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Richness of sources, could be combined w/formative and summative - could be basis for semester-long project. Jeanne had experience with a participatory action research project on this topic

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Research

Pharmacies are an important part of the health care system because they dispense prescription and over-the-counter medications and increasingly provide preventative services, including Covid-19 testing and immunization. However, geographic access to pharmacies varies throughout the US, especially in segregated American cities. Disparities in pharmacy access impact medication adherence, or how well a patient takes their medications. And medication adherence influences health outcomes ranging from cancer progression to cardiovascular disease.

In May, we published findings from a study of pharmacy locations in US cities between 2007 and 2015. We found that one-in-three neighborhoods throughout the 30 largest cities in the United States are pharmacy deserts. We defined pharmacy desert as a neighborhood where: (1) the average distance to the nearest pharmacy was one mile more or (2) the average distance to the nearest pharmacy was at least half a mile and at least 100 households had no vehicle access. We found troubling, persistent disparities associated with neighborhood racial and ethnic composition. Nearly 40% of segregated Black and Latinx neighborhoods were deserts in comparison to one quarter of White neighborhoods.

In an updated study, we found that these disparities persisted in the four largest US cities through 2020 ( figures above). Importantly, the few pharmacies that served segregated Black and Latinx neighborhoods were less likely to offer immunization, 24-hour availability, and drive-thru services than pharmacies located in other neighborhoods. They were also more likely to more likely to close permanently.

This inequitable distribution of pharmacies is not an accident. It is an expected result of longstanding health policies that neglect to protect pharmacies located in underserved neighborhoods. For example, many pharmacies close due to low reimbursement rates for Medicaid and Medicare Part-D (prescription drug benefits for older adults). Insurance plans often institute narrow pharmacy networks (which financially incentivize patients to use pharmacies through lower cost-sharing) that exclude many pharmacies in segregated communities of color.

Such policies are a form of structural racism that affects where pharmacies locate and stay open. For example, to improve the economic viability of pharmacies at risk of closures, 11 states provide higher Medicaid reimbursement rates in rural areas. However, most of these states fail to provide similar protections to pharmacies located in segregated Black and Latinx neighborhoods in their urban centers.

Low reimbursement rates are a root cause of pharmacy closures. Medicare and Medicaid programs must ensure that their reimbursement policies not exacerbate disparities across segregated neighborhoods. For example, the Centers for Medicare and Medicaid Services (CMS) could update Part D requirements and mandate higher reimbursement for pharmacies located in pharmacy deserts.

States could also require Medicaid managed-care plans to meet convenient pharmacy access standards. In other words, beneficiaries in cities should have access to in-network pharmacies within 1 mile of their home. Independent pharmacies are critically important because they disproportionally serve segregated minority neighborhoods, but they are more likely to close. Therefore, any policy reforms should guarantee that independent pharmacies, not just large chains, are included in Part D and Medicaid managed-care pharmacy networks.

In Chicago, an extremely segregated city, one of the largest providers of Medicaid managed-care, Aetna Better Health, narrowed its network of pharmacies to CVS pharmacies (the majority of which are in white neighborhoods) and a small number of independents. This reduced access to convenient pharmacies for Medicaid beneficiaries, who are disproportionately Black and Latinx. It may also lead to closures of pharmacies operating in segregated minority neighborhoods, as beneficiaries are forced to use pharmacies elsewhere. Residents of segregated Black neighborhoods were already experiencing substantial barriers to medication access, as at least 60 pharmacies operated in a reduced capacity in summer 2020 during the Black Lives Matter protests. Several closed and never reopened.
Notes: The figures depict the geographic distribution of pharmacy deserts and the number of pharmacies that provide immunization services in each city (not to scale). Pharmacy deserts were those low-income neighborhoods (1) whose average distance to the nearest pharmacy was ≥1 mile or (2) whose average distance to the nearest pharmacy was ≥0.5 mile and at least 100 households had no vehicle access. We also delineate city subdivisions, including boroughs in New York Cities, service planning areas in Los Angeles, planning districts in Chicago, and council districts in Houston. Adapted from Guadamuz JS, Alexander GC, Kanter GP, Zenk S, Wilder JR, Qato DM. Access to Pharmacies and Pharmacy Services in New York City, Los Angeles, Chicago, and Houston, 2015-2020. J Am Pharm Assoc. 2021. Disclosures: J.S. Guadamuz reported current employment with Flatiron Health Inc, an independent subsidiary of Roche. D.M. Qato does not report potential conflicts of interest.
Lacking access to a local pharmacy can directly impact health equity. Pharmacy closures are more likely to occur in Black and Latinx neighborhoods and lead to lower adherence to medications that can prevent a heart attack or stroke. Inequitable access to pharmacy services, such as drive-thru and immunization, has likely aggravated disparities in COVID-19 testing and vaccinations in these same neighborhoods. Therefore, to improve health equity, we need to improve access to pharmacies and their services in Black and Latinx neighborhoods throughout the country.

