International Journal for Equity in Health最新文献

{"title":"Informal payments and the illusion of free care: a perspective from Somalia's fragile health system.","authors":"Ilyas Abdullahi Khalif, Yusuf Abdullahi Hubow, Abas Nor Abdi, Nour Ahmed Dahir, Aniso Mohamed Abdi, Sharmake Gaiye Bashir","doi":"10.1186/s12939-026-02923-x","DOIUrl":"10.1186/s12939-026-02923-x","url":null,"abstract":"<p><p>Universal Health Coverage (UHC) promises access to care without financial hardship, yet in many low- and middle-income settings this ideal is undermined by pervasive informal payments. This perspective introduces the concept of the \"illusion of free care\" to explain how official fee-exemption policies coexist with hidden, off-the-record charges that reshape access and equity. Drawing on Somalia as a critical case of health system fragility, we argue that informal payments are not isolated acts of corruption but predictable responses to chronic underfunding, weak governance, and workforce precarity. We conceptualize this dynamic as a four-stage process linking policy promises, systemic constraints, the normalization of informal payments, and inequitable patient outcomes. These practices disproportionately exclude the poorest, erode trust, and stratify care along socioeconomic and gender lines. Conventional policy responses, including anti-corruption measures and nominally free care policies, fail to address underlying structural drivers. Achieving equitable UHC requires shifting from rhetorical commitments to systemic reforms in financing, workforce protection, and accountability.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to healthcare amongst adolescent girls and young women in Ugandan artisanal and small-scale mining communities.","authors":"Hanna Chidwick, Sabahat Balaban, Betty Kwagala, David Owiredu, Lydia Kapiriri","doi":"10.1186/s12939-025-02717-7","DOIUrl":"10.1186/s12939-025-02717-7","url":null,"abstract":"<p><strong>Background: </strong>Artisanal small scale-mining (ASM) provides work to many adolescent girls and young women (AGYW) in Uganda. AGYW working in ASM face a unique set of health challenges such as exposure to mercury, HIV and sexually transmitted infections. AGYW in ASM are more vulnerable since they work and live in remote areas with limited health infrastructure which may limit their access to care. However, the AGYW's access to care, including SRH care, is not well understood or documented. This paper aims to explore the current healthcare access challenges and bottlenecks amongst Ugandan AGYW working in ASM communities.</p><p><strong>Methods: </strong>The findings are part of a large study which was conducted in Busia, Mubende, and Namayingo communities, from three mining regions in Uganda. While the large study employed a mixed methods approach involving a survey with AGYW and qualitative data (in depth interviews, focus group discussions with adolescent boys, older women, and AGYW, key informant interviews with local leaders and policymakers). Data were analyzed deductively based on the Tanahashi Model on access to care.</p><p><strong>Results: </strong>Overall, AGYW working in ASM communities expressed interest in using the health care facilities to treat their illnesses and for family planning services. However, with the exception of a few, they reported various challenges they face in accessing healthcare. All participants discussed challenges such as lack of personnel at facilities, lack of youth friendly health services, limited resources, distance to facilities, cost of care, and negative provider attitudes especially towards sexual and reproductive health care for unmarried AGYW.</p><p><strong>Conclusions: </strong>Despite some availability, accessibility, acceptability, and contact coverage, the gaps in AGYW's access to healthcare highlight a critical need to avail and strengthen health systems and especially sexual and reproductive health care in ASM communities in Uganda. This will contribute to achieving UHC and ultimately health equity. Mitigating the inequities in accessing care amongst ASM AGYW involves processes such as formalization, advocacy and rights-based accountability, and leveraging existing initiatives proposed in national Ugandan health policies.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of age at type 2 diabetes diagnosis with ethnicity and socioeconomic deprivation: observational study in 11.5 million people in England.","authors":"Jonathan Goldney, Sharmin Shabnam, Mary M Barker, Jack A Sargeant, Enya Daynes, Louise M Goff, Kamlesh Khunti, Joseph Henson, Melanie J Davies, Francesco Zaccardi","doi":"10.1186/s12939-026-02924-w","DOIUrl":"10.1186/s12939-026-02924-w","url":null,"abstract":"<p><strong>Background: </strong>In England, younger individuals with type 2 diabetes (T2D) are more likely to be from minority ethnic groups and from higher levels of socioeconomic deprivation as compared to older individuals with T2D. It remains unclear whether younger individuals from these groups are at a heightened risk of T2D, or whether the observed distribution of ethnicity, deprivation, and age among those with T2D reflects that of the general population.