Pharmacy Deserts: A Threat to Community Health and Access to Medications
Pharmacies were once abundant in the South Side of Chicago. Now, residents living in the majority Black neighborhood often find themselves with few options when it’s time to get a prescription refilled or stock up on cold medicine.
Ladell Johnson, a longtime resident of the South Side, drives half an hour from her house to the downtown area every time she needs to pick up her prescription. “Luckily, this pharmacy is close to where I work, but my house is half an hour away by car or one hour by bus,” she said. “If I didn’t have a car, I would have to walk 20 blocks one way to my closest pharmacy.”
As pharmacies shutter stores across the U.S., people in low-income and predominantly Black, Latino, and Indigenous neighborhoods are increasingly left in pharmacy deserts, without easy access to medications and other essentials. In November 2021, CVS announced that it would be closing 300 stores a year across the country in the next three years, and Rite Aid, which filed for bankruptcy in October, plans to close at least 150 stores in the next several months.
“Pharmacy deserts have been a longstanding issue that has gotten worse with recent closures of both independent and chain pharmacies,” said Dima Qato, an associate professor at the University of Southern California School of Pharmacy, who studies disparities in geographic access to pharmacies and spent more than a decade working as a community pharmacist in Chicago. That lack of access can have major consequences for the health of people living in marginalized communities.
How pharmacy deserts impact people’s health
A 2021 study co-authored by Qato, published in Health Affairs, examined disparities in pharmacy access in major cities such as Los Angeles, Chicago, Houston and Memphis. In Los Angeles, one-third of all Black and Latino neighborhoods were pharmacy deserts — meaning that the average distance to the nearest pharmacy was 1 mile or more. The biggest racial gap in pharmacy access was in Chicago, where only 1% of white neighborhoods were pharmacy deserts, compared to 33% of Black neighborhoods in the South Side.
Risks to Medication Adherence and Chronic Disease Management
Rural and suburban areas qualify as pharmacy deserts if the nearest drugstore is more than five or two miles away, respectively, Qato said. However, the radius drops to just half a mile in low-income neighborhoods with low vehicle ownership, as it can be hard for residents to walk or take public transportation to the nearest pharmacy.
“When pharmacies close, there’s some people who stop taking their medications — especially if they live in pharmacy deserts. Others may take time off work or delay picking up their prescriptions,” said Qato.
In an earlier study of 3 million adults, published in JAMA Network Open, Qato and her colleagues found that when pharmacies close in a community, older adults are more likely to stop getting their prescriptions filled for vital heart medications such as statins, beta-blockers, or oral anticoagulants.
Pharmacy deserts can take a particular toll on Black, Latino, low-income, and uninsured households because these groups are already at higher risk of chronic disease, said Juan Tapia-Mendoza, a community pediatrician who practices in Washington Heights in New York City. “Now it’s harder for them to access the prescription medications they rely on to treat common chronic diseases such as diabetes, heart disease, and arthritis.”
Limited Access to Vaccines
People living in pharmacy deserts also have more limited access to flu shots and vaccines for Covid-19. That’s a particular problem at a time when many community doctors and health facilities have not yet received the latest Covid vaccine, leaving patients in underserved areas with few alternatives, experts tell STAT. “Pharmacies were crucial in Covid vaccine rollout,” said Utibe Essien, an assistant professor of medicine and a health disparities researcher at the University of California, Los Angeles.
Given longstanding vaccine hesitancy among Black and Latino communities, making immunizations even harder to access puts this already-vulnerable population at higher risk. “We’re talking about a community that has been historically terrorized by homeland security, immigration and customs enforcement, and the police. There’s already an inherent fear to seek medical help because they think that somehow the information they provide is going to be used against them,” said Tapia-Mendoza.
In the South Side, Johnson received her flu vaccine at her local church, which transformed into a mass vaccination clinic in collaboration with a health center. This site has been imperative to making vaccines accessible for people in her community, she said, so they don’t have to travel to a pharmacy.
