> Do you have any insight into the reason for the unequal access? Is it that poorer or uninsured patients cannot afford non-emergency healthcare? Is it that they are too far away? Is it education/knowledge/social - belief that they shouldn't go to a doctor for "nothing". Are they "too busy".

I am not a Doctor observing patient populations, but I have lived and worked in East Palo Alto, CA for the last few years, which from my perspective, is a stark case study in all sorts of inequalities (For non-SV residents, East Palo Alto is a small historically socio-economically depressed city wedged between Palo Alto, Facebook, and Google. Zuck's house is a stone throw away from crack houses)

Anecdotally, what I have seen regarding poorer/uninsured people not utilizing health services involves all the things you have mentioned.

Non-emergency healthcare without insurance is pretty much out of the question. Even with insurance, co-pays can be prohibitively expensive. There are people I know living paycheck to paycheck with zero savings and like 50%+ of income going to housing expenses. Even a $50 unplanned-for copay is a painful blow.

Distance is also an issue for a population that may not have consistent access to a car--and the bus system takes too much time. If you are working a few jobs, it's nigh-impossible to take a random 1hr+ bus ride to a medical facility.

Education/knowledge is, unfortunately, also a huge issue. I have observed some astonishingly unhealthy habits that stem primarily from ignorance. Additionally, even navigating our health system requires some level of education, literacy, and time that often seems prohibitive for many in the population I have interacted with. And, with regards to distrust of the medical system, I have observed that as well. I have also seen this coupled with exploitative homeopathic "care" providers...which is doubly sad. These are more complex issues that I don't feel well-equipped to begin to speculate the underlying reasons for. Perhaps some of it is cultural. I am not sure if that is the primary story though.

Generalized ambient anxiety and depression is also, I believe, the more ultimate, albeit distal, cause here, rather these more proximate poverty mechanics. The emotional toll of living in poverty, primarily extreme _relative_ poverty (remember Zuck across the freeway and the swarms of Tesla commuting through your city on their way to high-paying tech jobs that are inaccessible to you) results in all sorts of extremely unhealthy compensatory behaviors. Heavy alcohol and drug use--even if just Marijuana, binge eating fast-food, violent communication styles that contribute to always-on fight or flight reactions, dangerous activities like racing cars or weaving bikes through traffic--perhaps done as some way to "feel something" or perhaps find identity in the only way available--acting out anti-social power displays as a way to reify self-worth contra a system that clearly treats them like shit on nearly all levels. And more.

Frankly, unequal access is both a moral failure and also, I believe, soon to be an instrumental failure for the strength of the United States. Having a large population of enfeebled, diseased people does not bode well for nice things we care about like innovation, improved quality of life, stability of our governance systems, or even things like the strength of our fighting force.

However you want to cut it, the issue of unequal health access is a shame.