The Future of Community Health: Lessons from the Reproductive and Sexual Healthcare Movement

By Adrienne Mansanares

For many people, the hardest part of accessing health care is everything that comes before the appointment: finding a provider you trust, having reliable transportation, navigating the insurance maze - if you have it! Those challenges are harder to overcome in recent years. Across our communities, the combined effects of COVID, inflation, medical job shortages, public funding cuts, and federal policy decisions have made it increasingly difficult for people to get the care they need. The result is a growing gap between having health coverage on paper and accessing care in practice.  

Colorado has experienced this firsthand. Following the end of pandemic-era Medicaid protections, hundreds of thousands of Coloradans lost their coverage. For many families, that loss had little to do with a change in eligibility and more to do with administrative barriers, leaving people at greater risk of delaying or foregoing care.  

Not every community experiences these barriers in the same way. Existing health inequities mean that communities of color often face greater barriers to accessing care and experience worse health outcomes. A 2024 statewide survey found that 81% of respondents of color experienced at least one health care affordability burden during the previous year, compared with 65% of white respondents. And cost isn’t the only barrier. A Colorado Health Institute survey found that Black Coloradans are more than twice as likely as white residents to report skipping care because they fear unfair treatment, while thousands of Coloradans of color report experiencing disrespect or discrimination when seeking health services. I hear these stories from my family regularly. If barriers such as cost, logistics, and lack of trust shape whether people receive care, then addressing those barriers must be part of health care itself.  

Yet too often, access is measured only by the services available, not by whether patients can actually reach them. As this landscape becomes more unstable, providers must be responsive and grounded in the realities of the lived experiences of the patients we serve. That's why community-based support programs must be treated as critical pillars of health care delivery, helping people overcome barriers long before they arrive for an appointment.  Reproductive and sexual health care organizations have long provided valuable models for extending care beyond the exam room. Faced with stigma, political attacks, funding restrictions, and systemic barriers, we learned long ago that clinical care alone is not enough. Through outreach, education, enrollment support, peer engagement, and patient navigation, we have built approaches that remove barriers, foster trust, and connect people to care where they live, work, and learn. 

Patient navigation is one of the most tangible examples of what it means to meet people where they are. At Planned Parenthood of the Rocky Mountains, our patient navigators work with patients seeking care banned in their home communities - abortion care. After Roe v. Wade was overturned, we noticed a troubling trend. Nearly 30% of patients traveling from out of state were not making it to their scheduled appointments because the cost and logistics of traveling across state lines, finding transportation, securing lodging, arranging childcare, and taking time away from work and family were too difficult to overcome. The care was available but reaching it was the challenge. In response, we expanded our patient navigation services to help patients overcome these obstacles. The impact was clear: The “no-show” rate for out-of-state patients who had spoken to a patient navigator dropped to zero. Everyone we helped came. Everyone made it to us. And we've extended this support beyond abortion care and to patients in our own local communities. When health care systems are designed around patients' real-world needs, rather than expecting patients to navigate complex barriers on their own, access improves. 

Our HIV prevention programs offer another compelling example. Our programs utilize peer educators and community health workers connecting people to free testing and prevention tools such as PrEP, while reducing stigma and building trust. Our fabulous teams go to where the people are - drag shows; hang outs; local bars and concerts. These approaches have driven measurable progress. Nationally, new HIV infections declined by 30% between 2018 and 2022 among young people ages 13 to 24. Experts attribute this progress in large part to the success of community outreach initiatives. By centering lived experience and trusted relationships, these programs help ensure that people receive accurate information, stay connected to prevention tools and care, and have the support they need to make informed decisions about their health, with zero judgment.  

Building healthy communities requires more than providing services. It requires investing in programs to help people overcome the systemic barriers that prevent them from reaching those services in the first place. As the health care landscape grows increasingly complex, the future of community health will rely on approaches that extend way beyond an online appointment portal. Reproductive and sexual health organizations have long demonstrated that combining clinical care with outreach, education, navigation, and community partnerships helps remove barriers, strengthen trust, and improve health outcomes.  

In Colorado, where too many people still struggle with affordability, coverage gaps, and unequal access to care, community-based support can make the difference between care being available and care being accessible. And these approaches can be especially impactful for communities that have historically faced discrimination or barriers within the health care system. As the President & CEO of a complex health care system, and as a daughter, sister, mother, and Latina, I believe our responsibility is not simply to provide excellent clinical offerings, but to build a system where every family can access care that is welcoming, trustworthy, and truly within reach.