When geographic proximity and access to medical services is not enough

Although many health determinants are outside of the health care sector, quality health care is crucial to population health.  Recently, we included a look at perceptions of local health care as part of a community needs assessment (https://beh.columbia.edu/community-needs-assessment/) in Rio de Janeiro’s third largest favela.  At the time of collecting data in 2015, only a geographic area with approximately 40% of the population was covered by the local family health clinic, and we thus expected that those outside of the coverage area might perceive greater barriers to care.

Family health clinic service area

However, when talking about public health care with residents during 14 semi-structured interviews, our colleague Débora Castiglione noted other salient concerns.  She led the qualitative analyses and coauthored with Dr. Lovasi a paper just published in Qualitative Health Research.  This paper highlights that residents felt disrespected or dehumanized in the process of seeking health care from the public system.  Substantial delays and appointments missed due to the doctor’s absence were perceived as exacerbating vulnerability faced by pregnant women or during injury recovery, extending periods of uncertainty, elevated risk, or disability.  Even in the face of scarce financial resources, residents would pay for private care if they could, in order to get timely care and feel well-received.


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