Mapping Pharmacy Deserts in Chicago

Data Collection and Analysis

This study employs a quasi‐experimental archival observational approach to examine the distribution of community pharmacies in Chicago between 1950 and 2000. Historical data were sourced from telephone directories, including the Chicago Yellow Pages and Polk’s City Directories, for specified years: 1950, 1955, 1960, 1983, 1991, 1996, and 2000 (sample of 1962 directory shown in Figure 1).⁷

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Figure 1.

“Drug Stores” Listing in Chicago Yellow Pages, December 1962. Source: Library of Congress, “Illinois—Yellow Pages—Chicago—1962 A through MAGNETI,” 1962, https://www.loc.gov/item/usteledirec04866x/.

Telephone books were selected to depict the pharmacy business landscape—the directories were readily accessible and summarized the information available to the public regarding pharmacy (then referred to as “drug store”) access.⁸ These directories, retrieved online from the Library of Congress (https://www.loc.gov/) and in‐person from the Newberry Library in Chicago, Illinois (https://www.newberry.org/), were transcribed according to a structured protocol to ensure consistency in data collection.⁹ Pharmacy names and addresses were recorded verbatim into a data table. The dataset¹⁰ was checked for duplicate entries, and addresses were reviewed and updated using an address verification software (Smarty, LLC). The pharmacies were categorized as “Independent,” meaning the pharmacy had only one location (often owned by a sole proprietor or small group); “Small Chain,” indicating the pharmacy had four or fewer unique locations (for example if a regional company owned three pharmacies across Chicago); or “Retail Chain,” indicating a pharmacy with more than four unique locations (e.g., Walgreens or other large, often nationwide, companies). Table 1 depicts the number of pharmacies over time. The “Small Chain” and “Retail Chain” categories indicate the number of pharmacy locations as well as the number of unique owners or companies (for example, 26 companies responsible for operating 56 pharmacy locations).

The collected data were then geocoded and processed using ArcGIS (ArcGIS Online, Esri) software to visualize the distribution and density of pharmacies across Chicago over time. This methodology allows for a longitudinal review of how community pharmacy accessibility has changed in Chicago over five decades. It captures key transitions in pharmacy practice—from neighborhood‐based, multifunctional drugstores of the 20th century to the rise of standardized, service‐oriented models and increasing corporate consolidation by the early 2000s.¹¹ While this study focuses on the period from 1950 and 2000, it is important to recognize that Chicago’s community pharmacy landscape has continued to evolve, with expanding clinical responsibilities, greater integration within health systems, and ongoing challenges to achieving equitable access. By grounding our analysis in historical primary sources and geospatial mapping, we situate pharmacy trends within broader socioeconomic and policy dynamics that have shaped Chicago’s urban development.

The following sections describe and provide context for the changes in pharmacy numbers and distribution: from the environment entering the 1950s, pharmacy in the pre‐Medicare era, pharmacy post‐Medicare, and entering the new millennium.

Setting the Stage: Entering the 1950s

Over the past century, the evolution of the US landscape of pharmacies and their locations has undergone significant transformations, particularly with the decline of independent pharmacies and the rise of large chain establishments throughout the 20th century.¹² In the early 1950s, independent pharmacies were far more than places to fill prescriptions; they were often family‐run establishments where residents could pick up a newspaper, enjoy a milkshake, and connect with their neighbors in a familiar, welcoming space.¹³ Stocked oftentimes with groceries, cosmetics, snacks, and other household essentials, these pharmacies functioned as neighborhood anchors and informal community hubs for daily interaction.¹⁴ Figure 2 depicts the window display of Sindler Drugs in 1955—located in the North Lawndale neighborhood at the intersection of South Pulaski Road and West 21st Street.¹⁵

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Figure 2.

Sindler Drugs, North Lawndale Pharmacy in 1955. Source: University of Illinois at Chicago, Library, Special Collections Department, Chicago Area Pharmacy Photograph Collection, Identifier CAPP_0001_0001_026, 1955, https://collections.carli.illinois.edu/digital/collection/uic_capp/id/108/rec/10. Sindler.

But as these establishments began to disappear, so did the accessible, multipurpose spaces they provided, contributing not only to gaps in healthcare access but to the broader erosion of community infrastructure in many Chicago neighborhoods. In 1968, Willard B. Simmons, the chief executive officer of the Chicago Retail Druggists Association (CRDA), captured this legacy when he wrote that community pharmacy is like a rock “buffeted by the waves of the ocean,” always adapting to public need and public whim, yet grounded by its foundational role in community life.¹⁶ His metaphor reflected the resilience and rootedness of the community (and often independent) pharmacy model at the time. Retrospectively, key community advocates like Simmons were unaware of the profound transformations the profession would undergo in the decades to follow.