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Pharmacy Deserts Hinder Medications Access in Segregated Black and Latino Neighborhoods

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Research Pharmacies are an important part of the health care system because they dispense prescription and over-the-counter medications and increasingly provide preventative services, including Covid-19 testing and immunization. However, geographic access to pharmacies varies throughout the US, especially in segregated American cities. Disparities in pharmacy access impact medication adherence, or how well a patient takes their medications.

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Very informative even in first paragraph.
Could debrief by talking about all the things you could touch on - role of govt in defining terms can narrow what it means
When do you stick with or change terminology based on its limitations?

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Food deserts are communities that have poor access to healthy, affordable foods (, 2).

Also known as healthy food priority areas, food deserts are concentrated in low-income and historically marginalized areas throughout the United States (, 2, 3, ).

In food deserts, healthy foods like fruits, vegetables, whole grains, dairy, peas, beans, meat, and fish are often expensive or unobtainable. The lack of access to healthy foods in these communities translates to health disparities and high rates of chronic disease (, 5, ).

This article examines the causes, health effects, and potential solutions for food deserts.

The causes of food deserts are multifaceted. Public policy and economic practices that are embedded in systemic racism often play a role. Social, economic, and political conditions have been shown to reduce people's access to healthy foods.

Contributing factors include food insecurity, social determinants of health, racial residential segregation, and poor access to transportation among low-income and historically marginalized populations (, , 8, 9).

Food apartheid

Apartheid is an enforced form of racial segregation.

"Food apartheid," however, is an emerging term meant to address the root causes of poor access to healthy, nutrient-dense foods by communities of color and low-income white people.

Food activists like Karen Washington, Malik Yakini, and Dara Cooper believe that this term more accurately represents the systemic racism and health inequities of a corporate-controlled food system.

The term "food desert" is sometimes scrutinized for its misrepresentation of the core issues within these communities.

For instance, the term "desert" suggests a natural, barren landscape and proposes that increasing the number of grocery stores is a quick solution. Furthermore, this term neither resonates with nor is a part of the identities of the individuals who live within these areas.

Instead, "food apartheid" addresses the root causes of poor food environments and health disparities among predominantly low-income communities of color.

Food insecurity

The U.S. Department of Health and Human Services (DHHS) estimates that 17.4 million American households were food insecure in 2014 ( 9).

Food security is the physical and economic access to sufficient nutritious foods by all people at all times. When this access is disrupted or limited, food insecurity occurs ( 10).

Food insecurity may be temporary - for example, if you run out of food for a day or two - or long-term, as exemplified by persistent poverty and poor access to food ( 10).

Food insecurity among low-income communities in food deserts is 2.5 times greater than the national average ( 9).

Social determinants of health

Social determinants of health are factors beyond your control, such as access to healthcare or transportation, that affect your quality of life. These factors play a major role in food deserts ( 11).

