text screening. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies (n = 70). Data were synthesised using thematic synthesis. Seven major and three minor themes were identified. The major themes related to (i) children and young people’s experiences of COVID-19; (ii) exacerbated pre-existing disparities relating to income, employment and housing security, health insurance and immigration status; (iii) lack of knowledge and information about COVID-19 and COVID-19 misinformation; (iv) racial history of medicine and treatment of racialised populations; (v) contemporary experiences of racism; (vi) impact on physical and mental health and wellbeing; (vii) concerns about safety at work. Minor themes related to (a) experiences of intercommunity mutual aid; (b) adherence to preventative guidance/COVID-19 restrictions; (c) the role of faith. Research needs to focus on developing and testing interventions that support transformation of social, cultural and economic systems towards equity of access to healthcare and healthcare knowledge. Research should be cognisant of interventions that have worked in shifting the equity dial in the past, implement these and use them to inform new approaches. Policy and practice should be mechanisms for enabling the implementation of interventions. Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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