HEALTH EQUITY
A Tale of Two Cities : How Charles Dickens Foretold Pharmacy Deserts
by TOM JAMES , MD , AYSHA KHAN & DEE ANTIMISIARIS , PharmD , BCGP , FASCP
“ It was the best of times , it was the worst of times , it was the age of wisdom , it was the age of foolishness , it was the epoch of belief , it was the epoch of incredulity , it was the season of Light , it was the season of Darkness , it was the spring of hope , it was the winter of despair , we had everything before us , we had nothing before us , we were all going direct to Heaven , we were all going direct the other way — in short , the period was so far like the present period , that some of its noisiest authorities insisted on its being received , for good or for evil , in the superlative degree of comparison only .” – Charles Dickens , London , 1859
Like many American cities , Louisville has great disparities in access to food , higher paying jobs and health care including pharmacies . On the surface , Louisville , overall , does not appear to live in a care or pharmacy desert . 1 The density of pharmacies in neighborhoods in the west and south part of Louisville seems equivalent compared to the east and north neighborhoods if measured by geographic distance . But it isn ’ t until you take a closer look that you discover that there ’ s a qualitative aspect to pharmacy deserts and likely all types of service deserts . This “ Tale of Two Cities ” reports the findings of a study exploring those qualitative factors resulting in a pharmacy desert for most residents of the western neighborhoods in Louisville .
Access to pharmacies and pharmacists is important for the maintenance of health for individuals with acute or chronic illnesses . There is a wide variation in density of open access drugstores in the city . Take two individuals with Type 2 diabetes and hypertension living in two different areas of Louisville . One lives near Seneca Park and has the choice of roughly 20 different pharmacies in the St . Matthews area . The other individual lives near Shawnee Park and has only two open access pharmacies within a reasonable distance . Access to a pharmacy ( plus or minus a mini clinic ), a pharmacist , with generous hours , over the counter and prescription products , durable medical goods , monitoring supplies and more , can make the difference between successful chronic and acute disease management in the community , versus overuse of a health care system already pushed to the limits of capacity . Studies published by the CDC have demonstrated the positive impact of both reasonable access to pharmacy dispensed medications and to consultative services by the pharmacist . 4 There is increasing evidence for the potential role of community pharmacies in addressing social determinants of health and addressing health inequities . 2 , 3
Over the past year , the University of Louisville ’ s ( UofL ) Speed School of Engineering , School of Public Health and Department
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