Barriers like income, community infrastructure, and access to supermarkets all influence the availability of healthy foods. Other social determinants of health that may contribute to food deserts include (, 8, 11, ):

education

employment and job training

socioeconomic status and concentrated poverty

access to healthcare

access to local food markets and fresh produce

access to transportation

racial segregation

public safety

These factors may lead to health disparities characteristic of food deserts, such as high rates of chronic diseases among historically marginalized and low-income communities (, 2, , 11).

Racial segregation

Low-income communities have a high proportion of Black and Latino populations who are disproportionately affected by poor food access (, , 9).

Robust evidence shows that racial segregation places historically marginalized populations, particularly Black people, in impoverished neighborhoods (, 9).

In 2016, compared with the national average, Black households were two times likelier to be food insecure, while Hispanic households had a greater prevalence of food insecurity ( 9).

Notably, 76% of neighborhoods with a high proportion of Black people were among the most impoverished ().

Transportation and proximity to supermarkets

In food deserts, the distance you have to travel to supermarkets is further than in wealthier areas (, ).

Plus, predominantly Black and Hispanic communities have fewer supermarkets and local food markets - which often offer affordable and nutritious produce - than white neighborhoods (, 6, , 9, , 13).

Thus, households in food deserts don't have equal access to the healthy foods available to white and affluent communities ( 6).

Furthermore, public transit and vehicle ownership play a role in food access ( 8, 13).

Summary
Food deserts are attributed to food apartheid and have root causes in food insecurity, racial segregation, proximity to supermarkets, access to a vehicle, and various other social factors.

Because there isn't an exact definition of food deserts, U.S. government agencies instead characterize communities, states, and populations based on food insecurity, income status, and access to stores and vehicles ( 14).

In 2014, an estimated 17.4 million American households were food insecure, while in 2016 31.6% of low-income households experienced food insecurity ( 9).

The Food Environment Atlas, which was developed by the U.S. Department of Agriculture (USDA), shows an interactive map that displays information on food insecurity, socioeconomic conditions, and proximity to supermarkets ( 14).

According to this map, food insecurity rose in 16 states between 2015 and 2017, although only Nevada, New York, and Rhode Island saw a significant increase in the percentage of households with very low food insecurity ( 14).

"Very low food insecurity" is defined as disrupted eating and reduced food intake due to poor access or economic hardship ( 9).

In the United States, populations with low access to stores are concentrated in the Southwest, Midwest, Northwest, and Florida, while households without access to a car and low food access are more common in the Northeast and Southeast ( 14).

As such, food insecurity, poor food access, and potential food deserts exist across the continental United States.

Summary
Food deserts are likely widespread throughout the United States. National statistics characterize geographic areas based on income status, food insecurity, and access to stores and vehicles.

Diet and nutrition play a major role in chronic disease ( 15, ).

Chronic illnesses are the leading cause of death and disability in the United States, with heart disease, diabetes, and cancer being the most common ().

Among low-income and food-insecure communities, disproportionate access to affordable, healthy foods contributes to poor nutrition and perpetuates health disparities, leading to higher rates of obesity and other chronic ailments (, , 9, 13, 15, , 17, ).

Notably, Black people - who are likelier to be food insecure - have the highest rates of disease and mortality, largely related to diabetes and high blood pressure (, ).

A vicious cycle may develop in which people with chronic diseases in food deserts rely on convenience stores and corner stores, which often sell expensive foods with low nutritional value - further limiting people's capacity to buy healthy foods ().

Summary
Food insecurity in low-income, historically marginalized communities is associated with higher rates of chronic illnesses, such as diabetes, heart disease, and cancer.

Understanding food deserts as food apartheid not only addresses their root causes but also challenges the quality of solutions that are often presented.

Temporary fixes that continue to perpetuate wealth inequities and health disparities include the placement of more fast-food chains and corner stores within food deserts (, 13, 19).

Simply increasing access to cheap food doesn't lead to equitable access to affordable and healthy foods ( 13).

At the community level, food distribution, locally run markets, and gardening make great tools for communities to increase food access, reduce food insecurity, and promote healthy diets and lifestyles.