The City of Chicago, Illinois, is separated into more than 200 neighborhoods that make up 77 community areas.¹⁷ Since 1830, Chicago has been divided into three “sides” based on the boundaries created by the Chicago River—the North Side, the West Side, and the South Side.

The Southeast Side, historically saturated with heavy industries, was not broadly populated for many years. The South and West Sides became home to predominantly Black, immigrant, and low‐income communities, which in the 1930s were graded as hazardous or undesirable by the Home Owners’ Loan Corporation (HOLC), a policy known as “Redlining.”¹⁸ These designations systemically excluded these neighborhoods from local financial investment, contributing to lasting gaps in pharmacy access and setting the stage for broader disinvestment in healthcare infrastructure, economic opportunities, and essential community services.¹⁹ Although city officials initially used HOLC’s city maps to assess risk and manage financial investment portfolios, their approach began to influence wider housing policies. This included the Federal Housing Administration (FHA), which incorporated racial considerations to exclude integrated or Black neighborhoods from mortgage insurance.²⁰ As a result of these Redlining policies, investors were discouraged from pursuing business loans and funding commercial development in “declining” and “hazardous” areas, and residents faced more obstacles in applying for mortgages.²¹ Figure 3 reveals a significant concentration of HOLC C (“declining”) and D (“hazardous”) graded areas in Chicago’s South and West Sides.²² While The Loop, Chicago’s central business district, falls within the South Side’s limits, it is often considered separate from these designations.

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Figure 3.

Home Owners’ Loan Corporation Residential Security Map, No 1. Map Section of North Shore and Suburbs. Source: Nelson, Robert K., LaDale Winling, et al., “Mapping Inequality: Redlining in New Deal America,” American Panorama: An Atlas of United States History, 2023, https://dsl.richmond.edu/panorama/redlining/. The key in the bottom right corner of the map indicate the varying “grades” of residental security, including “C” Third Grade and “D” Fourth Grade.

In contrast, predominantly white, affluent neighborhoods in Chicago, located in the North Side and central Loop, received favorable HOLC A (“best”) and B (“still desirable”) grades because it was considered a less risky investment with residents in these areas. These northern communities received significant investments, fostering a robust network of businesses (including more pharmacies per capita).²³ Figure 4 depicts the Chicago Housing Authority’s 1938 classifications of mortgage risk by neighborhood.²⁴

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Figure 4.

Chicago Housing Authority’s 1938 copy of the Federal Housing Administration’s Neighborhood Ratings of Chicago, IL. Source: Chicago Housing Authority & United States, Federal Housing Administration, “Holdings: Mortgage Risk Classified by Districts,” 1 Map : Hand Col. ; 73 x 45 Cm., Chicago Housing Authority (1938), Chicago, Illinois, UChicago Library, University of Chicago Library’s Map Collection. https://catalog.lib.uchicago.edu/vufind/Record/7697982.

Amidst Redlining policies, mid‐20th century urban renewal projects, such as those initiated under the Housing Act of 1949, compounded disparities by displacing entire communities and demolishing minority‐owned businesses.²⁵ For instance, redevelopment in the Near West Side in the 1950s and ’60s to construct the University of Illinois at Chicago campus and the construction of the Eisenhower Expressway (I‐290) displaced thousands of residents and hundreds of local businesses.²⁶ Similar patterns occurred with the Hyde Park‐Kenwood and Lake Meadows redevelopment projects, where approximately 4,000 and 3,400 families were displaced, respectively.²⁷ Figure 5 depicts the storefront of a Hyde Park business announcing its eviction.²⁸

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Figure 5.

Businesses on 55th Street in Hyde Park announce their eviction. Source: Erica Fischer, “Hyde Park‐Kenwood Urban Renewal (Chicago),” Flickr, 2014, https://www.flickr.com/photos/walkingsf/sets/72157643377779085.

Often powered by commercial planning, these urban renewal initiatives neglected minority‐owned businesses, including long‐standing independent pharmacies, further isolating low‐income residents from essential healthcare services. For white residents living in these neighborhoods, these urban renewal projects contributed to their mass exodus out of the city to the suburbs, a phenomenon known as the post‐World War II White Flight, along with escalating racial tensions and the desire for racially homogenous communities.²⁹ This prejudice‐fueled panic was exploited through a discriminatory real estate practice known as “blockbusting,” in order to profit from the rapid racial transition of neighborhoods.³⁰ Real estate agents would convince white homeowners to sell their properties at deflated prices by spreading rumors that Black families were moving nearby. These agents would then sell the same properties to Black families at inflated prices, often using exploitative contracts like contract buying.³¹ According to the Federal Reserve Bank of Chicago, in 1950 blockbusting occurred in 15 percent of census tracts that were not majority Black, all of which were located on Chicago’s West and South Sides.³² While zoning and housing practices may at first seem unrelated to pharmacy, they set the stage and provide context for the complex social and economic mechanisms in which inequities in community pharmacies were systemically perpetuated.

