Lucas A. Berenbrok, University of Pittsburgh; Michael Murphy, The Ohio State University, and Sophia Herbert, University of Pittsburgh

Neighborhood pharmacies are rapidly shuttering.

Not long ago, Walgreens, one of the nation’s biggest pharmacy chains, announced plans to close 1,200 stores over the next three years. That’s part of a larger trend that has seen nearly 7,000 pharmacy locations close since 2019, with more expected in the coming years.

Many community pharmacies are struggling to stay open due to an overburdened workforce, shrinking reimbursement rates for prescription drugs and limited opportunities to bill insurers for services beyond dispensing medications.

As trained pharmacists who advocate for and take care of patients in community settings, we’ve witnessed this decline firsthand. The loss of local pharmacies threatens individual and community access to medications, pharmacist expertise and essential public health resources.

The changing role of pharmacies

Community pharmacies – which include independently owned, corporate-chain and other retail pharmacies in neighborhood settings – have changed a lot over the past decades. What once were simple medication pickup points have evolved into hubs for health and wellness. Beyond dispensing prescriptions, pharmacists today provide vaccinations, testing and treatment for infectious diseases, access to hormonal birth control and other clinical services they’re empowered to provide by federal and state laws.

Given their importance, then, why have so many community pharmacies been closing?

There are many reasons, but the most important is reduced reimbursement for prescription drugs. Most community pharmacies operate under a business model centered on dispensing medications that relies on insurer reimbursements and cash payments from patients. Minor revenue comes from front-end sales of over-the-counter products and other items.

Advertisement

However, pharmacy benefit managers – companies that manage prescription drug benefits for insurers and employers – have aggressively cut reimbursement rates in an effort to lower drug costs in recent years. As a result, pharmacists often have to dispense prescription drugs at very low margins or even at a loss. In some cases, pharmacists are forced to transfer prescriptions to other pharmacies willing to absorb the financial hit. Other times, pharmacists choose not to stock these drugs at all.

And it’s not just mom-and-pop operations feeling the pinch. Over the past four years, the three largest pharmacy chains have announced plans to close hundreds of stores nationwide. CVS kicked off the trend in 2021 by announcing plans to close 900 pharmacy locations. In late 2023, Rite Aid said that thousands of its stores would be at risk for closure due to bankruptcy. And late in 2024, Walgreens announced its plans to close 1,200 stores over the next three years.

To make matters worse, pharmacists, like many other health care providers, have been facing burnout due to high stress and the lasting effects of the COVID-19 pandemic. At the same time, pharmacy school enrollment has declined, worsening the workforce shortage just as an impending shortfall of primary care physicians looms.

Why pharmacy accessibility matters

The increasing closure of community pharmacies has far-reaching consequences for millions of Americans. That’s because neighborhood pharmacies are one of the most accessible health care locations in the country, with an estimated 90% of Americans living within 5 miles of one.

However, research shows that “pharmacy deserts” are more common in marginalized communities, where people need accessible health care the most. For example, people who live in pharmacy deserts are also more likely to have a disability that makes it hard or impossible to walk. Many of these areas are also classified as medically underserved areas or health professional shortage areas. As pharmacy closures accelerate, America’s health disparities could get even worse.

So if your neighborhood pharmacy closes, what should you do?

While convenience and location matter, you might want to consider other factors that can help you meet your health care needs. For example, some pharmacies have staff who speak your native language, independent pharmacy business owners may be active in your community, and many locations offer over-the-counter products like hormonal contraception, the overdose-reversal drug naloxone and hearing aids.

Advertisement

You may also consider locations – especially corporate-owned pharmacies – that also offer urgent care or primary care services. In addition, most pharmacies offer vaccinations, and some offer test-and-treat services for infectious diseases, diabetes education and help with quitting smoking.

What to ask if your pharmacy closes

If your preferred pharmacy closes and you need to find another one, keep the following questions in mind:

• What will happen to your old prescriptions? When a pharmacy closes, another pharmacy may buy its prescriptions. Ask your pharmacist if your prescriptions will be automatically transferred to a nearby pharmacy, and when this will occur.