Keep in mind that comprehensive structural and policy changes are necessary to achieve equitable food access. Still, you can get started today on community-run solutions to improve access to affordable healthy foods in food deserts (, ).

Community gardens

In addition to creating green spaces and beautifying the neighborhood, community gardens provide fresh, nutritious produce and encourage healthy diets.

They also teach skills and foundational knowledge about environmental concerns, planting know-how, and where foods come from.

Finally, community gardens may help communities invest in their own health.

Farmers markets, arabbers, and roadside carts

Community markets promote local food production, as well as cultural foods that both appeal to the population and support a healthy diet.

At farmers markets, you buy directly from growers and support a local, thriving economy.

Arabbers - street vendors who sell fruits and vegetables from horse-drawn carts - and roadside produce carts may also create economic opportunities and improve food access in food deserts.

The USDA's Community Food Projects (CFP) Competitive Grant program is a potential source of funding to kick-start and nurture such programs ( 13, 22).

Surplus food sharing

To balance out food waste from wealthy communities with poor food access in food deserts, food sharing collaborations and alliances may support more efficient food economies.

Food rescue organizations even take produce that would be thrown out at grocery stores due to blemishes or physical deformities - but that's still perfectly good to eat - and resell it at affordable prices.

Federal resources for low-income people to get healthy foods

SNAP gives financial assistance to families in need and provides nutrition benefits.

The WIC program provides monthly nutrition packages, incentives for people who are nursing, and benefits for children up to age 5.

The National Council on Aging (NCOA) offers assistance to low-income older adults facing hunger.

Nongovernmental food assistance programs

Meals on Wheels and other organizations like Moveable Feast provide medically tailored food delivery and nutrition education to establish racial, social, and health equity.

Food Not Bombs provides free vegetarian and vegan meals in numerous locations around the globe.

Wholesome Wave works with community organizations to eliminate food insecurity and provide nutritious food to people in need.

Local food pantries, soup kitchens, and food banks run by religious or community organizations offer food to low-income communities to reduce food insecurity and hunger.

Summary
Community-based solutions to improve access to affordable, healthy foods in food deserts include local markets, community gardens, surplus food sharing programs, federal food assistance programs, and food pantries.

For immediate food assistance, call the USDA's National Hunger Hotline at 1-866-3-HUNGRY (1-866-348-6479) or 1-877-8-HAMBRE (1-877-842-6273), Mondays through Fridays from 7:00 a.m. to 10:00 p.m. EST.

How to improve your nutrition on a budget

Even if you're on a tight budget and don't have high quality, fresh produce available, there are numerous ways that you can enjoy nutritious foods, including ( 23):

Buy canned or frozen goods. Canned or frozen meats, fruits, and vegetables are both nutritious and inexpensive compared with their fresh counterparts - and they last longer. Opt for low salt canned food when possible.

Try nonmeat protein sources. Meat accounts for a large portion of many people's food bills. Dried peas and beans provide just as much protein as meat but are cheaper and longer-lasting.

Shop for foods in season. In-season produce is easier to obtain and less expensive than out-of-season fruits and veggies. If they're available in your area, visit roadside stands or other local markets and buy small amounts of fresh produce to avoid waste.

Freeze leftovers. To cut down on costs and food waste, freeze leftovers for reheating later in the week. You can also repurpose leftovers. For instance, plain rice from Sunday lunch can be made into vegetable rice for Monday or Tuesday.

Summary
If you're on a budget, freezing leftovers, eating more peas and beans, buying canned goods, and looking for in-season produce are a few strategies to save money and eat well. If you're experiencing hunger, call the USDA's National Hunger Hotline.

Food deserts - where nutritious food is often expensive or unavailable - usually occur in low-income, historically marginalized communities. They're marked by high rates of food insecurity, racial and health disparities, and high rates of chronic diseases.

Several federal and nonprofit programs are dedicated to improving food access in food deserts.

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Food Deserts: Causes, Effects, and Solutions

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Food deserts are areas in which healthy food is overly expensive or unavailable. This article explains the causes and health effects of food deserts, along with potential solutions.