Many people find healthcare offices and buildings sterile, confusing, and unwelcoming. Unfortunately, this can lead to distrust, leaving the facility against medical advice, and disengagement. A survey of 11,500 people in 5 countries (U.S., France, UK, Japan, and Brazil) found that women, ethnic minorities, people with disabilities, and individuals who identify as LGBTQ+ are far more likely to distrust their healthcare providers and the healthcare system as a whole (Hudson and Williams, 2023).

Features of a safe and welcoming healthcare facility include culturally competent communication, language assistance services (including oral interpretation), translation of written documents, signage, and wayfinding symbols. Individuals with language needs include those with limited English proficiency and those who are deaf or hard of hearing. Language assistance services should be provided at no cost to the patient (HHS, 2022).

Findings included (Sanofi, 2022):

• Ethnic minorities and people of color are more likely to say they have had experiences that damaged their trust in healthcare compared to non-minorities (73% vs 57%).
• People who identify as LGBTQ+ report a similar experience (66% vs 58% of their straight peers).
• People with disabilities, a group who fundamentally rely on healthcare, expressed the largest trust gap compared to non-disabled people (73% vs 56%).

A positive, welcoming, and safe environment promotes good-quality care. It has been shown to reduce hospital-acquired infection rates, hospital mortality, re-admissions, and adverse events. Furthermore, for workers, a positive work environment is strongly associated with attracting and retaining healthcare professionals (Maassen et al., 2021).

15.1 Institutional Culture and Health Equity

Institutional culture in healthcare refers to the shared beliefs, values, attitudes, and behaviors that are present within a healthcare organization. It encompasses all aspects of the organizational structure, from its mission and vision to its policies and procedures, and to the interactions and relationships among staff members.

Healthcare organizations that prioritize health equity will typically have an institutional culture that emphasizes diversity and inclusivity, values patient-centered care, and supports ongoing training and education for healthcare providers. This type of institutional culture prioritizes community engagement and outreach, and supports policies and initiatives aimed at reducing disparities in health outcomes and access to care.

The governance structure of a healthcare organization can play a role in improving health equity. Addressing health inequities by recognizing and decreasing institutional racism and other forms of discrimination can have a significant impact on improving an organization’s culture (Browne et al., 2018).

Health equity interventions can be implemented at multiple levels within health organizations and at the level of clinical practice. Specific interventions can vary but are characterized by a common goal of closing the health equity gap with the aim of 1) improving the health of populations, 2) enhancing patient experience and outcomes, and 3) reducing per capita cost of care (Browne et al., 2018).

15.2 Health Disparities and Social Inequities

Unequal social practices create gaps in health. One example is redlining, a practice where lenders deny mortgages to eligible buyers solely because of their race. These practices assured that Black people and other people of color are denied the right of home ownership and upward economic mobility that millions of White people enjoy. Redlining has been succeeded by gentrification, whereby middle-class people move into urban areas and displace others who have lived in a neighborhood for years (Julian, Hardeman, and Huerto, 2020).

Both redlining and gentrification perpetuate poverty in communities of color in America’s cities. As such, many Black and low-income Americans live in communities where clean water isn’t guaranteed, and social distancing is nearly impossible in crowded homes. In this way, redlining and gentrification have impacted the racial inequities seen during the COVID-19 pandemic (Julian, Hardeman, and Huerto, 2020).

15.3 Health Equity and Seniors

For older adults, creating a safe and welcoming healthcare environment has often been overlooked by healthcare organizations and providers. The lack of geriatric specialists in the U.S., overworked primary care providers, polypharmacy and medication errors, and a failure to monitor medications creates a sense of distrust and dread among older adults. Most older adults do not have a knowledgeable advocate for their care.

Many older adults, especially women and other marginalized people, are treated as if they do not matter. Our healthcare system is complex, with short appointments, a lack of primary care providers, and multiple professionals who often do not communicate with one another. For a person with mobility issues, getting to an appointment can be a challenge. Although access to healthcare services is an equity issue, little research has been done globally to understand the impact of these issues on the lives of older adults.

It may be difficult for young healthcare providers to understand the issues faced by older adults. The cost of housing, food, gas, and electricity, cuts to social security and Medicare, poverty, inadequate savings for retirement, and health issues place a great deal of pressure on older adults.

What is already known about this subject (Carroll et al., 2022)?

• Age is a known factor predicting inequity of access to healthcare.
• Multiple factors affecting different groups of people, such as age, income, education, location, are known to be relevant in accessing healthcare.
• Individual factors such as literacy, ethnicity, minority status and location, have been explored in empirical and conceptual studies examining older people’s access of services.

The equity or inequity of a system is determined by factors such as discrimination, minority status, and needs, based on individual physical, cultural, and financial circumstances. Factors such as these that might apply to one older person, might not apply to another, with different implications for equity of access (Carroll et al., 2022).

Studies of equity for older adults uncover the need for a more sophisticated understanding and acknowledgement of the differences in older people’s experience of services. Institutional frameworks tend to homogenize older people into one group, omitting clear differences in healthcare needs based on factors such as age, comorbidities, minority status, financial, and familial resources (Carroll et al., 2022).