</p><p><strong>Methods: </strong>In this cross-sectional study, we used the Clinical Practice Research Datalink to identify adults with newly-diagnosed T2D, matched to up to 5 individuals without, in England between Jan 2000-Mar 2021. We estimated the distribution of individuals with T2D across ethnic groups and deprivation quintiles by age at diagnosis, as compared to individuals without T2D. Proportion ratios were calculated by dividing the proportion with T2D from each ethnic/deprivation group by the proportion without T2D from the corresponding group.</p><p><strong>Results: </strong>We included 2,676,039 individuals with T2D and 8,987,347 without. Across age, the pattern in the proportions of individuals with T2D from each ethnic group closely resembled the patterns in individuals without T2D, although there were consistently higher proportions from Black, South Asian, and other ethnic groups, meaning that the proportion ratio of being from these groups (comparing with vs without T2D) was consistently > 1. Nevertheless, proportion ratios for Black or other ethnic groups generally increased with age, being more stable for South Asian ethnicity. The proportion ratios for White ethnicity were consistently < 1; however, the pattern was U-shaped across age. At most ages, White individuals with T2D were more likely to be from the most deprived quintile and less likely to be from the least deprived quintile compared to individuals without T2D. There was generally no associations between T2D status and deprivation in individuals from minority ethnic groups across age.</p><p><strong>Conclusions: </strong>Our findings suggest that minority ethnicity status is a consistent risk factor for T2D across all age groups, rather than being disproportionately elevated at younger ages. The varying associations between T2D and deprivation across ethnic groups requires further investigation, particularly to explore whether T2D may be underdiagnosed in individuals from minority ethnic groups who experience high levels of deprivation.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer clinical trial recruitment for patients from rural areas: a scoping review.","authors":"Patrick O'Donnell, Rose Galvin, Katie Robinson, Peter Hayes, Ruth Clifford, Niamh Peters, Deirdre Hartigan, Sarah Dillon","doi":"10.1186/s12939-026-02904-0","DOIUrl":"10.1186/s12939-026-02904-0","url":null,"abstract":"<p><strong>Background: </strong>This work will explore the literature on recruiting patients from rural and remote areas to cancer clinical trials. By examining the definitions employed, identifying levers and barriers to recruitment, and describing initiatives to promote recruitment, we seek to inform the development of future trials with these populations.</p><p><strong>Methods: </strong>A scoping review of primary research published since 2004 relating to the recruitment of patients from rural or remote areas to cancer clinical trials was conducted. The cancer could be of any type, haematological or solid tumour. A comprehensive literature search was conducted in CINAHL, PsycINFO, PubMed/MEDLINE, C2-SPECTR Campbell Systematic Reviews and Cochrane Library. All records were screened by two independent reviewers, and data on study characteristics and findings were extracted and analysed.</p><p><strong>Results: </strong>A total of 29,160 papers were identified in the searches. After screening, 27 studies met our inclusion criteria. Twenty-three of those papers focused on the context of the United States of America, with an additional three looking at Australia and one at Canada. There was no uniformity in researchers' classification of rurality, despite the existence of agreed measures. Several common levers and barriers to engagement were identified, including the distances patients must travel to cancer centres.</p><p><strong>Conclusions: </strong>Rurality is a significant challenge to the recruitment of cancer patients to clinical trials. The potential solutions are multifaceted and span the major determinants of health. Focus on the development of collaborative research networks between major academic cancer centres and rural healthcare facilities may help improve access to trials.