According to the Journal of the American Medical Association (JAMA) I grew up in a pharmacy desert. The nearest pharmacy was also nearly 20 miles away. An article in JAMA Network reports that 46% of American counties contain at last one pharmacy desert. According to the analysis, 1347 counties out of 3143 have areas that are more than 10 miles from a pharmacy. Some counties were far worse than others, and it’s getting worse:
Retail pharmacy chains have been closing thousands of locations throughout the US, possibly playing a role in health care gaps. Similar to the concept of food deserts, areas in which medications are harder to obtain have been deemed pharmacy deserts.In the US, CVS announced plans to close 900 stores in the next 3 years, and Rite Aid filed for bankruptcy.1 As pharmacies close, more and more individuals are left without easy access to medications, with disproportionate consequences for certain communities.
It should come as no surprise that not everybody lives in large, metropolitan cities. Where I live in far North Texas there seems to be a CVS on every corner and all grocery stores and major retailers that sell food all have pharmacies. Yet, if I used a protractor on neighboring counties I may be able to find specks on the map that are 10 miles from a pharmacy. It certainly would be the case in many Texas counties outside metro areas.
If an area lacks pharmacies then doctors and dentists are likely even more scarce. Neither should it surprise anyone that areas without retail pharmacies or doctors are probably poor and underdeveloped, with a higher social vulnerability index (SVI).
…pharmacy deserts may disproportionately affect individuals living in US regions with low practitioner supply and high social vulnerability.There is an association between SVI and number of chronic conditions. For example, diabetes and hypertension tend to be more prevalent among Black patients living in rural areas. Poor access to pharmacies is often associated with lower medication adherence. Patients in socially vulnerable communities may lack the means to travel to other pharmacies or may have limited access to broadband internet to find telepharmacy options. Furthermore, pharmacies often offer diagnostic, preventive, and emergency services. As high pharmacy desert density counties also have a lower PCP density, patients residing in these regions face increased barriers to accessing primary health care needs.
I suspect research would also show that areas with low pharmacy density are deprived in other ways, including higher unemployment, fewer jobs, scarce housing, fewer social services, less retail shopping variety, etc. Rural areas are depopulating with many small towns on the verge of turning into ghost towns. Numerous towns are little more than a gas station on the highway, with an aging convenience store, dilapidated housing and a disproportionate number of poor seniors.
There is little public health advocates can do to make either chain pharmacies or independent pharmacies operate in declining towns. On the other hand, Walmart specialized in rural areas before expanding into larger cities. Most Walmart stores have a pharmacy. According to Walmart:
With 90% of the U.S. population living within 10 miles of our stores, we’re primed to combine our physical locations with our e-commerce business to offer a level of convenience never before seen.
Public health advocates and academic physicians who live in large, metropolitan cities may not really understand what life is like in rural areas. As a child, we thought nothing of grocery shopping in a store 20 miles away, seeing a doctor 20 miles away and filling prescriptions in the same town. It was common to plan major shopping trips to regional towns 65, 85 and 100 miles from home. My early memories of Christmas shopping were in Dodge City, Kansas, a town 100 miles away. Specialist physician visits and surgeries were sometimes farther away, such as Amarillo, Denver or even Oklahoma City.
What could possibly bring more care to rural America? Increase the scope of practice allowing mid-level practitioners to work with greater independence in small towns. Deregulate telemedicine to boost access to care in areas not served by a doctor. Walmart recently decided to shutter its primary care storefronts. Maybe Walmart would change its mind if it were easier to create virtual medicine storefronts.