People who visit emergency departments (EDs) but leave without their care completed are often assumed not to have been ill enough to require that care.

However, the high rates of people who leave without completed care is a symptom of the mismatch between the Canadian promise of health care for all and the current capacity of the health-care system. The most profound effects of this mismatch fall on people who are structurally disadvantaged.

Our research shows that the people who rely the most on EDs report the poorest care experiences, and often leave without their care completed. This creates a cycle of worsening health and increasing costs.

Studying the care experiences of nearly 1,700 patients across three British Columbia EDs, our research team found that people facing the greatest social and economic disadvantages were more likely to report discrimination in the ED, lack access to primary care, depend on EDs for ongoing health problems and rate their care poorly. They were also the most frequent users of EDs.

In a different analysis, our research also showed that EDs can significantly interrupt this cycle.

Our team at EQUIP Health Care has been researching how to increase effectiveness by supporting health-care organizations to focus on people least well-served by the health-care system. In other words, researching ways to promote equity.

Studying primary care clinics that serve people marginalized by poverty, racism and other forms of stigma and discrimination, we identified three key dimensions to doing so: trauma- and violence-informed care, cultural safety/antiracism and substance-use health. We also identified 10 implementation strategies.

Our findings showed that........

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