Inequalities In Access Research Articles

Setting priorities in outpatient cardiovascular care to guarantee equitable access: the case of Tuscany region

Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.

Perspectives on telemedicine across urban, rural and remote areas in the Philippines during the COVID-19 pandemic

ObjectivesThis study explored attitudes, subjective norms, and perceived behavioural control of participants across urban, rural and remote settings and examined intention-to-use telemedicine (defined in this study as remote patient–clinician consultations)...

Operational recommendations for the implementation of home parenteral nutrition program of care according to the guidelines of the European society for clinical nutrition and metabolism

Home parenteral nutrition (HPN) is a complex therapy, which requires dedicated facilities and expertise. However, the management and provision of HPN differs significantly between countries and between HPN centers within countries. These differences lead to heterogeneity in the quality of care received by patients, with variable impact on the appropriateness, safety, and effectiveness of HPN, and resultant variability in the quality of life that a patient may expect.The European Society for Clinical Nutrition and Metabolism (ESPEN) have published guidelines on the appropriate and safe provision of HPN, with an associated practical version describing a short and precise way to implement the guidelines’ recommendations in clinical practice.This educational paper suggests means of implementation of evidence supported HPN guidelines, using “operational recommendations” applitngto healthcare professionals, administrators and stakeholders, with the ultimate aim of enhancing equity of patient access to an appropriate and safe HPN program of care.

Equitable Access to Genomic Molecular Testing for Australian Cancer Patients: Insights from the Victorian Precision Oncology Summit.

The Victorian Precision Oncology Summit, convened in 2023, was a joint initiative between the Victorian Comprehensive Cancer Centre Alliance (VCCC Alliance) and the Monash Partners Comprehensive Cancer Consortium (MPCCC) and was proposed to guide a coordinated state-wide conversation about how the oncology sector can overcome some of the current obstacles in achieving equity of access to clinical cancer genomics for Victorian patients. Themes that emerged from discussion groups at the Summit include standardisation, centralisation, funding, education and communication and insights across those themes are outlined in this manuscript. The event served as a large consultation piece for the development of a broader precision oncology roadmap, which explores equitable access to molecular testing for Victorian patients, currently in development by the VCCC Alliance and MPCCC in collaboration with other key Victorian and national stakeholders. While this symposium was a Victorian initiative, it is felt that the insights garnered from this consultation piece will be of interest to consumer groups, clinicians, researchers, educators, policy makers and other key stakeholders in other states of Australia as well as in other countries implementing comprehensive genomic profiling within complex health systems.

Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review.

Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women's Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic's policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available.

State inequities: Gaps in planned treatment for criminal legal referrals with opioid use disorder across two decades of US treatment admissions.

Criminal-legal (CL) referrals to addiction treatment have historically had low utilization of medications for opioid use disorder (MOUD). While state differences have been reported, an in-depth longitudinal analysis of state-by-state differences is lacking. The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset-Admissions 2000-2020 provided data for individuals entering their initial treatment with an opioid as their primary substance. Outcome was planned use of MOUD, assessing odds ratio (OR) of CL referrals relative to non-CL referrals cumulatively over the 21-year period and as incremental change (change in relative disparity) using effect sizes, stratified by each state. 2,187,447 cases met the criteria. Planned MOUD occurred in 37.7% of non-CL clients versus 6.5% of CL clients (OR = 0.11, 95% confidence interval = 0.11-0.12). For all clients, planned MOUD increased from 2000 (33.9%) to 2020 (44.8%). This increase was blunted within CL clients, increasing from 2000 (6.4%) to 2020 (13.3%). Rhode Island saw the greatest improvements in equity. While rates of planned MOUD increased over the 21 years, a significant disparity persisted among CL clients in most states. As opioid use disorders and opioid-related overdoses are more prevalent among those involved with the CL system, improving this has high impact. Provides the most comprehensive analysis of state-by-state inequities in MOUD access for CL relative to non-CL referrals over a 21-year period through use of a national data set. Positive outliers are used as case examples for others to follow in pursuit of more equitable care.

