Instituto Costarricense de Equidad de Salud

Health equity,
grounded in
evidence.

We produce rigorous, community-centered research—and pair evidence with local investment—to improve care and strengthen the places people call home across Costa Rica and the Americas.

Explore our research Partner with us
Rooted in place San José, Costa Rica
9.9281° N · 84.0907° W

Our purpose

Canyon landscape near Chinle, Arizona at sunset.
Rock formation in Chinle, Arizona.
Sign for Chinle Comprehensive Health Care Facility in Chinle, Arizona.

Field context
Images from Chinle, Arizona—where landscape, community, and access to care meet.Connecting place to health equity is central to how INCOESA understands underserved communities.

Better health systems begin by asking who has been left out—then designing the evidence, tools, and partnerships to bring them in.

Equity, diversity, and inclusion are foundational to our work. They shape the questions we ask, the communities we partner with, the investigators and artists we support, and how we share resources and opportunity.

Human dignity is indivisible. INCOESA stands firmly against antisemitism and against racism, xenophobia, anti-Palestinian hatred, anti-Muslim hatred, and religious discrimination in all forms.

Health equity also requires speaking clearly when civilian health and human rights are at stake. INCOESA calls for an immediate and durable end to the war in Gaza, protection of civilians and healthcare workers, and unhindered humanitarian access. INCOESA aligns with the September 2025 conclusion of the United Nations Independent International Commission of Inquiry that Israel has committed genocide in Gaza. Read about the Commission of Inquiry.

Healthy Places Initiative

Research helps us understand place.
Partnership helps us strengthen it.

INCOESA studies how geography and the built environment shape health, access, and belonging. We believe communities should not only be the subject of research—they should share directly in the investment that research inspires.

Our first creative-placemaking program will support community-led murals in Costa Rica and Tucson, Arizona, bringing residents, local artists, schools, clinics, and neighborhood organizations together to transform shared spaces.

Costa Rica Tucson, Arizona Pilot in development
Explore mural grants Propose a partnership
Colorful community mural on a building in Costa Rica reading Gracias por su labor.
Community Mural Grants Healthier places can also be more expressive places.
Community-designed · Artist-paid · Publicly accessible
01

Led locally

Residents and community partners help select the site, shape the story, and approve the final concept.

02

Artists are paid

Grant budgets prioritize fair compensation for local artists alongside materials, preparation, and maintenance.

03

Impact is documented

Each project will preserve its community story and examine participation, belonging, stewardship, and neighborhood pride.

Research

Questions that matter
where access is hardest.

Our research connects clinical care, technology, spatial analysis, and community knowledge to understand—and close—gaps in health access.

Research areas

Our portfolio is organized around four connected areas where geography, technology, clinical care, and community experience intersect.

01

Digital Health Equity

Examining who is represented in AI, mobile health, and telehealth research—and who is excluded from the benefits of clinical innovation.

02

Rural Emergency Care

Using health services research and geographic information systems to improve emergency care access in rural and resource-limited settings.

03

Point-of-Care Ultrasound

Studying equitable adoption of ultrasound and other clinical technologies within Costa Rica's national health system.

04

Indigenous Health

Supporting culturally grounded research and partnerships focused on Indigenous and hard-to-access communities.

Featured publication

PURA-ECHO: Mapping equitable ultrasound access across Costa Rica.

INCOESA’s inaugural publication uses ArcGIS and sixteen years of national ultrasound utilization data to show how diagnostic capacity expanded across Costa Rica’s CCSS network.

The study found a 3.2-fold increase in rural ultrasound exam volume, while distance from the national referral center did not predict adoption—highlighting the equity-promoting strength of Costa Rica’s EBAIS geographic empanelment model.

BMC Emergency Medicine · 2026
Read the article
Featured publication graphic showing an ArcGIS-based map of Costa Rica and key findings from the PURA-ECHO study.

Featured publication

Understanding the NIH Diversity Supplement and the emergency medicine research pipeline.

This Annals of Emergency Medicine research letter examined NIH ExPORTER data from 2002 to 2023 to understand how the NIH Diversity Supplement supported clinician-scientist development across medical specialties.

