Cancer Disparities and the Political Economy of Healthcare Access: A County-Level Analysis in a High-Disparity County

Cervical cancer mortality among Hispanic immigrant women remains disproportionately high in Tarrant County, Texas, despite national improvements. In this region, restrictive healthcare eligibility criteria and fragmented safety net systems limit access to preventive and life-saving care. A reactionary political environment further compounds these barriers. Drawing on the findings of a multi-year mixed-methods study and a subsequent academic-community partnership in Tarrant County, this article examines how governance decisions, fiscal priorities, and institutional policies shape immigrant health access. Using a political economy of health framework, we show how these structural conditions produce and sustain cervical cancer disparities. Qualitative research is essential for documenting how political and structural forces shape health outcomes. However, scholars working in restrictive policy environments within reactionary governance contexts face distinct methodological and ethical pressures. These include scrutiny of research framing, limitations on community collaboration, and risks associated with publicly naming policy-level drivers of inequity. Based on insights from conducting research in a politically contested setting, we identify strategies for maintaining rigor while minimizing harm to both research participants and community partners. These strategies include ethical community-engaged research practices, capacity-building efforts that strengthen local health infrastructures, and strategic framing techniques that communicate findings accurately without increasing political resistance. By pairing empirical analysis with pragmatic guidance for research in reactionary governance contexts, this article demonstrates how qualitative scholarship can contribute to public understanding, institutional reflection, and incremental system change even when direct policy reform is constrained. We ground these insights in cervical cancer survivorship among Hispanic immigrant women in Tarrant County to keep methodological guidance anchored in disease-specific realities.