In the openings and closings of local pharmacies, Chicago is yet again a tale of two cities.
In well-heeled parts of town, national chains (of the increasingly swanky variety) seem to pop up with the ubiquity of coffee shops. But in less affluent areas, pharmacy closures have reached a level where some neighborhoods are what researchers call “pharmacy deserts.”
Dima Qato, a professor in the University of Illinois-Chicago College of Pharmacy, says it’s the same concept as food deserts, except instead of a lack of access to fresh produce, residents in pharmacy deserts lack access to over-the-counter drugs and prescriptions that treat chronic conditions.
“Pharmacies aren’t just resources for medication; they have diapers, hygiene products, immunizations, health screenings,” Qato says. “The absence of a pharmacy can be disastrous from a health care perspective.”
Qato and her colleague, Shannon Zenk, last week were recently named to the Robert Wood Johnson Foundation Clinical Scholar Program where they’ll spend the coming years researching, building out referral networks and creating partnerships that can help to minimize the harm of pharmacy deserts on Chicago’s South and West Sides.
Qato says it’s well-known that predominantly black and Latino neighborhoods in Chicago tend to have fewer pharmacies than majority white neighborhoods, but the rate of closings in poorer communities has accelerated in the past few years. In the last 12 months, key pharmacies have closed in neighborhoods like Austin, Woodlawn, and East Garfield Park. Washington Heights on the far Southwest Side has one the oldest communities in Chicago (in terms of the age local residents); it, too, had recent closures.
Walgreens closures, which affected several South and West Side locations, didn’t result in a net reduction of stores, though. The Deerfied-based chain opened 200 new stores, in ostensibly more profitable areas.
“This really is [about] getting the right stores in the right places,” said Walgreens COO Alex Gourlay, who at the time was the company’s executive vice president.
Qato acknowledges the financial realities that prompt pharmacies to shutter locations in less profitable areas but said national chains are also playing with an unfair advantage over independent pharmacies, which are especially prevalent in black communities.
“Independent pharmacies … end up closing once a CVS or a chain pharmacy opens. And a lot of [those] pharmacies—not all of them—get TIF funding from the city to open,” Qato says. “The chains take the business from the independents and then three years later they close. An independent pharmacy survives 10 to 20 years until a chain closes it, and then those close, and you get these pharmacy deserts.”
Part of Qato and Zenk’s work in the coming years will look at how to keep chain stores accountable to the communities they open in, especially when they receive tax breaks or other incentives. Ideally, pharmacies notify the community in advance of a closure and refer them to a new location where they can shop and get their prescriptions filled. But Qato says it doesn’t always happen in a smooth or timely manner, which can leave customers scrambling.
“If you just follow an old woman on the South Side trying to get her meds, you see it,” Qato says. “I’ve worked in different cities and different neighborhoods. Even when it’s as simple as a pharmacy not having a drug in stock, it’s hard to tell someone to go visit a different location if there just aren’t many pharmacies in that neighborhood to begin with.”
Pharmacy deserts are also a larger public health problem, Qato says. Pharmacies help keep overall health costs down: They manage issues that lead to preventable hospital visits; provide people with wellness care; and are, in some cases, the only place insurance companies cover when it comes to things like immunizations. They're more prevalent than any community heath center or hospital, and they’re more accessible because of their hours.
“Asthma rates are higher in minority populations than white ones,” Qato says. “What’s the likelihood that you go to the ER for a rescue inhaler if you don’t have a local pharmacy?”
Throughout the course of Qato and Zenk’s three-year program, the professors plan to hold series of town halls that will bring together residents impacted by pharmacy closures with corporate pharmacy retailers and public health officials.
And, for residents who have already lost their local pharmacy, Qato says they’re already working to establish a pharmacy referral service which can fill and deliver medication to at-risk patients.