Some of the aisles — those for the snacks and the dollar deals — were empty. But as the Walgreens at Erdman Shopping Center in East Baltimore prepared to close permanently, many shelves were still fairly stocked as shoppers from neighboring communities roamed the store.
Lillian Warren surveyed the beauty supplies with bright orange clearance tags. The deals were about the only good thing that came out of the sudden news that the store would be closing.
But, Warren said, “You gotta allow yourself to accept change.”
Nationwide, there were disproportionately more pharmacy deserts in Black and Latino communities than in white or diverse neighborhoods, according to a 2021 study. They are also more likely to see pharmacy closures.
A Baltimore Banner data analysis found majority-Black and majority-minority neighborhoods do have a slight disadvantage in access to pharmacies. The average distance of all properties in Baltimore to a pharmacy is about three-tenths of a mile. Blocks in majority-Black and majority-minority neighborhoods were just above average, and majority-white and majority-Hispanic neighborhoods were just below.
On the last day that the Walgreens was open in February, customers expressed concern that neighborhood residents who can’t drive, like senior citizens, would no longer be able to easily access a pharmacy. Some health care companies, such as GoodRx, deliver to homes, but that also requires residents to have access to technology and the internet.
William Solomon, who lives in the nearby Four by Four neighborhood, worried that the closing of the Walgreens would prompt other businesses in the shopping center to close their doors. He also worried about the fate of other stores in Four by Four and in the nearby Berea and Belair-Edison communities.
“It seems that we are the forgotten sector of the city,” he said.
Not an isolated issue
Pharmacies play a multifaceted role in communities. In addition to selling over-the-counter medications and dispensing prescriptions, pharmacies serve as access points for customers to seek preventive care for viruses, chronic illnesses and sexually transmissible diseases. Their important role was underscored by vaccination efforts in the early stages of the COVID-19 pandemic, said Dima Qato, an associate professor and director at the University of Southern California school of Pharmacy.
Past segregation and redlining contributed to the exclusion of social services and certain businesses — including pharmacies, grocery stores and banks — from some neighborhoods. Experts in community health equity stress that pharmacies typically aren’t the only stores or resource centers missing from certain neighborhoods.
“It is important to look at it as a system issue and not an isolated issue, understanding that pharmacy deserts, food deserts, financial deserts … have this pattern and clustering,” said Kim Dobson Sydnor, dean of Morgan State University’s School of Community Health and Policy. “Community health and well-being is at the core of all this discussion. So how do we go about building that in ways that makes sense? And in ways that don’t require, you know, people to be gentrified, moved out their neighborhoods, to get resources?”
When a community is labeled, say, a pharmacy desert, it can begin a cycle in which a neighborhood is viewed as undesirable and less likely to attract businesses and investment, Sydnor said, which only furthers disparities. The lack of resources in these communities may also be contributing to the movement of Black residents out of the city and into neighboring counties, said Linda Loubert, an associate professor of economics at Morgan State University.
She said her research has found that a lot of Black Baltimoreans who left the city previously resided in neighborhoods on the East Side that lacked convenient access to food, banks and groceries.
Why pharmacy deserts emerge nationwide
Market forces contribute to the creation of pharmacy deserts, according to Qato.
Pharmacies are more profitable when the customers they serve are privately insured, while Black, Hispanic and Indigenous people are more likely than white people not to have insurance at all. Nationwide, many pharmacies are shutting down in neighborhoods that are primarily Black, Qato said.
Another factor is that public and private insurance companies often dictate where people can buy medications. Oftentimes, Qato said, network providers exclude independent pharmacies, which are more likely to serve Black and Latino neighborhoods.
Lack of access to pharmacies is “significantly associated” with worse health outcomes for people who live in pharmacy deserts, said Mariana Socal, an associate scientist at Johns Hopkins University. Historically, pharmacies in predominantly Black communities are not well-stocked with certain drugs, such as opioids, and Black people are “significantly less likely to be prescribed pain medication and that they generally receive lower doses of it when they are.”
Researchers typically describe pharmacy deserts as areas that do not have pharmacies within a one-mile radius, Socal said. But she stressed that there’s another layer of accessibility beyond geographic availability: the quality of care in the pharmacies and whether neighborhood residents trust the staff.
Residents of low-income neighborhoods, who face a higher risk of health issues than those in wealthy communities, may also have an increased need for pharmaceutical treatments, Socal said. Even if the neighborhood has a pharmacy within a one-mile radius, it does not mean the level of care is appropriate or accessible for all. And the lack of competition may also drive pharmacy prices up, Socal added.
“These are elements that are frequently not fully studied or examined, and they are also important because some areas may not pop up as a ‘pharmacy desert’ because maybe there are pharmacies there,” Socal said. “But these pharmacies may not be actually appropriately serving those neighborhoods because of the characteristics of the care that they can provide.”
“These are all factors that significantly contribute toward health outcomes in that community,” she added, “and an increased burden of disease in those communities is something that we should be all concerned about.”
Addressing pharmacy access disparities
During the early stages of the pandemic, the city’s health department provided vaccines for homebound individuals. It also briefly delivered medications when pharmacies suddenly closed amid the civil unrest that followed Freddie Gray’s death in 2015. However, the department does not currently have any programs that support people in pharmacy deserts, according to a city spokesperson.
Both Qato and Socal stressed that pharmacy access disparities stem from the lack of industry regulation, particularly when it comes to reimbursement rates.
Socal pointed to the importance of bringing more federally qualified health centers to historically underserved communities that can provide transportation services to those in need. Such centers, which also offer preventive health care services and specialized care, may also incentivize the opening of pharmacies.
Sydnor said the solutions need to be tailored to the needs of particular communities.
“Communities may have great ideas about how to redress their shortcomings,” she said.
More than two months after the Walgreens in East Baltimore closed, William Smith walked by the empty storefront. The business next door, Shoe City, was also closing.
He missed the store. It was convenient for him, said Smith, who lives nearby on Sinclair Lane.
A Walgreens spokesperson did not specify why its store on Erdman Shopping Center was shut down, only that “several factors are taken into account” when closing a particular location, including the “existing footprint of stores and dynamics of the local market, and changes in the buying habits” of patients and customers.
“I can’t say they was doing pretty good business, but I know they got my business,” Smith said. “We need something like that around here, we really do.”
The prescriptions of some Walgreens customers were transferred to a CVS store on Belair Road that’s about a half-mile away. Smith said he can make it out there if he needs to.
“But I ain’t that young,” said Smith, 70. “Don’t let me fool you.”
Learn more about our analysis and reproduce our findings by visiting our GitHub page.