• What’s the staffing situation like at other pharmacies? This is an important factor in choosing a new pharmacy. What are the wait times? Can the team accommodate special situations like emergency refills or early refills before vacations? Does the pharmacist have a relationship with your primary care physician and your other prescribers?

• Which pharmacies accept your insurance? A simple call to your insurer can help you understand where your prescriptions are covered at the lowest cost. And if you take a medication that’s not covered by insurance, or if you’re uninsured, you should ask if the pharmacy can help you by offering member pricing or manufacturer coupons and discounts.

• What are your accessibility needs? Pharmacies often offer services to make your care more accessible and convenient. These may include medication packaging services, drive-thru windows and home delivery. And if you’re considering switching to a mail-order pharmacy, you should ask if it has a pharmacist to answer questions by phone or during telehealth visits.

Remember that it’s best to have all your prescriptions filled at the same pharmacy chain or location so that your pharmacist can perform a safety check with your complete medication list. Drug interactions can be dangerous.

Advertisement

Community pharmacies have been staples of neighborhoods for more than a century. Unfortunately, current trends in pharmacy closures pose real threats to public health. We hope lawmakers address the underlying systemic issues so more Americans don’t lose access to their medications, health services and pharmacists.

Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of Pittsburgh; Michael Murphy, Assistant Professor of Pharmacy Practice and Science, The Ohio State University, and Sophia Herbert, Assistant Professor of Pharmacy, University of Pittsburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Gabriel Eckstein, Texas A&M University and Rosario Sanchez, Texas A&M University

Immigration and border security will be the likely focus of U.S.-Mexico relations under the new Trump administration. But there also is a growing water crisis along the U.S.–Mexico border that affects tens of millions of people on both sides, and it can only be managed if the two governments work together.

Climate change is shrinking surface and groundwater supplies in the southwestern U.S. Higher air temperatures are increasing evaporation rates from rivers and streams and intensifying drought. Mexico is also experiencing multiyear droughts and heat waves.

Growing water use is already overtaxing limited supplies from nearly all of the region’s cross-border rivers, streams and aquifers. Many of these sources are contaminated with agricultural pollutants, untreated waste and other substances, further reducing the usability of available water.

As Texas-based scholars who study the legal and scientific aspects of water policy, we know that communities, farms and businesses in both countries rely on these scarce water supplies. In our view, water conditions on the border have changed so much that the current legal framework for managing them is inadequate.

Unless both nations recognize this fact, we believe that water problems in the region are likely to worsen, and supplies may never recover to levels seen as recently as the 1950s. Although the U.S. and Mexico have moved to address these concerns by updating the 1944 water treaty, these steps are not long-term solutions.

Growing demand, shrinking supply

The U.S.-Mexico border region is mostly arid, with water coming from a few rivers and an unknown amount of groundwater. The main rivers that cross the border are the Colorado and the Rio Grande – two of the most water-stressed systems in the world.

The Colorado River provides water to more than 44 million people, including seven U.S. and two Mexican states, 29 Indian tribes and 5.5 million acres of farmland. Only about 10% of its total flow reaches Mexico. The river once emptied into the Gulf of California, but now so much water is withdrawn along its course that since the 1960s it typically peters out in the desert.

The Rio Grande supplies water to roughly 15 million people, including 22 Indian tribes, three U.S. and four Mexican states and 2.8 million irrigated acres. It forms the 1,250-mile (2,000-kilometer) Texas-Mexico border, winding from El Paso in the west to the Gulf of Mexico in the east.

Advertisement

Other rivers that cross the border include the Tijuana, San Pedro, Santa Cruz, New and Gila. These are all significantly smaller and have less economic impact than the Colorado and the Rio Grande.

At least 28 aquifers – underground rock formations that contain water – also traverse the border. With a few exceptions, very little information on these shared resources exists. One thing that is known is that many of them are severely overtapped and contaminated.

Nonetheless, reliance on aquifers is growing as surface water supplies dwindle. Some 80% of groundwater used in the border region goes to agriculture. The rest is used by farmers and industries, such as automotive and appliance manufacturers.

