Voices of inequality: a qualitative exploration of barriers and perceptions in achieving health equity
By: Jatoveda Haldar
Cite: Haldar, J. (2024). Voices of inequality: A qualitative exploration of barriers and perceptions in achieving health equity. Journal of Ethics, Equity and Empowerment, Indian Institute of Industrial and Social Research. https://doi.org/10.17632/wpwskv3thr.1
ABSTRACT
Purpose: This study explores how intersecting social identities shape experiences of health inequity, focusing on rural communities, immigrant families, and low-income women managing chronic illnesses. This study sought to understand the barriers, perceptions, and resilience strategies in pursuit of equitable healthcare.
Design/methodology/approach: This study adopts a qualitative, case-based design underpinned by intersectionality theory. Data were drawn from semi-structured interviews (n = 12), three focus groups, and relevant policy documents. Thematic analysis, combining deductive and inductive coding, was conducted to capture both the structural barriers and lived experiences of inequity.
Findings: Three themes emerged: (1) systemic exclusion and bureaucratic barriers, (2) perceived inequities in treatment and quality of care, and (3) resilience and adaptive strategies. Rural participants reported geographic isolation and invisibility in health planning; immigrant families encountered language exclusion, documentation barriers, and stereotyping; and low-income women faced financial constraints and dismissive clinical encounters. A unifying thread was systemic invisibility, with participants consistently perceiving their needs as deprioritized by health systems. Resilience strategies, such as pooled transport, diasporic networks, and peer support, were vital but framed as coping responses to systemic neglect.
Research limitations/implications: The case-based design prioritizes depth over statistical generalizability. The findings reflect specific contexts, although they offer transferable insights into the patterned nature of health inequities. Future research should adopt mixed-methods or longitudinal designs.
Practical implications: Health systems should embed intersectional sensitivity in policy and practice, institutionalize participatory decision-making, and strengthen culturally competent care to address systemic invisibility in healthcare.
Social implications: Achieving health equity requires shifting responsibility from marginalized groups back onto systems, ensuring structural accountability rather than reliance on community resilience alone.
Originality/value: By comparing three distinct contexts through an intersectional lens, this study demonstrates how inequities emerge in context-specific, but structurally patterned, ways. It highlights systemic invisibility as a cross-cutting driver of inequity, providing actionable insights for health policies and practices.
