You may have heard of food deserts — communities that lack access to fresh produce and other healthy foods. Now researchers in Chicago have found another type of desert, one that could play a similarly significant role in U.S. health disparities.
Pharmacy deserts are communities without access to nearby drugstores. Residents in these areas have to travel much farther than others to get prescriptions filled, buy over-the-counter medications or visit the growing number of urgent care clinics found inside stores.
“We found that in Chicago, a largely segregated city similar to many other cities across the country, pharmacies were persistently less accessible in black and Hispanic communities than in predominantly white communities,” says Dima Qato, assistant professor of pharmacy and public health at the University of Illinois at Chicago.
The researchers believe they’d have similar findings in other urban and suburban areas across the country.
Like other retail establishments, pharmacies set up shop in neighborhoods that promise to be the most profitable. Unlike with other types of stores, however, if pharmacies take their business elsewhere, there could be a profound effect on health outcomes in minority neighborhoods.
“Of Chicago’s 802 census tracts, 32 percent were in pharmacy deserts,” according to the study, which was published in the November 2014 issue of Health Affairs. “Approximately 1 million people live in pharmacy deserts, and 53 percent of these people live in segregated black communities.”
Fifty-four percent, or 156 of the segregated black communities examined, lacked pharmacy access. By contrast, only 5 percent of the segregated white communities were considered pharmacy deserts.
Disparate Health Outcomes
For diabetes, just one chronic disease among many for which disparities are evident, both the prevalence and the potential for negative outcomes are higher among minorities.
Diabetes risk is 77 percent higher among blacks and 66 percent higher among Hispanics than among non-Hispanic whites, according to the American Diabetes Association. Furthermore, both blacks and Hispanics are more likely to suffer complications and die from diabetes. There are similar findings for other chronic diseases.
While access to health care, health insurance and healthy foods, plus economic status, are frequently used to explain disparities like this, Qato and her team of researchers are some of the first to explore how pharmacy access may play a role.
In the case of diabetes, for instance, a patient who has to take two buses to get an insulin prescription refilled may be more inclined to skimp on doses, or skip blood tests when glucose meter supplies run low.
“We think access [to pharmacies] plays a very important role in health outcomes,” Qato says. “Especially moving forward with the fact that pharmacies now are not just providing or dispensing medication.”
Indeed, drugstores are increasingly expanding their offerings, including preventive care and immunizations, urgent care facilities and additional services like medication management.
“If we ignore the fact that certain communities lack pharmacies, we may be actually contributing to widening the gap over time between minorities and whites,” Qato says.
A Possible Solution: Community Health Centers
It may take financial incentive to compel pharmacies to open stores in largely minority communities. In the case of food deserts, government agencies including the Department of Agriculture, Department of the Treasury and Department of Health & Human Services have directed funds toward everything from grocery stores to farms and fisheries after recognizing the connection between lack of access to healthy food and poor health outcomes such as obesity, diabetes and heart disease.
That same recognition hasn’t yet occurred for the role of pharmacy access in health disparities. It’s Qato’s hope that this recognition will come, perhaps in connection with the Affordable Care Act’s $11 billion focus on expanding community health centers, which are used predominantly by minority populations.
Incorporating pharmacies into that plan “would be a great way for the public sector to address this issue, at least initially,” Qato says. Currently, only a small number of community clinics have on-site pharmacies.
If You’re In a Pharmacy Desert
For now, the solutions rest on community members themselves. Traveling to get a prescription filled may not be the easiest solution, but failing to fill it at all is not the answer either.
As with private insurance, in some instances, Medicaid and Medicare patients may qualify for mail or pharmacy-delivered medications. Find guidance on this by contacting your pharmacy or insurance carrier, or Part D provider in the case of Medicare.
Staff members at community clinics may also have advice for local solutions in pharmacy deserts and may be able to direct you to nonprofit programs that could assist with transportation or medication delivery.
Finding ways to save on prescriptions is difficult enough; a lack of easy access to a drugstore makes it even more challenging to maintain your health. While a far-off public policy solution may not solve the immediate problem for those living in pharmacy deserts, bringing attention to this lesser-known health issue could be a step in the right direction.
- Disease & Medical Conditions
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Pharmacy Deserts: Another Way Your Address May Affect Your Health
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