You’ve heard of food deserts. Pharmacy deserts are just as bad.
Even as drug stores increasingly provide more vital services, including COVID-19 tests, contraceptive counseling and wellness visits, communities on the South and West sides have fewer locations than other parts of the city.
Monica Mitchell has lived in South Shore for two decades, and in that time, she’s had to change pharmacies three times.
The 48-year-old registered nurse said when a Walgreens five minutes from her house was closed, she switched to one a few blocks over, but it didn’t carry all the items she needed. So she started going to one in Hyde Park.
Then came the murder of George Floyd by a Minneapolis police officer in the summer of 2020, which sparked days of protests, civil unrest and looting across the city and the nation.
In the aftermath, hundreds of businesses in Chicago shut their doors either temporarily or permanently, including many pharmacies, and Mitchell was forced to change drugstores once again. By then, the closest Walgreens was in southwest suburban Evergreen Park, 30 minutes away.
While Mitchell now gets most of what she needs via mail order, that convenience is not widely used by those who are more comfortable with brick-and-mortar stores or lack internet access, she said.
A few miles southwest of Mitchell, 68-year-old Renita Johnson said over the decades she has lived in Roseland, she has seen a number of nearby pharmacies close.
She can’t imagine how her older neighbors without cars and limited mobility even get to a drugstore these days.
“I would see it as a total nightmare,” she said.
The experiences of the two women are not unusual in many parts of Chicago.
Even as drugstores are providing more vital services — including COVID-19 tests and vaccinations, contraceptive counseling and wellness visits — a recent study shows communities on the city’s South and West sides have fewer pharmacy locations than other parts of the city.
These areas are called pharmacy deserts, a term coined in 2014 by Dima Qato, a former University of Illinois at Chicago professor now at the University of Southern California. In a pharmacy desert, at least a third of residents live more than a mile from a pharmacy, or over a third of residents with “low vehicle access” live more than half a mile from the nearest pharmacy.
In Chicago, North Side residents are far more likely to have easy access to pharmacies than their South and West side counterparts, according to Qato’s research. And the number of pharmacy deserts on the South and West sides has increased in recent years.
“Chicago actually has the widest gaps between white and Black neighborhoods in the country,” Qato told the Sun-Times.
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As Mitchell found, that problem was exacerbated by the civil unrest of 2020, when a number of pharmacies closed after many were looted. It was particularly an issue in Black neighborhoods where, the city confirmed, about one out of every five pharmacies was shuttered temporarily or permanently, according to a WBEZ analysis of August 2020 city data tracking the availability of pharmacies.
Meanwhile, a separate WBEZ analysis shows access to the two largest pharmacy chains in Chicago — Walgreens and CVS — is much higher in the city’s white communities than in Black or Latino areas.
Mitchell said she saw firsthand the public health effects of pharmacy deserts during the pandemic. She said it took weeks to find COVID testing sites, and she had trouble getting a vaccine.
Now, with COVID-19 tests and vaccines less scarce, Mitchell worries about the effects of the U.S. Supreme Court overturning Roe v. Wade.
In January, a new Illinois law took effect, easing access to hormonal contraceptives by no longer requiring a doctor’s prescription for things like the pill, patch or ring. But with so few pharmacies across South and West side neighborhoods, some, like Mitchell, wonder if the law will benefit as many women as it could.
“If you don’t have birth control, if you get pregnant, that’s generational,” Mitchell said. “That’s gonna go down the line, that’s gonna cause you to not succeed as much as you would have if you didn’t get pregnant.”
For Black women, especially, a lack of access to contraceptives can have harmful health impacts.
In 2019, the Chicago Department of Public Health found pregnant Black women are more likely than any other race to see short- and long-term consequences to their health after giving birth. They also are more likely to die during or within one year of their pregnancy.
For West Side resident Apriel Campbell, these statistics exemplify why access to contraceptives is vital.
“If we want to prevent the maternal deaths, I think that we have to address some of the factors that kind of play into that,” Campbell said.
The new state law also requires patient counseling in topics like birth control and STDs.
That’s something that in many cases could be done at pharmacies, said state Rep. Michelle Mussman, D-Schaumburg, who co-sponsored the contraceptives bill in the Illinois House of Representatives.
“A pharmacy, hopefully, is much easier to access than a normal doctor’s office, which we know there’s an inadequate supply of also, and very often they only are open during normal business hours,” Mussman said.
“Some pharmacies are actually open 24 hours, and they would not necessarily require an appointment and … if you have to pay directly because you don’t have insurance, they would be a more affordable alternative than attempting to pay for a full-on doctor’s visit.”
But for some Black and Brown Chicagoans, those pharmacies aren’t easy to access.
Nearly half of Black census tracts are pharmacy deserts
In 2020, to identify pharmacy deserts, Qato and her team used census tracts to map distance to the nearest pharmacy, racial composition and the percentage of residents with health insurance.
In one West Garfield Park census tract, for example, the population was nearly 97% Black, and 93% of the residents had health insurance — but the nearest pharmacy was nearly a mile away.
Overall in 2020, the research found that nearly 45% of majority-Black census tracts were pharmacy deserts, an increase from about 33% in 2015. Among Latino neighborhoods, about 13% were pharmacy deserts in 2020; that’s up from 9% in 2015. Only 1% of white neighborhoods were defined as pharmacy deserts.
In late 2021, CVS announced plans to close 900 stores throughout the United States over the next three years. The company did not specify which stores would close in the Chicago area.