Over 10 million people in 30 cities and communities throughout the border region rely on groundwater for domestic use. Many communities, including Ciudad Juarez; the sister cities of Nogales in both Arizona and Sonora; and the sister cities of Columbus in New Mexico and Puerto Palomas in Chihuahua, get all or most of their fresh water from these aquifers.

A booming region

About 30 million people live within 100 miles (160 kilometers) of the border on both sides. Over the next 30 years, that figure is expected to double.

Municipal and industrial water use throughout the region is also expected to increase. In Texas’ lower Rio Grande Valley, municipal use alone could more than double by 2040.

At the same time, as climate change continues to worsen, scientists project that snowmelt will decrease and evaporation rates will increase. The Colorado River’s baseflow – the portion of its volume that comes from groundwater, rather than from rain and snow – may decline by nearly 30% in the next 30 years.

Precipitation patterns across the region are projected to be uncertain and erratic for the foreseeable future. This trend will fuel more extreme weather events, such as droughts and floods, which could cause widespread harm to crops, industrial activity, human health and the environment.

Advertisement

Further stress comes from growth and development. Both the Colorado River and Rio Grande are tainted by pollutants from agricultural, municipal and industrial sources. Cities on both sides of the border, especially on the Mexican side, have a long history of dumping untreated sewage into the Rio Grande. Of the 55 water treatment plants located along the border, 80% reported ongoing maintenance, capacity and operating problems as of 2019.

Drought across the border region is already stoking domestic and bilateral tensions. Competing water users are struggling to meet their needs, and the U.S. and Mexico are straining to comply with treaty obligations for sharing water.

Cross-border water politics

Mexico and the United States manage water allocations in the border region mainly under two treaties: a 1906 agreement focused on the Upper Rio Grande Basin and a 1944 treaty covering the Colorado River and Lower Rio Grande.

Under the 1906 treaty, the U.S. is obligated to deliver 60,000 acre-feet of water to Mexico where the Rio Grande reaches the border. This target may be reduced during droughts, which have occurred frequently in recent decades. An acre-foot is enough water to flood an acre of land 1 foot deep – about 325,000 gallons (1.2 million liters).

Allocations under the 1944 treaty are more complicated. The U.S. is required to deliver 1.5 million acre-feet of Colorado River water to Mexico at the border – but as with the 1906 treaty, reductions are allowed in cases of extraordinary drought.

Until the mid-2010s, the U.S. met its full obligation each year. Since then, however, regional drought and climate change have severely reduced the Colorado River’s flow, requiring substantial allocation reductions for both the U.S. and Mexico.

In 2025, states in the U.S. section of the lower Colorado River basin will see a reduction of over 1 million acre-feet from prior years. Mexico’s allocation will decline by approximately 280,500 acre-feet under the 1944 treaty.

Advertisement

This agreement provides each nation with designated fractions of flows from the Lower Rio Grande and specific tributaries. Regardless of water availability or climatic conditions, Mexico also is required to deliver to the U.S. a minimum of 1,750,000 acre-feet of water from six named tributaries, averaged over five-year cycles. If Mexico falls short in one cycle, it can make up the deficit in the next five-year cycle, but cannot delay repayment further. https://www.youtube.com/embed/IgWSMgg9TmE?wmode=transparent&start=0 The U.S. and Mexico are struggling to share a shrinking water supply in the border region.

Since the 1990s, extraordinary droughts have caused Mexico to miss its delivery obligations three times. Although Mexico repaid its water debts in subsequent cycles, these shortfalls raised diplomatic tensions that led to last-minute negotiations and large-scale water transfers from Mexico to the U.S.

Mexican farmers in Lower Rio Grande irrigation districts who had to shoulder these cuts felt betrayed. In 2020, they protested, confronting federal soldiers and temporarily seizing control of a dam.

U.S. President Donald Trump and Mexican President Claudia Scheinbaum clearly appreciate the political and economic importance of the border region. But if water scarcity worsens, it could supplant other border priorities.

In our view, the best way to prevent this would be for the two countries to recognize that conditions are deteriorating and update the existing cross-border governance regime so that it reflects today’s new water realities.

