Spatial and social inequities in access to essential healthcare services: a case study of a fast-growing, diverse Canadian city

Access to healthcare services remains a persistent challenge, disproportionately affecting vulnerable populations. Limited access results in lower service utilisation and worse health outcomes, hindering progress toward inclusive and sustainable cities. This study developed a novel methodological framework integrating high-resolution (1-km²) socio-demographic data from the 2021 Canadian Census with an advanced multimodal transport routing engine (R⁵) to assess healthcare access via public transit in Surrey, British Columbia - a fast-growing, diverse city. Using a 30-min travel time threshold, we computed destination-oriented ('passive') and origin-oriented ('active') accessibility to walk-in clinics, urgent care centres, and hospitals. Eco-intersectional multilevel modelling was applied to examine accessibility inequalities across intersectional strata, defined as areas with a high concentration of vulnerable populations based on age, sex, race/ethnicity, education, income, and urbanicity (>vs. ≤ 400 people/km²). Overall, 319,402 (56.2%) residents could reach at least one healthcare facility within 30 min via public transit. Walk-in clinics were the most accessible, followed by urgent care centres and hospitals. Many vulnerable populations were concentrated near major urban centres, which generally had access to more facilities than the city's periphery and outer suburbs. Strata with a high concentration of females had higher odds of accessibility, while seniors and non-urban areas had lower odds. Access inequalities were most pronounced among senior visible minority communities living in non-urban areas. Equity-oriented planning and investments in sustainable transportation and healthcare infrastructure are required to close accessibility gaps. This scalable, open-data framework can inform inclusive urban policy and improve access to essential services for underserved communities.