EQUITABLE: Mitigating poverty and disablement in older age: Understanding the complex interactions of factors influencing equitable healthy ageing in Cambodia

EQUITABLE placed Sweden and the University of Gothenburg at the forefront of implementing the World Health Survey Plus (WHS+) in Cambodia, the first country to conduct this survey, under the leadership of the World Health Organisation and HelpAge International. Cambodia’s WHS+ provided key indicators for Universal Health Coverage and identified determinants of poor health and unmet healthcare needs.

EQUITABLE was a mixed method study consisting of a national quantitative survey of 5,275 national representative participants aged 18+, in-depth interviews with 11 healthcare providers, and 32 focus group discussions involving 251 older participants.

Key Findings on Healthcare Utilisation

Quantitative Study (Chhim et al, 2025):

• Public outpatient care remains underutilised despite government efforts
• Public and private inpatient care usage is similar
• Public healthcare is used more by women, lower-income groups, and those with health insurance

Qualitative Study (Maung et al., 2025):

• Limited local services force older adults to seek distant care, increasing financial strain.
• Poor provider communication and disrespectful treatment hinder access.
• Health professionals lack awareness of ageing-related policies, leading to poor implementation.
• Family and community support are vital for better healthcare outcomes.
• Government financial aid exists but should expand to include more older adults.

Other findings related to health and determinants of poor health

• Three latent classes were identified: lower metabolic risk alcohol users (34.1%), heavy substance users with unhealthy behaviours (12.9%), and alcohol users with increased metabolic risk (53.0%). Risky behaviours were more common among men, older adults, and those with lower education, highlighting the need for targeted public health strategies (Comey et al., 2025).
• Rural-to-rural and intra-provincial rural-to-urban migration increases food insecurity risk, with individuals in high-risk provinces facing a 14% greater likelihood of food insecurity, underscoring the need for targeted policies (Chong et al., 2025).
• Mammography and Pap smear uptake are low, with significant pro-rich inequality in Pap smear uptake, especially in urban areas. Education and socioeconomic status are key drivers of these disparities, necessitating improved access, infrastructure, and awareness (Hoang et al., 2025).
• Pre-T2D and undiagnosed T2D prevalence in Cambodia is 27.2% and 10.9%, with higher rates among urban residents, older adults, and those with metabolic risk factors. Targeted interventions are essential to prevent and manage diabetes (Chhim et al., 2025).

Societal impact

This project directly contributes to the Universal Health Coverage (UHC) agenda by identifying key barriers to healthcare access and utilisation in Cambodia and other low-resource settings, guiding efforts to reduce unmet healthcare needs and improve service accessibility.

In the short term, this research supports the UHC agenda by highlighting disparities in healthcare utilisation, particularly among vulnerable groups such as women, older adults, and low-income populations in Cambodia. Identifying financial barriers, poor provider communication, and gaps in ageing-related healthcare policies provides policymakers with actionable insights to strengthen primary healthcare services, expand financial protection schemes, and improve healthcare quality. Moreover, findings on risk behaviours, food insecurity, and chronic disease prevalence underscore the need for integrated public health strategies to address the social determinants of health.

In the long term, this project contributes to Sweden’s Policy for Global Development by fostering equitable and sustainable health systems. Evidence from this study can inform national health financing reforms, ensuring that healthcare services are accessible, affordable, and responsive to population needs. Strengthening UHC efforts through improved service delivery, expanded insurance coverage, and targeted health interventions aligns with Sweden’s commitment to reducing poverty and promoting global health equity.

To enhance societal impact, the project has engaged with Cambodian policymakers and healthcare providers to translate findings into policy and practice. Capacity-building initiatives and a dissemination meeting conducted in October and November 2024 have facilitated the training of the next generation of researchers at the National Institute of Public Health and the integration of research evidence into national health planning. Future efforts will focus on continued dissemination through policy briefs, academic publications, and strategic engagement with UHC stakeholders, ensuring that the research contributes to long-term improvements in healthcare access and equity.