Emergency medicine ranked strongly by participation rate: 21 diversity supplements were awarded across 14 parent grants at 7 academic programs, with 17 of the 21 awarded between 2020 and 2023.

Annals of Emergency Medicine · 2025
Read the article
Featured publication infographic summarizing the NIH Diversity Supplement paper, including line charts and key findings for emergency medicine research grants.

Featured publication

Embedding healthcare disparities education into existing medical school lectures.

This BMC Medical Education study evaluated a resource-conserving curriculum that used “teachable moments” to integrate guideline-based health disparities content into existing first-year medical school lectures without adding lecture time.

Across 43 lectures, 26 were enhanced with 213 disparities topics. Students who used the materials more frequently demonstrated greater post-course knowledge and higher confidence addressing healthcare disparities in clinical settings.

BMC Medical Education · 2021
Read the article
INCOESA infographic summarizing a healthcare disparities curriculum integrated into existing medical school lectures, including implementation steps, learning objectives, and student outcomes.

People

Physician-led.
Community-centered.

Portrait of Sean Treacy-Abarca.

Sean Treacy-Abarca, MD

Founder & President

Sean is an academic emergency physician and health equity researcher whose work spans digital health, rural emergency care, Indigenous health, and geographic analysis. He founded INCOESA in 2021 to support research and community grant-making for rural, hard-to-access, and Indigenous populations in Costa Rica and internationally.

Current appointments

  • Assistant Professor of Emergency Medicine, UCLA David Geffen School of Medicine
  • Attending Physician, Indian Health Service
  • Attending Physician, VA Palo Alto

Training

  • Stanford Emergency Medicine Residency
  • MD, David Geffen School of Medicine at UCLA
  • Research training at Harvard and UCSF

Research interests

  • Digital health equity
  • GIS and rural emergency medicine
  • Point-of-care ultrasound
  • Indigenous and global health

Selected recognition

  • David Geffen Foundation Medical Scholar
  • Stanford Emergency Medicine Professionalism Award
  • Stanford MSPA Outstanding Clinical Teaching Award

Leadership

Building the systems behind the mission.

Executive leadership Marisela
Aguilar, MD

Marisela Aguilar, MD

Chief Operating Officer

Assistant Professor of Pediatrics · UCLA David Geffen School of Medicine

Marisela is a pediatrician and academic physician who serves as INCOESA's Chief Operating Officer. She helps lead the institute's operations and supports the translation of its research, community partnerships, and grant-making priorities into durable programs.

Board of Directors

Governance grounded in service.

INCOESA is governed by a six-member Board of Directors providing oversight across research, community partnership, nonprofit stewardship, and long-term strategy. Member profiles will be added as appointments are finalized.

01

Board Member

Profile forthcoming

02

Board Member

Profile forthcoming

03

Board Member

Profile forthcoming

04

Board Member

Profile forthcoming

05

Board Member

Profile forthcoming

06

Board Member

Profile forthcoming

INCOESA Community Fellows

Building the next generation of community health leaders.

The Community Fellows program gives emerging investigators and health leaders mentored, hands-on experience in community partnership, outreach, education, and applied health-equity research.

Inaugural Community Fellow Natalia
Padilla

Natalia Padilla, MS

INCOESA Community Health & Education Fellow

Tucson, Arizona · Community outreach · Health-professions pipeline development · Medical education research

Natalia is INCOESA's inaugural Community Fellow. Working closely with Marisela Aguilar, MD, she supports community outreach and health-professions pipeline development with the Sunnyside School District in Tucson, with a focus on medical and health education research at the high-school level. Her background spans public-health outreach, K–12 STEM education, biomedical research, and mentorship of students pursuing careers in the health sciences.

EducationMS, Cellular & Molecular Medicine, University of Arizona
BA, Sociology, UC Berkeley
MentorshipWorks closely with Marisela Aguilar, MD
Chief Operating Officer, INCOESA

Grants

Backing locally
defined solutions.

Our grant portfolio is being developed to support community-driven health work, early-stage research partnerships, and creative placemaking.

Costa Rica · Proposed awards $5,000–$15,000 · Due April 1, 2027

Community Health Seed Grants

Small awards designed to help local organizations test practical responses to barriers in health access.

