Medical deserts and uneven access: a U.S.-anchored critical conceptual review.

IF 5.2 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International Journal for Equity in Health Pub Date : 2026-07-02 DOI:10.1186/s12939-026-02937-5

Ki Jun Kang

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引用次数: 0

Abstract

Background: Medical desert terminology is used inconsistently across rural health, health services research, and health policy. In some studies, it describes structural scarcity of local services. In others, it is used for waiting time, affordability, quality, or sociocultural barriers. This inconsistency blurs three different tasks: defining an underserved place, measuring that place, and explaining why people in the same place experience access differently.

Methods: This U.S.-anchored critical conceptual review draws together literature on desert terminology, access theory, rural service erosion, and medical mistrust.

Results: Medical deserts are defined here as structurally underserved places where needed services are locally unavailable, hard to reach, unstable, or difficult to replace after service loss. Institutional credibility and medical mistrust are treated as related explanatory dimensions of realized access. The review presents a heuristic that links structural access and institutional credibility while keeping them analytically distinct, and it outlines a multilevel measurement agenda for structural access, credibility, mistrust, and realized access.

Conclusions: This distinction may sharpen health equity research and policy by separating service infrastructure from the conditions that make care usable.

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医疗沙漠和不平等的获取：以美国为基础的批判性概念审查。

背景：在农村卫生、卫生服务研究和卫生政策中，医学沙漠术语的使用不一致。在一些研究中，它描述了地方服务的结构性稀缺性。在其他情况下，它用于等待时间、可负担性、质量或社会文化障碍。这种不一致模糊了三个不同的任务：定义服务不足的地方，测量那个地方，以及解释为什么在同一个地方的人们体验不同的访问方式。方法：这篇以美国为中心的批判性概念综述汇集了关于沙漠术语、获取理论、农村服务侵蚀和医疗不信任的文献。结果：医疗沙漠在这里被定义为结构上服务不足的地方，在这些地方，当地无法获得所需的服务，难以到达，不稳定，或在服务丧失后难以替代。机构信誉和医疗不信任被视为实现准入的相关解释维度。该综述提出了一种启发式方法，将结构性获取和机构可信度联系起来，同时保持它们在分析上的不同，并概述了结构性获取、可信度、不信任和实现获取的多层次测量议程。结论：这种区别通过将服务基础设施与使护理可用的条件分离开来，可以加强卫生公平研究和政策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal for Equity in Health Medicine-Health Policy

CiteScore

7.80

自引率

4.20%

发文量

162

审稿时长

28 weeks

期刊介绍： International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.