Pre–Medicare and Medicaid Era (1950 to 1965)

During the 1950s, independent pharmacies were the backbone of Chicago’s drug store landscape. Figure 6 visualizes the locations of community pharmacies in 1950.³³ As shown in Table 1, “Retail Chain” drugstores accounted for only 9 percent of the total Chicago pharmacies in 1950: Walgreens (operating 102 pharmacies), Stineway Drug Company (28 pharmacies), and Ford Hopkins Drug Stores (15 pharmacies). The remaining 1,444 pharmacies were independently owned, with some participating in franchise cooperatives like Rexall, which allowed independents to retain local ownership while benefiting from shared branding and bulk purchasing power.³⁴ These pharmacies thrived in tight‐knit, usually minority and immigrant neighborhoods, where pharmacists were not only healthcare providers, but also trusted community members. For example, pharmacies often served as the first point of contact for health‐related issues in many communities, with pharmacists serving as advisors, educators, and advocates for patient health, often before patients sought care from their primary physicians.³⁵ Pharmacists were also good sources of referrals to other health professionals.

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Figure 6.

Chicago Community Pharmacies–1950. Source: University of Illinois Chicago Instance of ArcGIS Softwre by Esri; Base Map and Layers include City of Chicago, Esri, TomTom, Garmin, SafeGraph, FAO, METI/NASA, USGS, EPA, NPS, USFWS; https://go.uic.edu/ChiPharmMap. Red points indicate independent pharmacies; green points indicate small chains; blue points indicate retail chain pharmacies.

Another defining feature of community pharmacies during this period was the pharmacist‐patient relationship. Pharmacists earned a level of trust within their communities, in part due to the compounding services they provided. Many independent pharmacists were known for formulating customized medications for patients.³⁶ Before 1950, more than 75 percent of prescriptions required some form of compounding, even though pharmacies didn’t make much profit from these personalized formulations.³⁷ This high level of personalization reinforced customer loyalty and transformed independent pharmacies into integral pillars in their communities, embracing roles like offering free health screenings and wellness events.³⁸ Unlike today’s pharmacy model, which is heavily reliant on mass production and standardized prescriptions, independent pharmacists in the 1950s and into the early 1960s played a crucial role in tailoring treatments to individual patient needs. Figure 6 also helps to illustrate the differences in geographic access to pharmacies in a pre‐Medicare era. The 1950 figure shows dense concentrations of pharmacies in the North Side and Loop central business district. Meanwhile, the South and West Sides contain fewer, more distantly spread pharmacies.

As shown in Table 1, between 1950 and 1955, the total number of pharmacies in Chicago declined slightly, from 1,598 to 1,515. Independent pharmacies still dominated in 1955, comprising over 90 percent of the total pharmacies.

Expanding urban retail developments in the 1950s and 1960s reinforced the concentration of new businesses in central business districts and affluent neighborhoods, as pharmacy chains increasingly prioritized wealthier communities for new store openings while neglecting lower‐income neighborhoods. While pharmacies in the North Side and central Loop benefited from higher consumer spending power and reliable public transportation, pharmacies in the South and West Sides continued to face economic hardship, likely due, in part, to the lower commercial viability of these neighborhoods.³⁹ As early as the late 19th century, public transit in Chicago evolved through a fragmented structure that primarily benefited the Loop and wealthier neighborhoods, while ignoring the transit needs of outlying residential areas.⁴⁰

During the 1960s, the pharmaceutical landscape continued to shift as chain pharmacy corporations expanded their reach and independent pharmacists faced growing competition and practice restrictions. Many pharmacists shifted away from traditional compounding, with most dispensed medications being pre‐manufactured capsules and tablets. Additionally, independent pharmacies were stepping away from soda fountains, candy, toys, and gift establishments and pharmacists began spending more of their time behind the pharmacy counter.⁴¹ The further emergence of large chains, such as Walgreens and Osco, introduced a new business model centered on standardized and a wider selection of product offerings, lower prices through bulk purchasing, and increased advertising.⁴² The rise of Walgreens as the corporate entity it is today is intimately intertwined with Chicago history, as its founder, Charles R. Walgreen, Sr., opened its second store in 1909 on Chicago’s South side.⁴³ It served as Walgreens’ base of operations as he expanded and opened more Walgreens stores across Chicago in the following decades.

