Publications

Opinion by Siphokazi Matika, Policy Trainee

The Equity Gap

While accessing healthcare can be straightforward for some, for others it is like stepping through a maze of unfamiliar doors, many firmly shut. Despite longstanding policy commitments to universal health coverage, the promise of equal care remains just out of reach for many. A recent study across Germany, Greece, Spain, and France found that 11.6% of adults who needed medical or dental care in 2019 reported unmet needs. For migrants, the gap was much wider, rising to 39% in Greece [1]. While affordability remains a critical barrier, administrative and cultural hurdles often intertwine, adding layers of complexity for marginalised communities seeking care. For these groups, seeking care is less about exercising a right to health guaranteed by instruments like the European Social Charter and more about navigating a system where restrictive eligibility rules, fears of discrimination, and systemic biases form an invisible fence around healthcare [2]. These barriers lead to delayed or forgone care that turns minor conditions into emergencies, driving avoidable suffering and unnecessary costs. Such systemic barriers represent an ongoing injustice and a persistent challenge to health equity. Confronting these obstacles requires moving beyond rhetoric toward approaches that meet people where they are. Across Europe, local and national initiatives have demonstrated how health navigation models can break down these barriers, making healthcare more accessible and responsive to those most at risk of exclusion.

Health Navigation: Support for intersectional needs

Health navigation, also called patient navigation, is a community-based intervention originally designed to eliminate barriers to timely diagnosis and treatment of cancer, especially among poor and underserved populations. Since its inception, its scope has expanded across the entire healthcare continuum – including prevention and survivorship – while also addressing broader social determinants of health such as housing, employment, and education, which profoundly affect health outcomes [3,4]. Navigators, whether health professionals, community workers, or peers, provide guidance, advocacy, and culturally sensitive support throughout the patient journey. Their work ranges from booking appointments and follow-ups to facilitating communication between patients and providers. Beyond healthcare, they connect people with social supports that help tackle the overlapping challenges affecting health. More than directing patients to resources, navigators often co-create personalised plans that build the skills and confidence needed to navigate care independently [4].

What makes navigators so effective is not just what they do, but who they are. Depending on the context, they may share the cultural, linguistic, or lived experiences of those they serve, which facilitates trust and responsiveness to patients’ needs. They understand the fear of discrimination, the frustration of not being understood, and the exhaustion of being turned away or having to explain oneself repeatedly. They meet people where they are and empower them to move from passive patients to active participants in their care [6]. For someone sidelined by bureaucracy or mistrust, a navigator can mean the difference between giving up on care and finding a safe route to it. For the system, it means people get the right care at the right time, before minor issues escalate into emergencies. At its core, health navigation bridges gaps that standard systems often leave unaddressed, laying the groundwork for inclusive and equitable care.

Health Navigation in Action: The European Landscape

Across Europe, health navigation models are transforming promise into practice, connecting marginalised communities with healthcare systems in ways that address both practical and social barriers.

• • • In Romania, Bulgaria, and Serbia, Roma Health Mediators have become trusted bridges between marginalised communities and the healthcare system. Drawn from the Roma community itself, they support families in securing health insurance documents, accessing maternal and child healthcare, and improving vaccination coverage. Over a three-year period (2008–2010), mediators in Serbia helped more than 9,000 Roma obtain documentation.  In Bulgaria, they played a vital role in the emergency vaccination of nearly 190,000 children following a measles outbreak and conducted thousands of health education sessions in just one year [5]. Beyond the numbers, their presence reduces fear and builds trust, guiding families through complex bureaucratic and cultural barriers. Despite ongoing challenges such as insecure funding and limited professional support, this long-standing EU-endorsed model remains one of the strongest examples of how community-based navigation can open doors to care for excluded groups.
    • In Ireland, Cairde’s Health Navigators mobile team works directly with asylum seekers and refugees, providing on-the-ground support with essential steps to accessing healthcare, including applying for medical cards, registering with GPs, and attending health screenings. Cairde’s Be Aware, Be Well programme addresses barriers to mental healthcare, particularly for migrant women who face social isolation, cultural adjustments, and a heightened risk of postnatal depression. The programme provides culturally safe support, advocacy, and guidance, and while data are limited, an initial evaluation report indicated improved health literacy, reduced stigma, and stronger engagement with health and social services among participants [6].
    • In Austria, Greece, Spain, and the UK, the CANCERLESS project delivers cancer prevention and screening services to people experiencing homelessness (PEH) by embedding navigators and peer support into social care settings. Designed with input from service users and stakeholders, the model aims to overcome barriers that often prevent timely cancer care [7]. Although comprehensive data are not yet available, the project is expected to support early cancer detection, provide evidence on cost-effectiveness, and offer lessons to guide the wider implementation and adaptation of the model for underserved populations [8].