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Service users' perspectives on primary eye care services following performance-based financing in Rwanda: an exploratory qualitative study.","authors":"Thierry Claudien Uhawenimana, Stella Matutina Umuhoza, Jean Bosco Ndayambaje, Yvonne Delphine Nsaba Uwera, Tiva Kananura, Angeline Mumararungu, Mohamed Semakula, Henry Mwangi, Hassan Mugabo, Emmanuel Ntawuyirusha, Janvier Mungarulire, Theoneste Mutsindashyaka, Donatien Ntagara Ngabo, Caroline Ndolo, James Humuza","doi":"10.1186/s12939-026-02916-w","DOIUrl":"10.1186/s12939-026-02916-w","url":null,"abstract":"<p><strong>Background: </strong>Visual impairment is a major global public health concern, disproportionately affecting populations in low- and middle-income countries (LMICs), where access to eye care services remains limited. In 2019, the Rwandan Ministry of Health integrated eye care services into the Performance-Based Financing (PBF) framework to improve accessibility, service quality, and utilization. However, service users' perspectives on this initiative remain underexplored. This study aimed to examine service users' perceptions of accessibility, quality, affordability, satisfaction, and challenges in accessing eye care services at primary healthcare facilities.</p><p><strong>Methods: </strong>An exploratory qualitative study was conducted in six purposively selected health centers in Rwanda. A total of 72 participants were recruited using maximum variation sampling, including older adults, individuals with disabilities, and participants from different socioeconomic backgrounds. Data were collected through six focus group discussions (FGDs), each comprising 8-12 participants. Discussions explored perceptions of accessibility, quality, affordability, satisfaction, and recommendations for improvement. Audio recordings were transcribed, translated into English, and analyzed inductively using Dedoose software. Trustworthiness was ensured through prolonged engagement, member checking, peer debriefing, and triangulation.</p><p><strong>Results: </strong>Participants reported that the decentralization of eye care services to health centers improved geographical access and reduced travel time. However, financial barriers remained a major constraint, particularly due to the cost of eyeglasses and certain medications not fully covered by Community-Based Health Insurance (CBHI). Users also described inconsistencies in service quality, including frequent stock-outs of essential supplies, limited equipment, and variability in the availability of eye care personnel. Despite these challenges, many participants expressed satisfaction with provider attitudes and interpersonal care, highlighting respectful and supportive interactions with health workers. At the same time, dissatisfaction was reported due to systemic inefficiencies such as limited service days, understaffing, long waiting times, and referral-related burdens.</p><p><strong>Conclusions: </strong>Findings indicate that decentralization may have contributed to improved geographic accessibility and perceived service responsiveness; however, these improvements are uneven and remain constrained by financial and system-level barriers. Addressing these barriers through expanded service packages, reliable supply chains, human resource strengthening, CBHI coverage, and community education is critical to optimize equitable eye-care delivery.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between health literacy and out-of-pocket health expenditure: exploring heterogeneity by chronic disease in Zhejiang, China.","authors":"Xuehai Zhang, Xinyu Wen, Yunfang Zhou, Mingyu Huang, Dingming Yao, Xiujing Hu, Qiaohong Lv, Chun Chen, Yuya Song","doi":"10.1186/s12939-026-02913-z","DOIUrl":"10.1186/s12939-026-02913-z","url":null,"abstract":"<p><strong>Background: </strong>Health literacy has been increasingly emphasized as a critical factor shaping healthcare behaviors and costs. However, empirical evidence on its association with out-of-pocket (OOP) health expenditure remains complex, and little is known about how this relationship varies by chronic disease status. This study aimed to identify distinct health literacy profiles within a large Chinese population, examine their associations with OOP expenditure, and explore how these associations vary by chronic disease status.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using data from a large-scale health literacy survey of 56,863 residents aged 15-69 in Zhejiang, China. Latent profile analysis (LPA) identified health literacy subgroups using the validated Chinese Health Literacy Scale. A Two-Part Model was employed to decompose expenditure into the probability of incurring costs and expenditure intensity. Stratified analyses were conducted to examine variation across chronic disease status.</p><p><strong>Results: </strong>LPA identified three health literacy profiles with weighted proportions of: Relatively High (61.45%), Moderate (26.54%), and Low (12.01%). The analysis revealed an inverted U-shaped trajectory. The Moderate group exhibited significantly higher total OOP expenditure than the Low group (AME = 554.71 CNY, P < 0.05), driven primarily by elevated expenditure intensity. Conversely, the Relatively High group showed no significant difference (P > 0.05), indicating expenditure levels comparable to the baseline. Interaction analysis suggested potential heterogeneity by chronic disease status (P for interaction = 0.053, in Part 2), which prompted exploratory stratified analyses. Among those with one chronic disease, the Relatively High group showed higher probability of incurring expenditure (Part 1, P < 0.01) but significantly lower expenditure intensity (Part 2, P < 0.05). However, this association was not statistically significant among those with multimorbidity.