Mapping pharmacy deserts across Minnesota

In partnership with the Minnesota Department of Health (MDH), the College of Pharmacy developed a map of pharmacy access gaps across the state to consolidate important data amid a national trend of pharmacy closures. 

Dr. Anjoli Punjabi, adjunct assistant professor, and Dr. Lindsay Sorge, senior strategic initiatives lead and assistant professor, began this work with the intention to help address the issue of pharmacy gaps. In 2020, Punjabi was helping organize medication drives to compensate for pharmacy closures in North Minneapolis. Around the same time, a critical pharmacy in Sorge’s neighborhood was facing several challenges. The two united to take action and started engaging partnerships to build out a team— which blossomed into a large, multidisciplinary project bridging multiple sectors.  

“The first step was to figure out where these pockets are in the community that do not have access to pharmacies. Not only is it a medication access problem, but pharmacists have historically been the most accessible healthcare professional,” Punjabi said. “They’re providing advice and guidance on preventative health and providing vaccines, point of care testing, medication management— many pharmacy services that would just be eliminated from these communities if these institutions close.”

Working with the Board of Pharmacy and college faculty, the team obtained access to lists of licensed pharmacies in the state, which team members called to confirm business status or discuss reasons for closure. In order to use the data for advocacy and solutions, it’s necessary to understand the root causes of closures, Punjabi noted. Collaboration with MDH offered a broad perspective into statewide priorities, geographic information systems (GIS) mapping expertise and applying census data to understand demographic information of the communities within the deserts.  The map also indicates areas at risk of becoming pharmacy deserts. 

“Those geographies will be critical because we have to understand who's living there and who's impacted,” Punjabi said. "We're seeing that some pharmacy deserts fall within underrepresented communities. One closure can further exacerbate disparities.” 

The current map identifies communities that are geographically distant from pharmacies as “low access” and those that are only served by a single pharmacy, leaving them at risk of losing access if that pharmacy were to close, as “limited access.” Some low access areas are in more affluent neighborhoods, where residents have the resources to access services despite living further away. This is why it is important to consider additional factors when classifying “pharmacy deserts” and targeting where support is needed to add or maintain pharmacy availability, said Emily Styles, an epidemiologist from MDH who works on the project.  

The next phase of the project will assess the demographics of these populations and narrow the definition to identify pharmacy deserts. Understanding community demographics is a critical next step toward leveraging the map data for legislative advocacy work and figuring out what statewide policies can support at-risk pharmacies and their financial stability, as well as how to incentivize pharmacies to open in deserts (or soon-to-be deserts). Dr. Sarah Westberg, professor and associate dean for professional affairs, said the mapping project could aid the college’s advocacy efforts tremendously. 

“We are able to bring quantitative data combined with qualitative reports to strengthen the stories of community impact. Using the map, we can show where those closures happened and what communities were impacted, versus just a big statistic,” Westberg said. “I think the map helps to paint that picture of the communities impacted by the closures and we didn't really have that data before.”

Westberg said the map “tells a story with facts,” and is a helpful visual tool for policymakers. It could also help connect community members to their legislators and amplify community voices, which she said is more effective in advocacy work than hearing from institutions. Dr. Todd Sorensen, professor and senior executive associate dean for strategic initiatives and faculty affairs, agreed that the visualization offers an impact that the raw data might not have on its own. 

“A map is a point-in-time representation, so it's really about multiple maps and the data summary that goes along with it showing over time how many Minnesota residents are actually living in a classified desert,” said Sorensen, who served as the principal investigator of the grant project alongside MDH. “I think the power of the map is in that visualization… but it's the changes over time that we're really trying to bring people's awareness to— the way the map looks today is not the way it looked 10 years ago.”

MDH has committed to completing the demographic analysis, but future iterations of the map are unconfirmed, Sorge said. Regardless of future mapping efforts, Sorge, Westberg and Sorensen are hopeful that with the map being created, it can serve as a tool for community mobilization. 

“There's pharmacists in tough situations who are putting all their energy into their own community and business and who may not be as connected to the advocacy work.  We want to be able to identify these communities — hear their stories and bring their voices forward, recognizing that if you're not sure your business will be open tomorrow, you may not be able to put energy into the extra advocacy work,” Westberg said. 

The project denotes larger issues at play within the core of the pharmaceutical field— not only the “viability of the profession,” but most importantly, “patient access to valuable pharmacy services in communities,” Punjabi said.  

“This isn't just a pharmacy need, this is a state need,” Sorensen said. “The evidence of this is that the Department of Health has declared health equity as one of its top priorities— and patient access to pharmacy services is a health equity issue.”