Modeling Gender Gap in Access to Empowerment and Agricultural Productive Resources: Evidence from Farming Households in Kaduna State

This research examined gender access to empowerment and agricultural productive resources with a gender dimension. Respondents were selected with random and stratified sampling techniques. Primary data were generated through the administration of well-structured questionnaire. Generated data were analyzed with descriptive statistics, Women Empowerment Index (WEI), Global Gender Parity Index (GGPI) and Gini Inequality Index (GII). The result shows that 37% and 60.20% of women and men had access to empowerment programmes respectively in the study area. WEI result showed that women had low access to empowerment variable (WEI = 0.67), the GGPI revealed that women (GGPI = 0.63) had low parity as against the men (GGPI = 0.77) with higher parity index. Furthermore, the Gini Inequality Index that there is inequality in access to agricultural productive resources between men (GII = 0.286) and women (GII = 0.383). The research concluded women had low empowerment and low access to agricultural productive resources as against the men. The research recommended that government programmes should be mainstreamed to ensure that more women have access to them and the extension department should design their programmes to ensure that more women have access to extension services in the study area.

Sociodemographic Differences in Nonfinancial Access Barriers to Health Care Among Adults: United States, 2022.

Nonfinancial access barriers to care describe various reasons why adults may delay or not get medical care, beyond cost. This report focuses on five access barriers to care and describes the percentage of U.S. adults who delayed or did not get medical care in the past 12 months because of 1) being too busy with work or other commitments; 2) an appointment not being available when needed; 3) not being able to get to the doctor's office or clinic when open; 4) difficulty finding a doctor, clinic, or hospital that would accept their health insurance; and 5) it taking too long to get to the doctor's office or clinic from their house or work. Data from the 2022 National Health Interview Survey were used to produce estimates of the percentage of adults who delayed or did not get medical care in the past 12 months because of those access barriers to care, overall and by selected sociodemographic characteristics. Among U.S. adults in 2022, 12.5% delayed or did not get medical care in the past 12 months because they were too busy to go to a provider, 10.6% could not find an available appointment when needed, 4.6% were unable to get to a provider when open, 4.4% had difficulty finding a doctor compatible with their health insurance, and 2.4% responded that it takes too long to get to a provider. Percentages varied by sociodemographic characteristics. This study provides nationally representative estimates of selected nonfinancial access barriers to medical care, both overall and for selected sociodemographic groups. Findings suggest that nonfinancial access barriers to care are widespread in the United States, and ongoing monitoring may help to address inequities in access to care.

Young people's views and experience of diet-related inequalities in England (UK): a qualitative study.

Inequalities in diets contribute to overall inequalities in health. Economic inequality and inequalities in access to healthy food are key drivers of poor diet and ill health among young people (YP). Despite mounting evidence of structural barriers to healthy eating, less is known about how YP view and experience these inequalities where they live, and how to address them. To explore YP's perspectives on the drivers of diet-related health inequalities, we conducted three interlinked focus groups with YP aged 13-21 years from six youth groups across three geographical areas in England. We analysed the data inductively and deductively using reflexive thematic analysis and generated themes by examining how social structure, context and agency interact and impact YP's diet. YP were aware of how inequalities in employment conditions impact their families' income and ability to eat a healthy diet. They cited the high availability of hot food takeaways in their local areas as a significant barrier to healthy eating but did not support closing or restricting these outlets. They held strong views on policies to tackle diet inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Our study showed that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities. However, further efforts are needed to shape and promote policies that resonate with YP and address both their health and wider social concerns.

A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English

To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English. We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent. 125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001). Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.