The June closure of a CVS pharmacy in Little Village, which is majority Latino, drew protests from the community. Residents and public officials sent a letter to the company and held a news conference demanding in vain that CVS keep the store open.
Less than 14% of CVS locations in Chicago — nine out of 65 locations — are found in the city’s majority-Black or majority-Latino ZIP codes, despite those areas being home to nearly half the city’s population, according to a WBEZ analysis of store locator data on the company’s website.
However, the analysis found the rate of CVS locations per 10,000 residents is about seven times higher in the city’s majority-white ZIP codes than it is in majority-Black or majority-Latino ZIP codes.
In a written statement, CVS spokesman Mike DeAngelis said store closings are “based on our evaluation of changes in population, consumer buying patterns and future health needs to ensure we have the right kinds of stores in the right locations.”
It continued: “Any closures in Chicago this year will be a small percentage of our overall store presence in the city.”
Walgreens, the largest pharmacy chain in Chicago, has more than 130 locations, but they are harder to find in Black communities.
The rate of Walgreens locations per 10,000 residents is nearly twice as high in Chicago’s majority-white ZIP codes than in the city’s majority-Black ZIP codes, according to a WBEZ analysis of data on the company’s online store locator.
On the South Side, empty hulking shells of former Walgreens stores and others, taken over by other retailers, have become common sights. Those Walgreens closures include a string of locations along 95th Street — at Jeffrey Boulevard, King Drive and Halsted Street — as well as at 87th Street and Ashland Avenue.
On the West Side, a WBEZ analysis of the Walgreens online store locator shows just five locations among the four majority-Black ZIP codes on the West Side — 60612, 60624, 60644 and 60651. Collectively, it’s an area with more than 175,000 residents. By comparison, three North Side ZIP codes — 60618, 60647 and 60657 — each have six or more Walgreens stores.
Campbell, the West Side resident, said high demand and limited staffing at the few pharmacies there are can mean it takes hours to get a medication filled.
“The line and the wait is just so long,” she said.
In a statement to the Sun-Times, Walgreens said the company is “focused on driving equitable access to health and wellness services” and removing barriers to prescriptions, and that in the Chicago area, “99% of residents live within two miles of one of our stores.”
The company also said it was spending $35 million to reopen 80 Chicago locations damaged in the summer of 2020. All but a few had reopened by the beginning of the year.
Independent pharmacies see opportunities — and challenges
The diminished presence of large pharmacy chains in some communities has presented opportunities for smaller, independent pharmacies.
“Independents try to enter markets that chains don’t enter,” Qato said. But those stores might have a smaller selection and may be less likely to stock food or household items, serve customers around-the-clock or offer drive-thru service, she added.
And independent pharmacies have struggled with some of the same issues as the chains, including lootings and low reimbursement rates from insurance providers.
“It’s a very aggravating business,” said Howard Bolling, who has run Roseland Pharmacy, 11254 S. Michigan Ave., for nearly 50 years. In 2020, his store was looted twice.
Now, he’s looking to retire.
“The only thing that you get to feel good about is if you feel you help someone,” he said.
“But overall the business of trying to make it” is hard, he said, when reimbursements are “so low.” One provider recently offered him a contract to fill prescriptions. The reimbursement rate per medication? $0.
Garth Reynolds, executive director of the Illinois Pharmacists Association, calls these practices “restrictive” and a main reason locally-owned drug stores struggle.
“Prescription products have been notoriously, drastically under-reimbursed,” Reynolds said.
Closing the gap
Online pharmacies are another option for residents without easy access to a nearby store. But patients need access to a computer or smartphone, and internet connectivity — with those rates on the South and West sides have lower.
Nor can such services meet all health care needs.
Qato has a suggestion for closing the pharmaceutical gaps: reimbursement mandates.
“The vast majority of time, pharmacies in these neighborhoods that are predominantly or disproportionately publicly insured with Medicare and Medicaid are getting paid less per prescription they fill,” she said.
If legislatures can find a way to reimburse the costs Medicare and Medicaid won’t cover, she said, then the pharmacy desert gap could narrow.
For its part, the state of Illinois launched the Critical Access Pharmacy program in 2019 to provide subsidies for pharmacies in some rural and underserved areas. But that program ended up benefiting, almost exclusively, independent pharmacies in rural areas, Qato said. Only three Chicago-area pharmacies were included, even though more are eligible.
Still, Melvin Thompson, executive director of the Endeleo Institute, the nonprofit community development arm of Trinity United Church of Christ, said more is at play than just reimbursements and revenue when it comes to corporations’ presence in Black neighborhoods.
He rejected the idea that low revenue and theft alone forced pharmacy chains out of the communities. Residents of Washington Heights, where Endeleo is based, and surrounding neighborhoods are “loyal to a fault” when it comes to brands like Walgreens and CVS, he said, and they will seek out the stores even if they are farther away.
“But what troubles me about that is … corporations have figured that out about our behavior and our tendencies to say, ‘Hey, you don’t even have to ... locate there, they’ll come to you.’”
Thompson said City Hall needs “some real economic policy that stipulates that, if you have any designs on doing business in the city of Chicago ... a high percentage of that must be done in Black communities.”
Cheyanne M. Daniels worked on this story as a staff writer for the Chicago Sun-Times through the Report for America program. She is now a reporter for The Hill in Washington, D.C.
Esther Yoon-Ji Kang is a reporter for WBEZ’s Race, Class and Communities desk.
WBEZ Senior Editor Alden Loury contributed to this story.