</p><p><strong>Conclusions: </strong>The findings indicate that health literacy is associated with expenditure in a non-linear pattern. While higher literacy maintains expenditure at baseline levels, exploratory analyses suggest this protective effect may be attenuated under high disease burden. To enhance both equity and efficiency, policy strategies should focus on cultivating decision-making capabilities for appropriate healthcare utilization among general populations and strengthening financial protection for those with complex needs.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward inclusive healthy ageing: a systematic review of equity in healthy ageing interventions.","authors":"Chava Kurtz, Odelia Ben Harush, Anna Zisberg, Paola Buedo, Stuart McLennan, Efrat Shadmi","doi":"10.1186/s12939-026-02905-z","DOIUrl":"10.1186/s12939-026-02905-z","url":null,"abstract":"<p><strong>Background: </strong>Health inequities arising from social determinants such as income, education, gender, and socioeconomic status profoundly affect disease burden and ageing outcomes. Despite global efforts to promote equitable healthy ageing, substantial gaps remain. This systematic review examined how equity-related factors, defined by the PROGRESS framework: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, are incorporated into evaluations of healthy ageing interventions and how outcomes vary across these dimensions.</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus were searched from database inception through August 12, 2024, for quantitative evaluations of healthy ageing interventions.</p><p><strong>Results: </strong>Of 5,892 screened studies, 66 met inclusion criteria, most published after 2018 and involving older adults (mean age 71.4 years). The most frequently reported PROGRESS factors were gender/sex (N = 66, 100%), education (N = 49, 74%), and race/ethnicity (N = 38, 58%). Twenty-five studies (38%) reported PROGRESS-related data without analysing outcomes by PROGRESS factors, whereas 41 studies (62%) analysed intervention outcomes by at least one PROGRESS dimension. Across 254 extracted outcome results, 98 (38.6%) suggested decreased inequity, 146 (57.5%) were non-significant, and 10 (3.9%) suggested increased inequity. Physical activity interventions were the most frequently studied and showed the largest number of favourable findings, whereas social connectedness interventions showed the highest proportion of unfavourable outcomes. Intersectional analyses were rare, and only six studies examined more than one PROGRESS dimension jointly.</p><p><strong>Conclusions: </strong>Equity considerations are increasingly present but remain inconsistently integrated into healthy ageing intervention research. Greater attention to underrepresented PROGRESS dimensions, improving standardised equity reporting, and expanding intersectional analyses is needed to ensure interventions contribute to reducing, rather than reinforcing, inequities.</p><p><strong>Registration: </strong>The protocol was registered with PROSPERO (CRD42024585709) before the final search.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-oriented leadership and health equity: the role of NGO support in advancing public health policy and nutritional literacy.","authors":"Muhammad Zada, Shagufta Zada, Nicolás Contreras-Barraza, Alejandro Vega-Muñoz","doi":"10.1186/s12939-026-02896-x","DOIUrl":"10.1186/s12939-026-02896-x","url":null,"abstract":"<p><p>Leadership initiatives are increasingly recognized as crucial drivers of policy implementation, well-being, and nutritional literacy. However, the relationship between health-oriented leadership, healthcare policy, community well-being, and community nutritional literacy remains underexplored. With increasing awareness of health and nutrition in developing countries, this study explores the role of Health-Oriented Leadership (HOL) in the implementation of human health policies, well-being, and nutritional literacy. Based on a multi-source, multi-wave survey of 355 management personnel and 360 community and stakeholder personnel in Pakistan, this study highlights the cross-level trickle-down effect of health-oriented leadership. The proposed model was tested using qualitative methods, and for analysis, this study employed multilevel structural equation modeling and regression analysis to examine direct, mediating, and moderating effects. Drawing on the human needs theory, our findings show that health-oriented leadership positively impacts the implementation of public health policy and fosters well-being and nutritional literacy in communities. Furthermore, NGO support (NS) moderates the relationship between health-oriented leadership and the execution of healthcare policy. This research is innovative and the first to examine HOL's role in implementing public health policy with NGO backing, promoting well-being, and enhancing nutritional literacy within communities. It makes a valuable contribution to the literature on nutrition and health management by providing practical insights for governments, NGOs, and community stakeholders seeking to implement leadership strategies that protect community health and promote initiatives for a balanced diet and improved living standards.