Stakeholder Theory, Public Engagement, and Epistemic Injustice: The Case of Covid-19 Vaccine Hesitancy in Scotland’s African, Caribbean, and Black Communities

The adoption of a stakeholder approach to public engagement within the public sector has been extensive. However, there remain critical gaps in the understanding of stakeholder participation arising from hidden disparities that contribute to unequal access to communication channels, information, and hence ultimately knowledge and decision making. The term “epistemic injustice” has been used to describe such inequality of access and consequently, the outcome that ensues. Epistemic injustice is much overlooked in stakeholder theory. This article shows how epistemic injustice can act as a barrier to effective stakeholder engagement and hence to successful public policy formulation and implementation. We use the case of vaccine hesitancy among Scotland’s African, Caribbean, and Black (ACB) communities to illustrate this problem of unequal participation. The study drew on primary data involving 85 participants and secondary data sources from extant literature and explored salient factors shaping barriers to vaccine uptake during the recent pandemic. The findings demonstrate how the failure to grasp epistemic injustice undermines the effectiveness of the stakeholder approach, even with the most well-intentioned efforts. We argue that epistemic injustice is a critical barrier to effective stakeholder approaches.

Getting It Right First Time (GIRFT) – implementation of GIRFT and MedTech Funding Mandate policy around minimally invasive surgery for BPH in the UK

The MedTech Funding Mandate (MTFM) policy was introduced in 2021 by the National Health Service (NHS) England, to facilitate the adoption of innovative, cost-saving medical technologies approved by the National Institute for Health and Care Excellence (NICE) within the NHS. This policy aligns with the objectives of the Getting It Right First Time (GIRFT) initiative, which aims to improve clinical effectiveness by reducing unwarranted variations in healthcare practices. In April 2022, the MTFM policy included four technologies for the treatment of bladder outlet obstruction (BOO). These technologies offer clinical effectiveness, resource efficiency, and affordability, as recommended by NICE. Despite the availability of NICE-approved minimally invasive surgical treatments (MISTs) for BOO, transurethral resection of the prostate (TURP) remains the commonest surgical treatment for BOO, although there is debate as to whether this remains the gold-standard of care. The inclusion of the four BOO technologies in the MTFM policy aims to address the existing inequalities in patient access to NICE-approved treatments and support the adoption of these effective alternatives to monopolar TURP. Key stakeholders, including GIRFT, Urology Area Networks (UANs), and the 15 Academic Science Networks (AHSNs), play a crucial role in implementing the MTFM policy. The policy has significant implications for clinical practice, promoting pathway transformation, resource and cost savings, and a comprehensive range of treatment options for patients with BOO.

Promise and Perils of Primary HPV Testing.

Cervical cancer screening has reduced morbidity and mortality in many countries, but efforts to optimize screening modalities and schedules are ongoing. Using data from a randomized trial conducted in British Columbia, Canada, in conjunction with a provincial screening registry, Gottschlich and colleagues demonstrated that the estimated risk for precancerous disease (cervical intraepithelial neoplasia grades 2 or worse) at 8 years following a negative human papillomavirus (HPV) test was similar to the current standard of care (Pap testing after 3 years). The study supports extending screening intervals for those with a negative HPV test beyond currently recommended 5-year intervals. In an ideal world, the resources saved through less frequent routine cervical screening could be redirected to increasing screening uptake and follow-up of abnormalities to improve equity in cervical cancer prevention. However, implementation of extending screening intervals remains less than straightforward in settings with fragmented healthcare systems that lack information systems to support patient call/recall, such as the United States. To achieve the full promise of primary HPV testing, stakeholders at every level must commit to identifying and addressing the diverse spectrum of barriers that undergird existing inequities in care access, appropriately resource implementation strategies, and improve health information systems. See related article by Gottschlich et al., p. 904.

Bringing Care Close to Home: Remote Management of Heart Failure In Partnership with Indigenous Communities In Northern Ontario, Canada