Together, these examples demonstrate how navigation models can act as vital safeguards against health disparities that disproportionately affect marginalised groups, while also addressing gaps left by traditional systems. Each case offers valuable insights for expanding and adapting navigation approaches to better serve diverse marginalised populations across Europe, paving the way toward truly inclusive and equitable healthcare.

Gaps in Practice and Policy

Despite its benefits, many people who could benefit from a health navigator never meet one. Too often, navigation remains a short-term pilot rather than a permanent  feature of health systems with fragmented funding that is typically reliant on temporary grants, restricting long-term impact. Navigators themselves frequently face job insecurity due to short-term contracts, inconsistent training, and limited opportunities for professional development [5]. When experienced navigators leave, communities lose trusted guides and essential support. Additionally, as healthcare increasingly incorporates digital tools and online platforms, digital inequality poses an additional obstacle. For those lacking internet access, digital literacy, or trust in technology, these innovations risk deepening exclusion [9]. Without navigators empowered to bridge this divide, vulnerable communities face growing obstacles to care. Addressing these intersecting challenges requires expanding navigation services, integrating them into existing systems, and ensuring their sustainable support to meet people’s needs throughout their care journeys.

Policy Recommendations: Moving from Pilots to Systemic Change

Without system-wide coordination, navigation risks remaining fragmented and unsustainable despite its vital role in people-centred care. To maximise impact, the following targeted policy actions are proposed, classified by level of responsibility:

Member State Level

• • • Embed health navigation as a core health service, recognising it as fundamental to equitable healthcare delivery, especially for those facing intersecting systemic barriers.
    • Expand community-embedded models that engage civil society, diaspora networks, and patient groups in co-designing navigation services responsive to diverse cultural and linguistic needs.
    • Promote integration across health and social systems to reflect the complex realities of marginalised populations.

EU Level

• • • Establish standardised and culturally competent training for health navigators, drawing on WHO’s frameworks for people‑centred health services and community health worker competencies.
    • Develop EU-wide metrics and evaluations that include both quantitative outcomes and qualitative patient experiences, guiding continuous improvement and scale-up.
    • Facilitate an EU platform for exchanging best practices, supporting collaboration and learning across Member States to scale successful navigation models.

Conclusion

At a time of major demographic shifts and growing health inequities, health navigation can no longer be regarded as an optional add-on. It is a necessary investment for building fairer, stronger, and more resilient societies and health systems. However, achieving this requires moving beyond fragmented pilots and isolated successes to firmly embed navigation within policy, funding, and system design. This commitment recognises not only the medical needs but the full humanity of those navigating intersecting social, legal, and economic barriers, ensuring that all communities can access care with dignity and confidence.

References

1. 1. 1. Fares H, Domínguez JP, Puig-Junoy J. Differential probability in unmet healthcare needs among migrants in four European countries. J Int Migr Integr. 2023;24(4):1523–46. doi:10.1007/s12134-023-01024-w
      2. González-Rábago Y, Lanborena N, Rodríguez-Álvarez E. Barriers to healthcare for racialised populations in Europe: a scoping review of reviews. Int J Equity Health. 2025;24(1):212. doi:10.1186/s12939-025-02577-1
      3. Budde H, Williams GA, Scarpetti G, et al. What are patient navigators and how can they improve integration of care? [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2022. (Policy Brief, No. 44). Available from: https://www.ncbi.nlm.nih.gov/books/NBK577643/
      4. Schaffer J, Patiño M, Jones P, Sullivan L. Community Navigation as a Field of Practice: Reframing Service Delivery to Meet the Needs of Communities’ Marginalized Populations. The Foundation Review. 2018;10(4). doi:10.9707/1944-5660.1440
      5. Open Society Foundation. Roma Health Mediators: Successes and Challenges [Internet]. 2011. Available from: https://www.opensocietyfoundations.org/publications/roma-health-mediators-successes-and-challenges
      6. Michael L, Marchelewska E, Omidi N, Stewart I, in collaboration with project participants and facilitators. Wellbeing and Integration program for women. Evaluation Report. Cairde; 2024.
      7. Coronado-Vázquez MDV, Gómez-Trenado R, Benito-Sánchez B, Barrio-Cortes J, Gil-Salmerón A, Amengual-Pliego M, Grabovac I. Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project. Front Public Health. 2024;12:1371505. doi:10.3389/fpubh.2024.1371505
      8. Gil-Salmerón A, et al. Homelessness and Cancer Prevention: Three Years of Experience with the CANCERLESS Project. Int J Integr Care. 2025;25(S1):260. doi:10.5334/ijic.ICIC2426
      9. Western MJ, Smit ES, Gültzow T, et al. Bridging the digital health divide: a narrative review of the causes, implications, and solutions for digital health inequalities. Health Psychol Behav Med. 2025;13(1):2493139. doi:10.1080/21642850.2025.2493139