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Country-level determinants of healthcare access for refugee populations in a host country: a comparative case study.","authors":"Sarah Yeo, SeYeon Kim, Gohtbyeol Kim, Pratibha Bhandari, Angela Dawson","doi":"10.1186/s12939-026-02915-x","DOIUrl":"10.1186/s12939-026-02915-x","url":null,"abstract":"<p><strong>Background: </strong>Given the unprecedented global volume of forced migration, ensuring equitable access to healthcare for refugees has become a pressing global health priority. This comparative case study examined country-level determinants that influence healthcare access and social determinants of health among refugees in Australia, South Korea, and the United States.</p><p><strong>Methods: </strong>We conducted a comparative case study to identify country-level factors influencing refugee healthcare access in Australia, South Korea, and the United States. Countries were selected to capture diversity in geographic context, immigration and integration policies, and healthcare system structures. Data sources included a comprehensive review of laws, policies, and peer-reviewed literature, as well as in-depth interviews with refugees, healthcare providers, resettlement agency staff, and legal professionals. We used framework analysis guided by a conceptual model, incorporating both deductive and inductive coding. This study focused on cross-case themes emerging from the synthesis of all data sources.</p><p><strong>Results: </strong>Findings revealed that, while refugees in all three host countries generally view health services as superior to those in their countries of origin, significant disparities persisted in access across various factors. The availability of culturally and linguistically appropriate care, legal frameworks, insurance systems, and social supports varied widely, contributing to health disparities. In the United States, complex healthcare navigation and insurance gaps posed substantial barriers, while in South Korea, legal mandates for interpretation services were lacking, and health insurance coverage was limited for certain refugee groups. Australia's universal health coverage and government-funded language and interpretation services supported more inclusive access, although barriers existed for vulnerable subgroups.</p><p><strong>Conclusions: </strong>This study underscores the significance of national policies, culturally competent care, and long-term integration support in promoting health equity for refugees. It also highlights the need for targeted, context-sensitive strategies to address persistent barriers and calls for better-tailored policies to support the health and well-being of refugees in host countries and beyond.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women medical missionaries in Kashmir from the late 1800s to the early 1900s.","authors":"Hilal Ahmad Tantray","doi":"10.1186/s12939-026-02901-3","DOIUrl":"10.1186/s12939-026-02901-3","url":null,"abstract":"<p><p>Female medical missionaries significantly contributed to the advancement of healthcare practices in colonial Kashmir, especially in women's healthcare, nursing, midwifery, and medical outreach. This article analyzes the role of female medical missionaries in the development of institutional healthcare in Kashmir from the late nineteenth to the early twentieth centuries. It inquires how missionary women navigated local social and cultural obstacles, including gender norms and purdah regulations, to enhance access to medical care for Kashmiri women. The study examines the convergence of medicine, gender, and colonial action in the region by utilizing missionary records, official reports, travelers' accounts, and secondary historical sources. The research contends that female medical missionaries not only introduced Western medical methods but also influenced new modalities of public health involvement through dispensaries, prenatal care, nursing services, and medical education. The study contextualizes its findings within the extensive history of medicine in Kashmir, emphasizing the gendered aspects of healthcare evolution and the frequently neglected role of women in the region's medical narrative.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}