Take your medicine as directed and experience improved health outcomes. It seems easy, but more than 1 million Chicagoans cannot follow these simple instructions even if they wanted to. They have no access to a pharmacy to fill the prescriptions that will help them get better.
Just as experts say that living in a “food desert” without easy access to healthy food options may put you at risk for being overweight, obese or diabetic, living in a “pharmacy desert” without easy access to a local pharmacy may put communities of color at risk for poor health outcomes because of lack of access to lifesaving medications.
In a recent issue of the journal Health Affairs, our research shows that if you live in one of Chicago’s predominantly non-white communities on the South or West Sides, you must travel further to get your prescriptions filled than if you lived in a majority white community on the North side.
Using U.S. Census data and data on the address of every pharmacy in Chicago, the study defines a pharmacy desert as any neighborhood with no pharmacy within one mile, or any neighborhood with low vehicle ownership and no pharmacy within half a mile.
Using this definition, the results reveal that about 1 million Chicagoans live in pharmacy deserts. More than half of these people live in segregated black communities. Only 5 percent of segregated white communities were pharmacy deserts. Fully 54 percent of black communities and 34 percent of Hispanic communities were pharmacy deserts.
The disparities are getting worse. Between 2000 and 2012, the number of pharmacies in segregated white communities increased by 30 percent, while the number of pharmacies declined by 17 percent and 11 percent in segregated Hispanic and segregated black communities, respectively.
Perhaps it should not be surprising, therefore, that Blacks and Hispanics in the U.S. are less likely to take prescription medications than Whites, according to a 2010 study for the National Institutes of Health.
Patients of color may not be taking their prescription medications, even if they were affordable, because they are not able to get their prescriptions filled. There simply may not be any pharmacy in their neighborhood. The lack of proximity, especially when combined with limited access to transportation, affects their ability to physically obtain prescription medications.
Prescription medications are often critical in promoting good health, especially among those patients who disproportionately suffer from or are at-risk for chronic conditions, such as heart disease and diabetes.
The Affordable Care Act focuses on expanding insurance coverage and community health centers in low-income communities. It does not address access to prescription medications, specifically access to pharmacies, but it should.
The number of individuals who are publicly insured will continue to increase under the ACA, and the long-term costs associated with not taking prescription medications will only grow for the U.S. government if access to pharmacies is not improved.
Ensuring access to pharmacies is also important considering the changing role of pharmacies in the community, and the longstanding public health goal to reduce health disparities.
Pharmacies now provide diagnostic, preventative and treatment services that go beyond the dispensing of prescription medications and the provision of over-the-counter products. Pharmacies are frequently used by community residents for immunization, health screenings and urgent care services.
If pharmacies are so important to the community, for both accessing medications and increasingly, preventative services, then why has their role been overlooked by major public health and policy initiatives?
Despite being the primary source of prescription medications, which are increasingly being paid for by the government for many low-income Americans, pharmacies belong to the private sector.
Unlike hospitals, whose construction must be approved by the Illinois Health Facilities and Services Review Board after completing a Certificate of Need, chain, independent and grocery store pharmacies make location decisions based on market principles such as return on investment, not based on any assessment of existing capacity or public health need.
There are very few “public” pharmacies or pharmacies located within federally funded community health centers. This research has identified more than 100 community health centers scattered across low-income communities in Chicago, but only a handful have an on-site pharmacy.
Incorporating pharmacies in community health centers is one potential solution to the problem of “pharmacy deserts” in low-income Black and Hispanic communities.
Another is to increase governmental oversight in the distribution of pharmacies across communities in the United States. Pharmacy organizations could be required to collectively ensure, and monitor, accessibility to pharmacies across all communities. The process used to approve the construction of new hospitals based on an analysis of local needs could serve as a model to guide future decisions about where to locate pharmacies.
To overcome objections about excessive regulation, tax or other market-based incentives might also be used to encourage pharmacies to locate in underserved areas.
Community organizations, pharmacies and the government should work together to find solutions to the newly identified problem of pharmacy deserts in Chicago, because people cannot “take the medicine as directed” if they cannot get their hands on the medicine in the first place.
Dima M. Qato, PharmD, MPH, PhD, is assistant professor in the Department of Pharmacy Systems, Outcomes and Policy at the University of Illinois at Chicago and a Network Fellow with the Edmond J. Safra Center for Ethics at Harvard University.
Bruce L. Lambert, PhD, is professor of Communication Studies and director of the Center for Communication and Health at Northwestern University and part of the NU Public Voices Fellowship through The OpEd Project.
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