Geographic Inequities In Preventive Healthcare Access Among Older Immigrants In Los Angeles: Implications for Health Equity and Social Work

Background and Purpose

Access to preventive healthcare stands as a fundamental determinant of health equity, representing a primary focal point for social work interventions with marginalized populations. While language barriers and financial constraints are well-documented, the spatial dimension of healthcare inequality—specifically the geographic distance from culturally and linguistically appropriate services—remains an under-examined structural disadvantage in social work research. This study addresses this gap by investigating the spatial accessibility of preventive care for older Korean immigrants in Los Angeles, a rapidly aging and linguistically isolated community. Using Geographic Information Systems (GIS) analysis, we compare the accessibility levels of this immigrant group against those of non-immigrant older adults, identifying geographic concentrations of disadvantage and their broader implications for health equity policy and social work practice.

Methods

This study integrated four data sources: California preventive healthcare facility records including physician counts and language capabilities; American Community Survey (ACS) census-tract data; OpenStreetMap road network data; and survey data from 650 older Korean immigrants documenting actual travel behavior to preventive care facilities. Accessibility was quantified using the Generalized Two-Step Floating Catchment Area (G2SFCA) method with an empirically derived log-logistic weighting function fitted to observed travel patterns. To operationalize effective access for the immigrant group, accessibility was restricted to Korean-language-capable facilities, reflecting the linguistic necessity documented in the field. Disparities were evaluated through independent-samples t-tests, while intra-group equity of access distribution was assessed using Gini coefficients for both populations across census tracts.

Results

The findings reveal a systematic geographic disadvantage for older Korean immigrants, who exhibited significantly lower spatial accessibility to preventive care than non-immigrant older adults (M = 0.587, SD = 0.263 vs. M = 0.658, SD = 0.197; t(4616.8) = 10.76, p < .001). Beyond the average disparity, access was more unequally distributed within the Korean immigrant community (Gini = 0.256 vs. 0.168). Spatial mapping identified heavy clustering of linguistically appropriate facilities in Koreatown and Downtown LA, leaving residents in San Fernando Valley, South LA, and East LA with severely limited options. A substantial subset of participants traveled over 30 minutes to reach appropriate care, confirming that physical proximity alone does not equate to effective access for linguistically minoritized older adults.

Conclusions and Implications

These results suggest that spatial inequity functions as a structural barrier that operates independently of individual-level obstacles such as income or insurance status. For social work practitioners, this study underscores that traditional needs assessments may underestimate the barriers faced by older immigrants if geographic and linguistic variables are not integrated. Incorporating GIS-based mapping into routine social work assessments can facilitate more targeted outreach and resource deployment. For healthcare policy, the findings advocate for expanding language-capable providers in peripheral neighborhoods, implementing mobile health units, and enhancing transportation support for mobility-limited immigrants. This study demonstrates the role of spatial analysis in social work research to document and dismantle structural inequities that remain invisible through individual-level methodologies alone.