BackgroundThe Weeneebayko Area Health Authority (WAHA) is a regional, community-based Indigenous health authority in Northern Ontario, Canada. From September 2022 to March 2023, the WAHA and University Health Network engaged in a partnership that designed a collaborative model of care to address inequities in cardiology specialist access in Northern Ontario. This model implemented a digital therapeutic for heart failure, (the Medly program) and in-person cardiology clinics in the region. MethodsA WAHA-based Medly program clinical coordinator worked closely with the University Health Network team to deliver care and support patient self-management of HF. The use and effectiveness of the Medly program were tracked through app usage and rules-based algorithm alerts, based on patient self-reported data. Distribution of relevant equipment (a scale, a blood pressure cuff, and a mobile device) for the Medly program was recorded. Surveys to assess patient and provider satisfaction with the Medly program also were administered. A retrospective chart audit of electronic medical records and administrative databases was conducted. ResultsA total of 33 patients in the WAHA were enrolled in the Medly program during a 7-month period, surpassing the enrollment goal of 25 patients. A total of 93% of eligible patients were on optimized guideline-directed medical therapy or were being titrated for it. Of 15 surveyed patients, 100% agreed or strongly agreed that the Medly program facilitated delivery of care close to home, and 86% of surveyed clinicians (n = 7) agreed or strongly agreed that the Medly program addresses a gap in available care in the region. ConclusionsThe implementation of the Medly program in partnership with the WAHA has demonstrated success in terms of the volume of referrals, the quality of care, adherence to evidence-based best-practice guidelines, and satisfaction with the program.

Systemic inequalities in heat risk for greater London

The temperature rise and increases in extreme heat events related to global climate change is a growing public health threat. Populations in temperate climates, including the UK, must urgently adapt to increased hot weather as current infrastructure primarily focusses on resilience to cold. As we adapt, care should be taken to ensure existing health inequalities are reduced. Lessons can be learned from regions that experience warmer climates and applied to adaptation in the UK.We identified known indicators of heat-health risk and explored their distribution across area level income for London. Understanding these indicators and their distributions across populations can support the development of interventions that have the dual aim of improving health and reducing inequalities. An exploratory analysis was conducted for each indicator at neighbourhood level to assess existence of disparities in their distributions across London. A systems-thinking approach was employed to deduce if these amount to systemic inequalities in heat risk, whereby those most exposed to heat are more susceptible and less able to adapt. Using this information, we proposed interventions and made recommendations for their implementation.We find inequalities across indicators relating to exposure, vulnerability, and adaptive capacity. Including inequalities in urban greening and access to greenspace, physical and mental health and access to communication and support. Through a system diagram we demonstrate how these indicators interact and suggest that systemic inequalities in risk exist and will become more evident as exposure increases with rising temperatures, depending on how we adapt. We use this information to identify barriers to the effective implementation of adaptation strategies and make recommendations on the implementation of interventions. This includes effective and wide-reaching communication considering the various channels and accessibility requirements of the population and consideration of all dwelling tenures when implementing policies relating to home improvements in the context of heat.

Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity.

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.

Eliminating Health Care Access and Quality Inequities in Sickle Cell Disease: Policy Lessons from the End Sepsis Initiative

Abstract: Sickle cell disease is a prime example of the devastating impact of healthcare inequities. The End Sepsis Initiative developed after a tragic death due to sepsis, provides a powerful model for the sickle cell community. This model recognizes the importance of evidence-based protocols and policy recommendations/mandates to drive transformative systems change. We propose that the sickle cell community mirror this approach. We propose that hospital systems, healthcare organizations, and insurers implement evidence-based protocols, including personalized pain plans, stigma reduction through staff training, vaccinations, preventative screening, disease-modifying therapies, pediatric to adult transition, and connecting unaffiliated SCD patients to a medical home. We recommend state-level interventions, such as using SCD navigator in electronic health records for quality reporting, supporting community health workers' use, and ensuring rural hospitals have access to SCD specialists.

Disparities in availability of new cancer drugs worldwide: 1990-2022

IntroductionDespite progress in the development of new cancer drugs, concerns about equity of access remain. This study aimed to examine the availability and timeliness of availability of new cancer drugs...