Why pharmacies like CVS, Walgreens, and Rite Aid are closing stores
Often, the decision to close a chain pharmacy store is purely a business one — albeit without the effects on communities in mind, said Tapia-Mendoza. Rite Aid spokesperson Alicja Wojczyk told STAT in a statement that as part of its bankruptcy process, “we notified the Court of certain underperforming stores we are closing to further reduce rent expense and strengthen overall financial performance.”
Walgreens spokesperson Kris Lathan told STAT that the company takes several factors into account when closing locations, “including our existing footprint of stores, dynamics of the local market, and changes in the buying habits of our patients and customers.” Lathan also noted that Walgreens has partnered with local churches and civic groups to “
SDGs, Targets, and Indicators
SDGs Addressed:
- SDG 3: Good Health and Well-being
- SDG 10: Reduced Inequalities
- SDG 11: Sustainable Cities and Communities
Targets Identified:
- Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
- Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
- Target 11.1: By 2030, ensure access for all to adequate, safe, and affordable housing and basic services and upgrade slums.
Indicators:
- Indicator 3.8.1: Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, and service capacity and access).
- Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities.
- Indicator 11.1.1: Proportion of urban population living in slums, informal settlements, or inadequate housing.
Analysis:
The article addresses several Sustainable Development Goals (SDGs) related to health, inequalities, and sustainable cities. Specifically, it focuses on the issues of pharmacy deserts in low-income and predominantly Black, Latino, and Indigenous neighborhoods, and the impact on people’s health and access to essential medications. The article also discusses the closure of chain pharmacies and the struggles faced by independent pharmacies.
SDG 3: Good Health and Well-being
The issue of pharmacy deserts directly relates to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The lack of access to pharmacies in marginalized communities can have major consequences for the health of residents, leading to medication non-adherence and delays in receiving vital medications. This can particularly affect older adults and individuals with chronic diseases.
SDG 10: Reduced Inequalities
The article highlights the disparities in pharmacy access, with a significant racial gap in pharmacy deserts. While only 1% of white neighborhoods are pharmacy deserts, 33% of Black neighborhoods in the South Side of Chicago face this issue. This demonstrates the unequal distribution of resources and services, contributing to health inequalities. SDG 10 aims to reduce inequalities within and among countries, making it relevant to address the disparities in pharmacy access.
SDG 11: Sustainable Cities and Communities
The concept of pharmacy deserts aligns with SDG 11, which focuses on creating sustainable cities and communities. Access to adequate, safe, and affordable healthcare services, including pharmacies, is crucial for urban populations. The article emphasizes the need for pharmacies to remain open in marginalized communities and suggests policy measures to ensure that these communities are not excluded from health plans’ pharmacy networks.
Targets and Indicators:
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. | Indicator 3.8.1: Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, and service capacity and access). |
| SDG 10: Reduced Inequalities | Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status. | Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities. |
| Target 11.1: By 2030, ensure access for all to adequate, safe, and affordable housing and basic services and upgrade slums. | Indicator 11.1.1: Proportion of urban population living in slums, informal settlements, or inadequate housing. |
The identified targets and indicators are directly relevant to the issues discussed in the article. Target 3.8 emphasizes the importance of ensuring access to essential medicines for all, which is compromised in pharmacy deserts. Indicator 3.8.1 measures the coverage of essential health services, including access to medications, which can be used to assess progress in addressing the issue of pharmacy deserts.
Target 10.2 focuses on promoting social, economic, and political inclusion, irrespective of various factors such as race and economic status. Indicator 10.2.1 measures the proportion of people living below 50 percent of median income, which is relevant to understanding the financial challenges faced by individuals in marginalized communities with limited access to pharmacies.
Target 11.1 aims to ensure access to adequate, safe, and affordable housing and basic services, including healthcare facilities. Indicator 11.1.1 measures the proportion of urban population living in slums or inadequate housing, which reflects the living conditions in communities affected by pharmacy deserts.
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Source: statnews.com
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