For Women Who Live On The Margins, Health Care Is Often Out Of Reach. Here’s How We Can Build A Bridge To Access

Most Canadians either know personally or are aware that getting an appointment with a family doctor can be difficult. Across the country, it’s estimated that 6.5 million people do not have a family doctor or nurse practitioner they see regularly.

For women who live on the margins — those experiencing poverty, racism, trauma, care-giving stress or unstable housing — the barriers to care are even greater.

From adolescence through to mid-life, such women often put their own health needs last. Even if they have a family doctor, the structural realities of care — uneven geographical access, long waits, limited appointment slots and rigid scheduling systems — are difficult for most people to navigate. For women with limited resources of income, time and agency, the barriers to access are, too often, insurmountable.

Life satisfaction is lower among women in Canada than men, and serious conditions such as cardiovascular disease, cancer or reproductive health problems are often diagnosed late. For many women, cultural norms may make it difficult to raise issues such as sexual health, contraception or depression within a 15-minute medical visit, especially if they lack language or gender concordance with their family doctor.

The World Health Organization (WHO) estimates that primary care can deliver more than 90 per cent of essential health services, but only if people can access it. For women who live on the margins, gaining this access is difficult.

Real-world needs not met

In 2023, the federal government’s agreement with the provinces committed to expanding access to family health services, especially in rural and remote areas, and to supporting health workers while reducing backlogs.

Under this plan, Ontario was designated receive $2.5 billion between 2023 and 2026 to strengthen family health services, including $90 million specifically to expand inter-professional primary care teams in high-need communities and to help existing teams manage rising costs.

Ontario’s Primary Care Action Plan has committed to incentives and investments to improve rates of attachment to team-based primary care. But it’s not clear if these can overcome the barriers for marginalized women.

There are other forces that impact the availability of access to family physicians. Studies from the United States indicate that if primary care physicians followed every preventive and chronic-care guideline, they would need 27 hours a day — more than half of that devoted to prevention alone.

The system as designed may not be able to meet the real-world needs of patients, especially those with complex social and health circumstances.

A bridge to access: Learning from global innovation

Women on the margins often experience stigma, mistrust and have a scarcity mindset, and are unable to prioritize their own health needs. As a result, they end up in walk-in clinics or emergency departments at a late stage of serious illnesses. Our current system — stretched and time-deficient — is not optimized for preventive, trust-based, community-embedded care.

As physicians and population health researchers, we propose importing and adapting a proven innovation from the Global South — the Community Health Worker model, first endorsed by WHO and UNICEF in the 1978 Alma-Ata Declaration.

A community health worker (CHW) is typically a trusted member of the local community who understands the challenges of those who are sick or socially excluded. With targeted training, CHWs can conduct basic health screenings for conditions such as high blood pressure, diabetes, breast and cervical cancer, and reproductive and mental health problems.

Importantly, CHWs act as bridges to primary care physicians, meaning when a woman’s screening reveals a concern, the CHW can prioritize her for a physician review. This approach builds trust, continuity and access — creating the “first mile” of connection to the health system for women who might otherwise remain invisible.

Unlike nurses, CHWs do not require professional credentials, though many have college or allied-health backgrounds such as a personal support worker or occupational therapy assistant. Their greatest assets are trust, cultural competence and mobility — the ability to meet marginalized women where they are at.

Implementation is key

The CHW model has the potential to deliver community-based, first-contact access — what we call “A Bridge to Access.” These workers can provide the first mile of care, ensuring that prevention, screening and support reach the women who need it most.

While CHWs can be equipped with digital or artificial intelligence (AI) enabled screening tools to optimize the connection with care, technology should complement — not replace — human connection. Digital tools can support communication and record-keeping, but relationships and trust remain the foundation of effective care.

Money alone cannot fix Canada’s patchwork health-care system of today. Funding is necessary, but innovation is essential. The CHW model — an evidence-based success in countries from India to Indonesia — represents an opportunity for reverse innovation: bringing proven global strategies from the Global South to Canada.

If implemented well, CHWs have the potential to strengthen first-contact accessibility, foster trusting relationships and deliver person-centred, integrated care. For women on the margins, this could mean earlier diagnosis, greater continuity and restored faith in a system they currently cannot access easily.

Testing and evaluating the CHW model in Canada offers a path to close the health-equity gap for women and other underserved populations. If successful, it could be scaled across provinces, contributing to a stronger, more inclusive health-care system — one that delivers on prevention, screening and primary care for those most in need.

Sonia Anand receives funding from Public Health Agency of Canada, and the CIHR. She receives speaking honoraria from pharmaceutical companies. She volunteers for the Heart and Stroke Foundation of Canada.

Gina Ogilvie receives funding from Canadian Institutes of Health Research.

Cathy Risdon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.