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By Grace, Catherine, Zichen, Akhil, Rishi


Structural barriers are policies, practices, and norms that collectively and disproportionately disadvantage a marginalized group while perpetuating disparities in health, social, educational, and other outcomes. In this collection, we focus on structural barriers to health, which include a wide range of challenges, such as location, language, and migrant status. Several oral histories reinforce and support the idea that structural barriers to healthcare work to support a larger system of inequity and disparity and prevent marginalized communities and peoples from accessing high quality healthcare and achieving well being.

Communication barriers are one such structural barrier within the healthcare system, primarily driven by inadequate language proficiency and poor communication skills, and they are rooted in healthcare-related education, politics, and economic systems. These obstacles can significantly affect the already limited health literacy among patients, negatively impacting the quality and accessibility of healthcare. Andrea Williams-Morales, an administrative assistant at CommWell, discusses the mental strain faced by non-native patients dealing with communication barriers, highlighting their impaired health literacy and worsening mental well-being. Lisa McKeithan, the Program Director for Positive Life, talks about the ways physicians’ communication skills, especially the use of jargon, exacerbate patients’ health literacy and lead to poor accessibility of healthcare. She highlights education as a privilege for understanding medical information while discussing the significance of physicians’ communication skills in controlling HIV pandemics and reducing the stigma surrounding HIV.

Immigration status in the US further serves as a barrier to health and well-being since it often exacerbates preexisting structural barriers such as language of services and materials, insurance access, costs and payment methods, and proximity to care. Andrea Williams-Morales discusses her experience growing up as the child of migrant farm workers as well as her lack of insurance and primary care when she was younger. The structural nature of legal status stems from the fact that many systems put in place to ensure health and well being exclude migrants, especially those without documentation.

Physical location also plays an important role in healthcare access and maintenance. It not only determines proximity to a healthcare provider or consistent care, but it also often necessitates transportation, determines environmental impacts, and decides preventative healthcare access. Leslie Rummage, an educator from Misenheimer, NC, talks about prominent health problems in her community, such as lung cancer, resulting from poor air quality and environmental issues.

Food access is another structural barrier to health and well being, and food deserts lead to less healthy communities and increased rates of disease. Jennie Franklin, an educator in Warrenton, NC, discusses the lack of grocery stores and healthy foods nearby. Carla Norwood, a business owner also hailing from Warrenton, similarly laments the lack of affordable healthy options and the difficulty that many community members face in terms of traveling for produce. Both women go on to discuss the negative impact that a lack of healthy options has on their communities, demonstrating the significance that food access has on healthy behaviors and well being.

Perceived barriers by physicians, such as financial barriers and rurality, exacerbate health issues and delay timely interventions, posing challenges for physicians in delivering comprehensive care. George Cosmos, a retired obstetrician-gynecologist, discusses his personal experience with being a healthcare patient and his experience as a healthcare provider. He retrospects barriers he faced as a patient and then dives into barriers faced by his patients in rural North Carolina, which include a lack of informed consent and a lack of healthcare resources.

Ultimately, barriers to health and well being include a variety of systemic challenges that both originate from and perpetuate societal disparities and flaws in the healthcare system. In this collection of essays, this group explores the ways inadequate food access, physician attitude towards healthcare, legal status, medical literacy, and rural residential status impede certain individuals’ abilities to access high quality healthcare and achieve positive health outcomes.

Student Essays

The Structural Challenges of Geographic Barriers to Healthcare

Physical location affects how and how much healthcare access individuals can get. The study of these location-based, geographic barriers, in our contemporary healthcare system reveals immensely important underlying structural challenges that hinder adequate care access. North Carolina has the second … Read more

Immigration Status as a Barrier to Healthcare and Well-being: Migrant Stories in the Rural South

The United States foreign-born population totals 46 million people, the largest globally. While 53% are naturalized citizens, the other nearly 47% hold a migrant status (1). While this number is the highest it has ever been, migration to the United … Read more

Physicians’ Perceived Barriers to Healthcare

Access to healthcare is essential for promoting health and well-being, yet numerous barriers hinder an individual’s ability to obtain timely and effective healthcare services. Understanding perceived barriers to healthcare by physicians is important, as it sheds light on factors that … Read more

Food Access as a Structural Barrier to Health and Wellbeing

Introduction Food deserts are residential areas classified as having poor access to healthy and nutritious food. The existence and establishment of food deserts in the United States correlates with race and socioeconomic status, resulting in health outcome disparities across different … Read more

Health Literacy’s Impact on Accessibility to Healthcare and Well-being

Communication barriers represent a significant structural barrier within the healthcare system, driven primarily by two critical factors: patients’ language proficiency and healthcare providers’ communication skills. Effective communication is essential for ensuring that patients possess the necessary health literacy to understand … Read more