Collaborative · Proposed awards $5,000–$15,000 · Due April 1, 2027

Research Partnership Awards

Early-stage support for equitable collaborations between communities, clinicians, and investigators.

Costa Rica + Tucson, Arizona · Two $5,000 awards · Due April 1, 2027

Community Mural Grants

Two $5,000 grants supporting community-led public murals that compensate local artists, celebrate neighborhood identity, and create more vibrant shared spaces.

INCOESA Community Grants

Community Health Seed Grants

INCOESA Community Health Seed Grants provide proposed awards of $5,000–$15,000 to support locally defined, practical projects that address barriers to health, access, prevention, or wellbeing in Costa Rican communities. The program is intended for early-stage ideas that can be tested with a focused plan and meaningful community participation.

Apr 12027 application deadline
Costa RicaCommunity-focused projects
$5K–$15KProposed award range

Who should apply

Community organizations, nonprofit groups, clinics, schools, local leaders, multidisciplinary teams, and other community partners proposing a practical project with a clear public-health or wellbeing benefit in Costa Rica.

Examples of eligible projects

  • Improving access to preventive, primary, or emergency care
  • Community health education or outreach
  • Local navigation, transportation, or referral solutions
  • Projects addressing environmental or built-environment barriers to health
  • Pilot programs that strengthen community wellbeing or access to resources

Application materials

  • Applicant name, contact information, and organization or community affiliation
  • Short CV, résumé, or organizational background for the project lead
  • Project title and concise statement of the community need
  • Two to three project aims describing what the project will accomplish
  • Brief implementation plan and project timeline
  • Simple itemized budget and budget justification for a request of $5,000–$15,000
  • Description of community participation or local partnership
  • Brief plan for measuring whether the project achieved its aims

How projects will be reviewed

  • Importance of the locally identified need
  • Meaningful community leadership and participation
  • Feasibility of the aims, timeline, and budget
  • Potential benefit to health access, equity, or wellbeing
  • Clear plan for learning from and documenting the pilot
  • Potential for sustainability, adaptation, or future scale

How to apply

Submit the application materials as a single PDF by email to research@incoesa.org with the subject line “Community Health Seed Grant — 2027.” Please include the project title and lead applicant name in the email.

Deadline

April 1, 2027. Applications received after the deadline may be considered only if funds remain available. Funding decisions and project-start guidance will follow after review.

Questions or ready to submit?

Apply by email

INCOESA Research Partnerships

Research Partnership Awards

INCOESA Research Partnership Awards provide proposed awards of $5,000–$15,000 to support early-stage collaborations between communities, clinicians, investigators, and institutions developing equitable research around health access, health technology, the built environment, rural care, or related health-equity questions.

Apr 12027 application deadline
Team-basedCommunity + research collaboration
$5K–$15KProposed award range

Who should apply

Community-clinician, community-investigator, or multidisciplinary teams developing a clearly defined research partnership. Strong proposals will demonstrate shared leadership and a meaningful role for the community or population most affected by the research question.

Areas of interest

  • Health access and health-services research
  • Rural, Indigenous, and underserved-community health
  • Digital health, telehealth, AI, and diagnostic innovation
  • GIS, geography, and the built environment
  • Emergency care and point-of-care technologies
  • Community-engaged and implementation research

Application materials

  • Project title, lead contacts, institutional or community affiliations, and team roles
  • CV or résumé for the principal project leads
  • One-page project summary describing the problem and why the partnership is needed
  • Two to three specific project aims or research questions
  • Brief methods or work plan appropriate to the stage of the project
  • Partnership and community-engagement plan describing shared decision-making
  • Project timeline and itemized budget with brief justification for a request of $5,000–$15,000
  • Plan for dissemination, including how findings will be returned to community partners

How projects will be reviewed

  • Importance and clarity of the research or health-equity question
  • Strength and equity of the proposed partnership
  • Scientific or evaluative rigor appropriate to an early-stage award
  • Feasibility of the aims, timeline, and budget
  • Potential to generate future scholarship, funding, or community benefit
  • Commitment to ethical, transparent, and community-responsive dissemination

Research requirements

Formal IRB or other regulatory approval is not required at the time of application unless already available. Any project involving regulated human-subjects research must obtain all required approvals before those activities begin.

