by Daphne Smith, NoHLA Co-Executive Director and Excelsior Wellness Board Member
Originally written for Excelsior Wellness and cross-posted here with permission from the author.
A few years ago in Spokane, hospitals and urgent care centers seemed to appear almost overnight. Many were placed in central, highly trafficked areas — often near one another and their competitors. At the time, I was too overwhelmed by their volume and proximity to consider what informed those decisions — why those locations, why those services.
Health spaces are often defined from a distance. They’re planned in conference rooms with city leaders, highly educated healthcare executives, and real estate developers. Brilliant minds offer legal, safety, and financial guidance. Together, they design what they understand to be beneficial — and scalable — for the communities they intend to serve.
Equity is more than a value — it is a responsibility. An equity lens is needed long before services are delivered.
It begins in those planning spaces, which are often small, private, and consistent in perspective. Even with the best intentions, when the room lacks a range of lived experiences, the outcomes reflect that limitation. It shows up later as missed barriers, low trust, and uneven outcomes.
If access is meant for everyone, why aren’t all experiences shaping it?
Access isn’t just about where care is located. It’s also about how people are spoken to, whether they feel safe, and whether their realities were considered before the plan was ever made.
Maybe the question isn’t just how we expand access — but how we define it in the first place.
Equity doesn’t begin when services are delivered. It begins in the rooms where decisions are made.
Consider a rural patient traveling more than an hour to receive care. That trip likely requires time off work, delayed scheduling, and added stress before the appointment even begins. And even then, the experience matters — whether they feel listened to, understood, and safe enough to return. That’s why equity must be embedded from the beginning, not as a corrective measure, but as a design principle.
At Excelsior Wellness, the development of the Wellness Village reflects this belief. Indigenous voices, nearby residents, and communities frequently excluded from planning conversations have had space alongside real estate professionals, legal counsel, and healthcare leadership. Not as symbolic contributors, but as essential participants.
This approach hasn’t been about adding equity after decisions were made. It’s been about expanding who gets to be in the room to make those decisions in the first place.
Because when more lived experiences are present at the beginning, access is no longer something we try to fix later — it’s something we build into the foundation. Equity, then, is not aspirational. It’s operational.
And that responsibility belongs to all of us who sit in those rooms.