By Al Thompson, Contributing Writer

The rising cost of health insurance is significantly impacting individuals' access to healthcare. In 2022, 28 percent of adults reported delaying or foregoing medical care due to cost concerns — a trend that has only worsened in subsequent years. 

This issue is particularly severe in underserved communities, where limited financial resources, lack of availability to employer-sponsored insurance and the high cost of private plans leave many people without adequate coverage. As a result, these communities are disproportionately affected by health inequities, exacerbating health disparities and leading to poorer outcomes. 

Understanding the unique challenges urban and rural communities face is crucial for addressing disparities. While both populations encounter significant difficulties, the obstacles they face are shaped by their distinct environments and call for tailored solutions. 

Architects and designers can improve reach and outcomes by reimagining healthcare environments as inclusive, supportive, community-focused spaces. Through intentional design, healthcare providers can better address the unique needs of these populations, breaking down barriers and fostering environments where affordable care is not just a goal but a reality. 

Urban hurdles 

Given their dense populations and complex infrastructures, urban communities face a unique set of hurdles when it comes to healthcare availability. One significant barrier is the lack of nearby healthcare facilities. 

Many low-income neighborhoods lack convenient access to medical centers and often require public transportation to reach care. But unreliable transit can deter individuals by causing missed appointments, lengthy travel times and higher expenses. Because of these challenges, preventive care is more easily neglected, and many people only seek medical attention when acute issues arise, worsening the management of chronic conditions. 

Safety issues are another obstacle in urban communities. In some inner cities, the lack of secure and accessible public spaces for exercise can discourage outdoor physical activity, directly impacting residents' overall health. 

The lack of available nutritious, affordable food also remains a concern, compounding the challenges to overall well-being. Fifty percent of chain restaurants are located in urban areas, compared to 38 percent in suburban and just 10.7 percent in rural regions, according to Nation’s Restaurant News. While quick, inexpensive fast-food options can be convenient for many busy families, these options contribute to poor dietary habits and associated health issues. 

Innovative hubs for urban wellness 

One solution to combat these challenges is the integration of healthcare hubs that function like community centers, similar to the model TPG Architecture designed and implemented for Emblem Health in Elmhurst, New York. These hubs are strategically designed to offer various comprehensive services, such as radiology, pediatrics, women’s health, wellness visits, preventive care, family check-ups and cardiac care — all under one roof to promote a culture of health beyond simply treating illness. 

Designed for ease and convenience, these centers offer extended hours and are located near public transportation to reduce travel barriers and foster equitable entry to essential healthcare services. Their multi-floor layouts are designed to accommodate entire families, allowing them to receive care simultaneously and minimizing the need for multiple appointments at different locations. 

This approach empowers residents to seek care before health issues become acute but also helps address challenges like lack of insurance, which can discourage timely treatment. Ground-floor facilities offering wellness education and exercise classes also further promote proactive health management, encouraging residents to take charge of their well-being before problems arise.

Navigating challenges 

Rural communities face similar challenges with obtaining care, shaped by limited availability and reduced local resources. These areas typically have smaller, more dispersed populations, which results in a lower demand for large hospitals. Consequently, regional hospitals are more likely to struggle with inadequate funding and might be forced to close, leaving residents with limited nearby options. 

These closures also lead to a loss of personalized care, as it is common for smaller-scale providers to foster close-knit relationships with patients. When replaced by larger, unfamiliar systems, continuity of care diminishes, and patients face more standardized treatment. This can affect patient trust and satisfaction for those who feel less comfortable in a system that lacks the personalized attention they were accustomed to. The loss of local care also can lead to worsened health outcomes, as patients might delay seeking treatment or miss opportunities for prevention and early diagnosis. 

This situation can occur in rural communities that also rely on general practitioners for basic needs. A local clinic might not have the equipment for more specialized care, leaving patients to travel long distances to neighboring towns for certain services. This contributes to the same sense of disengagement when patients have no choice but to see unfamiliar providers. 

Improving healthcare access 

To address these challenges, healthcare designers have been exploring creative solutions that bridge the gap between available services and the needs of rural residents. Two key strategies that have shown promise are mobile care units and telehealth-ready clinics. 

Mobile care clinics, typically housed in buses or vans, bring services such as preventive screenings, chronic care management and vaccinations, directly to schools, libraries and community centers in areas where traditional facilities are unavailable or too far away. These mobile units can travel between towns, ensuring care reaches those in areas with limited healthcare infrastructure or who would have to travel long distances for basic services. 

These units are designed to be compact yet highly functional, often incorporating flexible configurations that can serve a variety of medical purposes, from patient examinations to consultations. This adaptability mirrors the design evolution seen during the pandemic when patient room sizes increased from the more traditional 100 square feet to 120 square feet or more to accommodate the inclusion of more equipment, allowing exam rooms to flex to serve different modalities. 

This flexibility allows clinic staff to change the way they treat patients as practice evolves to address business trends in healthcare delivery. But the approach also presents challenges, such as higher construction costs, more complex design requirements and a reduction in patient beds. Ensuring adequate power and flexible HVAC systems to manage air changes and different air pressures is crucial in this context. 

Another innovative solution is the incorporation of telehealth technology into local clinics, which can significantly improve access to specialized care. By enabling remote consultations with specialists, telehealth reduces the need for time-consuming, costly travel. 

Underserved urban and rural communities face significant challenges when it comes to healthcare access. Shaped by distinct environmental factors, urban areas struggle with infrastructure complexities, safety concerns and the prevalence of unhealthy food options, while rural areas contend with hospital closures, reliance on distant providers and the loss of personalized care. 

In both cases, architects and designers have a crucial role to play in addressing these disparities. By creating inclusive, community-focused spaces, designers can reimagine healthcare environments to meet the unique needs of these populations. Emerging advances such as mobile care units and telehealth-ready clinics hint at a future when healthcare can be seamlessly integrated into daily life, potentially revolutionizing availability for underserved areas and paving the way for more adaptive, community-centric care models, reducing barriers and enhancing overall health equity. 

Al Thompson is managing executive at TPG Architecture.