By Dianne Anderson

Now is not a good time for pharmacies to bail out and close up shop, leaving those who need services the most – people of color – without access to medication.

But that’s exactly what’s happening in a national trend by pharmacy chains in recent years across the U.S., and more of the same is expected to come. CVS recently announced its plans to close 900 pharmacies, following the examples set by other big chain pharmacies.

“Pharmacy deserts,” similar to food deserts, are eroding health access for bigger swaths of low-income communities of color, where health professionals are already in short supply.

“Even though they may live close, a mile or more to the pharmacy, but if you didn’t have a car, a lot of them have to ride a bus. Sometimes it takes two hours to get to their medication,” said Dr. Cheryl Wisseh, University of California, Irvine pharmacy practice assistant professor, and co-first author.

Through her recent research, Dr. Wisseh believes that pharmacists must take on a greater role in reducing racial and ethnic disparities in public healthcare, now and into the future.

She and her colleagues are researching race and place-based disparities, such as in Los Angeles County in areas where non-Hispanic Blacks and Hispanics are lacking basic health insurance.

“Because I am a professor, it’s just thinking about how we train our pharmacists, and how pharmacy students and the future pharmacists need to know about the effects of structural racism and how it affects patients,” said Dr. Wisseh, who led the study, “Conceptualizing Social Ecological Model in Pharmacy to Address Racism as a Social Determinant of Health.”

Their paper, within her education working group in the National Pharmacy Association (NPA), looks at the effects of racism in health fields, and racism concepts that must be included in the pharmaceutical curriculum.

She said it is a call to action, but also stressed that the disconnect requires a multi-faceted approach at all levels to address access to the disparities. Policy-wise, she hopes that changes will be made to get either the people in need of access to the pharmacies, or a way to bring the medications to the people.

On top of all of the civil unrest of the past year, she said that race and place-based concerns are sparking interest to finally be able to talk about it and to start seeing what’s going on within the pharmaceutical discipline.

She is disturbed at the increased pharmacy closures, and the impact of the shrinking availability of brick and mortar structures in low-income communities of color.

Dr. Wisseh also works in a federally qualified health center in Los Angeles where they have a mobile van that goes out to provide various healthcare services. During the pandemic in some rural areas, she said many pharmacies worked with Uber or Lyft to get people out to the pharmacy to get vaxxed.

However, she notes that access is more complicated than getting vans to drive through communities with medications on board. There are safety concerns.

“You don’t want to necessarily be walking around with medications, or have it in a mobile van,” she said.

Another option for medication delivery is online pharmacies, but that requires access to reliable internet. On the flip side, she said some pharmacies lately are providing additional healthcare services to resemble community clinic services.

Even so, she said more policy action is needed to incentivize independent pharmacies serving uninsured patients, or those below the federal poverty level. She sees pharmacies closing in areas where most of the people have Medicaid and Medi-Cal.

“And the reimbursement rate is low – pharmacies can’t stay open because they can’t make a profit just to pay their employees. There’s a big problem and a lot of it goes back to policy,” she said.

While doing her residency in a historical African American community in Pittsburgh, she saw approaches that worked. One solution could be using familiar faces and community-based healthcare workers to provide or deliver medications. As importantly, she said the community must have a seat at the table to provide their input.

“If you are a policymaker, you see data numbers but having that community piece is very important because people will speak up to what’s going on in their community,” she said.

Partnering with Black churches can also provide awareness and the brick-and-mortar setting to reach the community and the elderly. Along with community health workers and churches, pharmacies could partner at the local level to provide services.

Within their pharmaceutical health discipline, their research is fresh, but she said the disparities have been around long before NPA was founded in 1947. She hopes their research and awareness opens up what used to be uncomfortable conversations around entrenched racism within the medical industries.

“I think it will take time, but just acknowledging it is powerful. If you know there’s a problem then you can start thinking about solutions. You can train the next generation of healthcare professionals to be able to do something about it,” she said.

Part of her motivation for the research has been to shed light on discrimination within her discipline.
She said that her colleagues always look to their peers in medical literature in areas of Black health, but for NPA, the call was for original research to address social inequities, and also the vast inequities revealed by COVID-19.

“Being a Black organization, we were looking at racism because of social injustice of the murders of George Floyd, Ahmaud Arbery, Breonna Taylor, and many others. It became a wake-up call within the discipline and health itself,” she said.

The study is published in the American Journal of Pharmaceutical Education, see
www.ajpe.org/content/85/9/8584

Or see, https://nationalpharmaceuticalassociation.org