Synergistic evaluation of energy security and environmental sustainability in BRICS geo-political entities: An integrated index framework

Research background: The increasing demand for energy, driven by economic growth and population expansion, is a critical driver of societal progress. However, the predominant reliance on fossil fuels to meet this demand presents significant challenges, particularly in the rapidly developing BRICS nations (Brazil, Russia, India, China, and South Africa). These countries are faced with a complex interplay of energy security and environmental sustainability issues, stemming from their substantial fossil fuel reserves and the associated environmental consequences. The challenges manifest as inequalities in access to clean energy, environmental degradation, and heightened vulnerability to the impacts of climate change. Addressing these multifaceted issues requires a comprehensive approach. Metrics-based strategies, which employ aggregated indices derived from a diverse set of energy and environmental indicators, have the potential to provide valuable insights into these complexities. However, the development of a universally applicable energy sustainability index is complicated by the heterogeneity of metrics, disparities between countries, and methodological challenges, emphasizing the need for an innovative and holistic analytical framework. Purpose of the article: This study aims to develop a tailored Energy Security and Environmental Sustainability Index for BRICS economies to evaluate the robustness of their energy systems and the viability of their ecological practices. The index serves as an instrument to assess the progress of these nations in the Energy and Environment domain and identify areas that require targeted interventions and improvements. Methods: The construction of the composite ESESI involves the selection of relevant parameters and the application of a Multi-Criteria Decision Analysis (MCDA) framework in conjunction with the Weighted Product Method (WPM). To ensure objectivity in the determination of optimal and least favorable weights for each indicator, the study employs the Multiplicative Data Envelopment Analysis (MDEA) model. Findings &amp; value added: The ESESI analysis reveals disparities in the progress made by BRICS nations in enhancing energy security, promoting renewable energy deployment, and mitigating environmental impacts. While some countries demonstrate substantial advancements, others face challenges in improving energy efficiency and reducing carbon emissions. The study underscores the necessity for tailored policies and targeted infrastructural enhancements that align with the unique challenges and strengths of each nation. Harnessing the abundant renewable energy potential through advanced energy trade mechanisms and fostering cross-border investments are identified as crucial strategies for ensuring environmental sustainability and long-term energy in the BRICS region. The ESESI provides a valuable tool for policymakers and researchers to evaluate the progress of BRICS nations in achieving sustainable energy goals and to inform evidence-based decision-making processes. By offering a comprehensive and scientifically rigorous assessment framework, this study contributes to the ongoing discourse on sustainable energy transitions and environmental stewardship in the context of rapidly developing economies.

Impacts of COVID-19 shelter in place across key life domains among immigrant farmworker Latina mothers and young adults

ObjectiveIndividuals and families from racial and ethnic groups experience social and economic disadvantage making them vulnerable to the disproportionate impact of the COVID-19 pandemic. This study sought to capture the impacts of Shelter in Place (SIP) across key life domains including family life, education, work, mental health, and coping strategies among a sample of Mexican-origin mothers who were currently engaged in agricultural work, or whose spouses were engaged in agricultural work, and young adults who had a parent working in agriculture.MethodDuring the summer of 2020, while California was under SIP orders, we conducted three virtual focus groups using Zoom(r). We recruited focus group participants from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), an ongoing, 20-year, longitudinal cohort study of Mexican-origin families in a predominantly agricultural area of California. Three focus groups were conducted with mothers (n = 9), mean age = 48 years, young adult women (n = 8) and young adult men (n = 5), mean age = 18 years, respectively.ResultsMothers reported high levels of stress stemming from fear of Covid-19 infection, work instability and financial concerns, children’s schooling, anxiety about an uncertain future, and the demands of caretaking for dependents. Adverse mental health impacts were particularly pronounced among participants experiencing multiple adversities pre-dating the pandemic, including unemployment, single motherhood, and having undocumented family members. For young adults, work instability and varying work hours were also a source of stress because they made it difficult to make decisions about the future, such as whether to attend college or how many classes to take. Families used coping strategies including expressing gratitude, focusing on what’s under one’s control, familismo, and community engagement to manage mental health challenges during SIP.ConclusionIn the event of future pandemics or disasters, particular attention is needed to those who experience unemployment, are undocumented and/or have undocumented family members, and/or are single parents facing economic adversity. During public health emergencies, action at the local, state, and national level is needed to support farmworkers and other vulnerable groups’ secondary major stressors stemming from inequities in access to affordable housing, childcare, living wages, healthcare, and other benefits.