Gabriel Eckstein, Professor of Law, Texas A&M University and Rosario Sanchez, Senior Research Scientist, Texas Water Resources Institute, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Advertisement

Elizabeth Currid-Halkett, University of Southern California; Bryan Tysinger, University of Southern California, and Jack Chapel, University of Southern California

Rural Americans – particularly men – are expected to live significantly shorter, less healthy lives than their urban counterparts, according to our research, recently published in the Journal of Rural Health.

We found that a 60-year-old man living in a rural area is expected on average to live two fewer years than an urban man. For women, the rural-urban gap is six months.

A key reason is worse rates among rural people for smoking, obesity and chronic conditions such as high blood pressure and heart disease. These conditions are condemning millions to disability and shortened lives.

What’s more, these same people live in areas where medical care is evaporating. Living in rural areas, with their relatively sparse populations, often means a shortage of doctors, longer travel distances for medical care and inadequate investments in public health, driven partly by declines in economic opportunities.

Our team arrived at these findings by using a simulation called the Future Elderly Model. With that, we were able to simulate the future life course of Americans currently age 60 living in either an urban or rural area.

The model is based on relationships observed in 20 years of data from the Health and Retirement Study, an ongoing survey that follows people from age 51 through the rest of their lives. Specifically, the model showed how long these Americans might live, the expected quality of their future years, and how certain changes in lifestyle would affect the results.

We describe the conditions that drive our results as “diseases of despair,” building off the landmark work of pioneering researchers who coined the now widely used term “deaths of despair.” They documented rising mortality among Americans without a college degree and related these deaths to declines in social and economic prospects.

Advertisement

The main causes of deaths of despair – drug overdoses, liver disease and suicide – have also been called “diseases of despair.” But the conditions we study, such as heart disease, could similarly be influenced by social and economic prospects. And they can profoundly reduce quality of life.

We also found that if rural education levels were as high as in urban areas, this would eliminate almost half of the rural-urban life-expectancy gap. Our data shows 65% of urban 60-year-olds were educated beyond high school, compared with 53% of rural residents the same age.

One possible reason for the difference is that getting a bachelor’s degree may make a person more able or willing to follow scientific recommendations – and more likely to work out for 150 minutes a week or eat their veggies as their doctor advises them to. https://www.youtube.com/embed/_WzwHJbAGVc?wmode=transparent&start=0 Rural communities are increasingly hampered by their lack of access to health care.

Why it matters

The gap between urban and rural health outcomes has widened over recent decades. Yet the problem goes beyond disparities between urban and rural health: It also splits down some of the party lines and social divides that separate U.S. citizens, such as education and lifestyle.

Scholarship on the decline of rural America suggests that people living outside larger cities are resentful of the economic forces that may have eroded their economic power. The interplay between these forces and the health conditions we study are less appreciated.

Economic circumstances can contribute to health outcomes. For example, increased stress and sedentary lifestyle due to joblessness can contribute to chronic health issues such as cardiovascular disease. Declines in economic prospects due to automation and trade liberalization are linked to increases in mortality.

But health can also have a strong influence on economic outcomes. Hospitalizations cause high medical costs, loss of work and earnings, and increases in bankruptcy. The onset of chronic disease and disability can lead to long-lasting declines in income. Even health events experienced early in childhood can have economic consequences decades later.

Advertisement

In tandem, these health and economic trends might reinforce each other and help fuel inequality between rural and urban areas that produces a profoundly different quality of life.

What still isn’t known

It should be noted that our results, like many studies, are describing outcomes on average; the rural population is not a monolith. In fact, some of the most physically active and healthy people we know live in rural areas.

Just how much your location affects your health is an ongoing area of research. But as researchers begin to understand more, we can come up with strategies to promote health among all Americans, regardless of where they live.

The Research Brief is a short take on interesting academic work.

Elizabeth Currid-Halkett, James Irvine Chair in Urban and Regional Planning and Professor of Public Policy, University of Southern California; Bryan Tysinger, Assistant Professor of Health Policy and Management, University of Southern California, and Jack Chapel, Postdoctoral Scholar in Economics, University of Southern California

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Advertisement