Studies Highlight Barriers to Health Equity: Access to Pharmacies & Telehealth

Two studies recently published in Health Affairs shed light on important health equity issues.

Pharmacy Deserts/Closures

One of the strategies employed by the federal government to expand nationwide access to vaccines was to establish the Federal Retail Pharmacy Program for COVID-19 Vaccination. The Centers for Disease Control and Prevention (CDC) describes the program as a collaboration between the federal government, states, and 21 national pharmacy partners and independent pharmacy networks to increase access to COVID-19 vaccinations across the United States. According to a study published in Health Affairs, however, access to pharmacies is notequal.

The authors of the study examined 10,074 neighborhoods in the nation’s 30 most populous cities. They found 79% of those neighborhoods were segregated by race/ethnicity, and there were “persistent differences in the availability of pharmacies across types of neighborhoods based on their racial and ethnic composition.”[1] Throughout the study period (2007-15), the authors found there were fewer pharmacies in Black and Hispanic/Latino neighborhoods than in White or diverse neighborhoods. The study also found:

• Approximately one-third of the neighborhoods in the 30 most populated cities in the U.S. were “pharmacy deserts,” lacking pharmacies, in 2015, affecting nearly 15 million people.[2]
• In all cities, pharmacy deserts were significantly more common in Black neighborhoods than White neighborhoods – especially in low-income Black versus low-income White neighborhoods.
• Pharmacies located in Black and Hispanic/Latino neighborhoods were more likely to close than pharmacies located in other neighborhoods in urban areas.
• Pharmacies were least likely to open in minority neighborhoods that lacked pharmacies.

Telehealth

This study centers around disparities in telehealth use for patients with language barriers. According to the study, 25.6 million people in the United States (almost 8 percent of the population) have limited English proficiency. Just over a quarter of that population lives in California. The study found that patients with limited English proficiency had half the odds of using telehealth services compared with those who were English-proficient. Additionally, those who had limited English proficiency were “more likely to be older, female, less educated, poorer, uninsured and Medicaid recipients and lack a usual source of care.”[3] Furthermore, the study reports that those were “uninsured or were covered by Medicaid had lower odds of telehealth use compared with patients with employer-based insurance.”

The use of telehealth greatly increased during COVID-19 and has been seen as technology that can increase access to care. The challenge is to ensure that such access is inclusive. The Center for Medicare Advocacy previously reported a study that found inequities in use and access to telehealth services during COVID-19, affecting older adults, low-income individuals, non-English speakers, and minority groups the most.

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[1] Guadamuz, Jenny S., Jocelyn R. Wilder, Morgane C. Mouslim, Shannon N. Zenk, G. Caleb Alexander, and Dima Mazen Qato. “Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007–15.” Health Affairs 40, no. 5 (2021): 802–11. https://doi.org/10.1377/hlthaff.2020.01699.  
[2] The study defines a pharmacy desert as a neighborhood with low geographic access to pharmacies.
[3] Rodriguez, Jorge A., Altaf Saadi, Lee H. Schwamm, David W. Bates, and Lipika Samal. “Disparities In Telehealth Use Among California Patients With Limited English Proficiency.” Health Affairs 40, no. 3 (2021): 487–95. https://doi.org/10.1377/hlthaff.2020.00823.