A Walgreens pharmacy is closing in Roxbury, a predominantly Black neighborhood, and residents are calling the closure unjust. Rightly so. The closing of a neighborhood pharmacy is not just an inconvenience to the community; the lack of access to a pharmacy can worsen health inequities.
Health inequities are caused by policies, practices, and other barriers that keep some groups from achieving optimal health. To advance health equity, which means to create conditions that ensure optimal health for everyone, these obstacles need to be removed. In this case, the absence or closure of pharmacies in Black neighborhoods create obstacles for residents to obtain medications, vaccines, diagnostic tests, and other essential health services.
In a study published in JAMA Network Open, researchers analyzed data from 3.1 million individuals and found that pharmacy closure impacted older adults’ adherence to medications for heart-related diseases. The researchers noted that people were more likely to fall behind on taking their prescribed medications during the first three months after the pharmacy closed, compared to those who did not experience pharmacy closure. Differences in medication adherence between older adults who experienced a pharmacy closure and those who didn’t remained for over 12 months. These disparities are troubling especially given the fact that heart disease is the leading cause of death in the United States across all races.
Neighborhood pharmacies are also an important source of vaccines, like the influenza vaccine, and emergency medications, such as naloxone — a medication to quickly reverse opioid overdose. There are racial and ethnic disparities in influenza vaccine coverage, with lower coverage among non-Hispanic Black and Latino adults compared to non-Hispanic white adults. For example, during the 2022 to 2023 influenza season, more than 42 percent of non-Hispanic Black adults and nearly 37 percent of Latino adults received an influenza vaccine, compared to more than 51 percent of non-Hispanic white adults. The closure of pharmacies in Black neighborhoods could worsen these racial and ethnic disparities.
The problem of pharmacy access and closures in marginalized neighborhoods is not new. In a 2014 study published in the journal Health Affairs, researchers found that segregated Black communities in Chicago were more likely to have pharmacy deserts. The researchers defined a pharmacy desert as a low-income neighborhood that has greater than 33 percent of its residents living beyond 1 mile of a pharmacy. Of the 1 million people who lived in pharmacy deserts in Chicago, more than 500,000 lived in predominantly Black communities.
In another study published in JAMA, researchers reported that from 2009 to 2015, 1 in 8 pharmacies in the United States closed. The pharmacies at highest risk of closure were those serving neighborhoods with low-income, uninsured, and publicly insured populations. A 2021 study noted that across New York City, Houston, Chicago, Los Angeles, and Chicago, pharmacy deserts were most prevalent in Black and Latino neighborhoods. Pharmacy deserts remained the same or increased across 3 of the 4 cities from 2015 to 2020. Researchers have also found that compared to majority white neighborhoods, there are fewer pharmacies in Black and Latino neighborhoods in Boston and several other large cities.
There is no lack of evidence on who is impacted by pharmacy closures and deserts, but it is unclear what solutions cities like Boston are developing to prevent future closures and the emergence of pharmacy deserts. Legislative changes are needed to prevent the closures of pharmacies in Black and Latino neighborhoods. Policies must ensure Black and Latino neighborhoods have access to medications, vaccines, and other lifesaving medical interventions that are typically provided by pharmacies, as white neighborhoods do. For example, pharmacies have reported low reimbursement rates on prescription medications as a reason for closure. Policies that ensure that pharmacies are adequately reimbursed for prescription medications could reduce the number of pharmacies that close.
Some studies have recommended public financing or regulations to ensure that pharmacies are located in pharmacy deserts. For patients that have to travel long distances to obtain prescription medication, researchers have observed that mail orders and transportation to and from pharmacies, especially for people on Medicaid, could reduce barriers to access. Policy makers should work with local communities and pharmacies to create effective and sustainable solutions.
Elaine O. Nsoesie is an associate professor at Boston University School of Public Health and a Public Voices fellow of The OpEd Project and AcademyHealth.