Predictor Access to health services

Regular health checkups help prevent illnesses, and access to health services is associated with reduced hospitalization. These resources support people’s physical health, and by extension their sense of power and autonomy.

Evidence on the Relationship between Access to Health Services and Upward Mobility Outcomes

As of December 2021, researchers have documented the following connections between this predictor and upward mobility. Asterisk (*) indicates primary reference. 

  • Having a usual source of care affects children’s health outcomes. When compared with other children, those with a usual source of care had fewer unmet needs, including unmet medical, dental, and prescription needs; problems getting care, tests, or treatment; delayed urgent care; difficulties seeing a specialist; and other inadequate treatment needs. Among children with health insurance, those with no usual source of care had higher rates of unmet needs than those with one (Devoe et al. 2012*).
  • Access to health care moderates the prevalence and severity of chronic conditions, because regular health checkups help prevent illnesses. Bindman and colleagues (1995) find that better access is associated with reduced hospitalization rates for asthma, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and diabetes.
  • Access to health services is related to health status and use of health care. Ettner (1996) shows that having a usual source of medical care is strongly correlated with earlier receipt of preventive services, such as pap smears, breast exams, and mammograms. Early detection of preventable diseases can lead to better future health, thus relieving a person of a significant amount of stress and additional expenses for medical care as well as freeing them from the confines of a hospital.
  • A study on asthma and health services looked at children who had asthma in families both experiencing and not experiencing poverty. The study found that children with asthma in families experiencing poverty had 40 percent fewer doctor visits, 40 percent more hospitalizations, and an additional seven days in bed because of asthma (Halfon and Newacheck 1993).
  • Research points to evidence of racism historically and within the current health care system in the US (Peek et al. 2010; Vyas, Eisenstein, and Jones 2020; Washington 2006). Racism affects access to and use of health services in many ways. For example, fewer hospitals are built in areas where people of color live, and providers often neglect to listen or believe patients of color, offer subpar pain management to patients of color, and design treatment plans based on research of primarily white subjects. Which hospitals people have geographic and monetary access to, as well as the hospitals people generally trust and choose to use, are affected by segregation caused by racist practices (Kowalczyk et al. 2017). Research also demonstrates that racism in health care is associated with less use of preventive care and other types of health services, such as when people delay or decline to seek care or adhere to a treatment regimen (Ben et al. 2017; Peek et al. 2010).
  • Freeman and colleagues (2008) conducted a systematic review of 14 empirical studies that look at the causal relationship between health insurance and health care use and other health outcomes. They found that having health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality as a result of injury and disease.

Promising Local Policy Interventions

Research from both Urban and others in the field suggests the following policies could help communities improve this predictor. These suggestions are not exhaustive, and communities should work with residents and leaders to identify solutions that are best suited to their local contexts.


Mobility Metric(s) Used to Measure This Predictor

Number of people per primary care physician

Primary care providers play central roles in the provision of health services. A lower number of residents per physician suggests better access to essential health services in a community. 

View the full suite of metrics used to measure all the predictors in the Upward Mobility Framework.

Mobility Dimensions Engaged

  • Power and autonomy