How to apply

Submit all application materials as a single PDF by email to research@incoesa.org with the subject line “Research Partnership Award — 2027.” Applications are due April 1, 2027.

Questions or ready to submit?

Apply by email

INCOESA Healthy Places Initiative

Community Mural Grants

INCOESA will provide two $5,000 pilot grants for community-led mural projects in Costa Rica and Tucson, Arizona. The program is designed to support artists and community partners who want to strengthen belonging, cultural identity, and the shared spaces that shape everyday life.

2 × $5KTwo $5,000 awards
CR + AZCosta Rica and Tucson, Arizona
Apr 12027 application deadline

Who should apply

Local artists, artist collectives, neighborhood groups, nonprofit organizations, schools, clinics, and other community partners proposing a publicly accessible mural with meaningful local participation.

What the grant can support

  • Artist and project-team compensation
  • Paint, supplies, surface preparation, and equipment rental
  • Permits and reasonable installation costs
  • Community design meetings and engagement activities
  • Project documentation and modest maintenance expenses

Application materials

  • Applicant name, contact information, and community or organization affiliation
  • Project title and a concise statement of the community need or opportunity
  • Project aims describing what the mural will accomplish and who it will serve
  • Proposed location, site photographs, and evidence that site permission can be obtained
  • Community engagement plan explaining how residents or local partners will help shape the project
  • Artist CV or résumé and a short portfolio of prior work
  • Itemized project budget, up to $5,000
  • Simple project timeline from design through completion
  • Names and roles of collaborating organizations or partners, if applicable
  • Brief plan for mural maintenance and long-term stewardship

How projects will be reviewed

  • Demonstrated community leadership, participation, and public benefit
  • Strength of the artistic concept and connection to local identity
  • Clear relationship to place, belonging, wellbeing, or a healthier built environment
  • Feasibility of the proposed budget, site, and timeline
  • Fair compensation for artists and collaborators
  • Potential to create a durable and welcoming community asset

Project expectations

  • The final mural should be publicly visible or accessible to the community.
  • Selected projects must secure all required property-owner and local permissions before installation.
  • Grantees will provide basic project documentation, including before-and-after photographs and a short completion summary.
  • INCOESA may feature the project, artist, and community story on its website and research-to-action portfolio with appropriate permission and credit.

How to apply

Submit the application materials as a single PDF by email to research@incoesa.org with the subject line “Community Mural Grant — 2027.” Include the project title, lead applicant, and proposed mural location in the email.

Deadline

April 1, 2027. Applications should be complete by the deadline. Prospective applicants may contact INCOESA in advance to discuss project fit, site readiness, or community partnerships.

Questions or ready to submit?

Apply by email

Selected publications

Research with
real-world reach.

Selected peer-reviewed work across health systems, emergency medicine, technology, and equity.

2026

PURA-ECHO: Analysis of the evolution of ultrasound utilization in austere health care settings in Costa Rica's Geographic Empanelment Model

Treacy-Abarca S, Aguilar M, Padilla N, Batchelor T, Anderson KL, Ashenburg N.

BMC Emergency Medicine26:130
2025

Emergency Medicine Clinician Research Pipeline: Understanding the National Institutes of Health Diversity Supplemental Award

Treacy-Abarca S, Cooper RJ, Schriger DL.

Annals of Emergency MedicinePublished online
2023

Use of POCUS for the identification of oligohydramnios with concern for premature rupture of membranes

Treacy-Abarca S, Han D, Lanter P.

Visual Journal of Emergency Medicine32:101758
2022

Technological Proficiencies, Engagement, and Practical Considerations for mHealth Programs at an Urban Safety-Net Hospital Emergency Department

Treacy-Abarca S, Mercado J, Serrano J, et al.

JMIR Diabetes7(2):e23641

Contact

Let's build
better evidence
together.

We welcome conversations with communities, researchers, clinicians, funders, and institutions aligned with our mission.

Location San José, Costa Rica
Research & partnerships research@incoesa.org
Phone · WhatsApp available +506 8426 9777