Findings from telephone book records data highlighted a citywide reduction in the total number of pharmacies—from 1,515 pharmacies in 1955 to 1,424 pharmacies in 1960. Table 1 illustrates that independent pharmacies remained the majority, accounting for 1,212 locations, while small chains with four or fewer locations increased slightly to 61, and retail chains with more than four locations grew to 151.

While this study did not examine archival community responses to pharmacy closures, a community’s profound discontent surrounding the deep loss of local healthcare infrastructure and community trust can be approximated and inferred by looking at specific community memories. In an online web forum called “Forgotten Chicago,” (active between 2011 and 2016), residents recalled independent pharmacies and local pharmacists who mixed medicines by hand, lived in the neighborhood they served, and remained accessible after hours, often serving as informal caregivers in communities to those without health insurance.⁴⁴ Other residents describe the fond memories of soda fountains, newspaper pick‐ups, and personal relationships with pharmacy owners, all of which gradually disappeared as chain pharmacies took over in the 1970s and 1980s.

Similarly, we can approximate patient perceptions by examining community statements regarding pharmacy closures persisting in Chicago today.⁴⁵ One Chicago metropolitan area pharmacy owner forced to close in early 2025 described how they felt like they were “fighting huge corporations to keep [their] business up and running . . . while fighting to keep the same service for the community.”⁴⁶ In 2024, an alderperson representing the South Side stated that “there [was] a sense of abandonment, anger, frustration” within these communities that feel like residents had “to be in a certain place to deserve health care.”⁴⁷ Community members voiced their opinions, emphasizing that “it should not be about profit margin, but rather about becoming part of the community, being with the people in the community.”⁴⁸

These patterns of pharmacy closures set the stage for the industry’s corporate consolidation, which foreshadowed the ongoing struggles of independent pharmacies in economically disadvantaged neighborhoods. Despite legislative and professional efforts by independent pharmacists to safeguard community‐based services, market forces ultimately favored a more corporate‐driven model beginning in the mid‐20th century. The shrinking presence of independent pharmacies during the 1960s laid the foundation for what we now recognize as pharmacy deserts.⁴⁹

The introduction of Medicare Parts A and B and Medicaid in 1965 profoundly influenced expanding healthcare coverage across the US and increased the demand for pharmaceutical services and coverage nationwide.⁵⁰ Medicare (Title XVII of the Social Security Act) was established as a national social insurance program administered by the federal government to provide insurance coverage for Americans at retirement (at least 65 years of age).⁵¹ Initially, Medicare’s prescription drug coverage was primarily focused on drugs administered to hospital inpatients (Part A) or by physicians (Part B).⁵² This meant that most outpatient prescription drugs, a key source of revenue for independent pharmacies, were not covered. The lack of outpatient drug coverage led to calls for expansion, but concerns about controlling costs led to the establishment of the Task Force on Prescription Drugs in 1967.⁵³ The task force’s findings further highlighted the complexity of adding a comprehensive drug benefit, which would not be accomplished until the creation of Medicare Part D in 2003.⁵⁴ Under the same Title XVII of the Social Security Act, Medicaid was also established. Through joint federal and state efforts, the Medicaid program established formularies for medicines that would be available and covered for low‐income patients. Often, patients also become dual‐eligible beneficiaries under both programs, meaning they could receive assistance from both Medicare and Medicaid. With its establishment, these programs provided essential access to medical and pharmacy benefits for the elderly and low‐income populations. However, this growth introduced significant challenges for independent pharmacies, particularly for those in locations with greater populations of uninsured or underinsured, since they became reliant on Medicaid reimbursement for a significant portion of their business.⁵⁵

Post–Medicare and Medicaid Era (post 1965)

In the post‐Medicare era, independent pharmacies often served as the most accessible healthcare professionals in their communities. In a letter from the National Association of Retail Druggists (NARD) dated October 18, 1968, the organization highlighted that pharmacists routinely performed at least 15 major professional functions beyond simply dispensing prescriptions.⁵⁶ Over the course of a typical month, retail pharmacists provided a wide range of services, including physician consultations, patient counseling on drug therapies, and broader health advice.

However, in the late 1960s, the increased administrative burden of processing prescription claims from insurance, Medicare, and Medicaid led to the emergence of Pharmacy Benefit Managers (PBMs) as administrative intermediaries to negotiate drug prices, manage formularies, and determine reimbursement rates for pharmacies.⁵⁷

Before the widespread insurance coverage and the introduction of PBMs, most pharmacy transactions were cash‐based, allowing pharmacists greater flexibility over their own pricing and greater control over the sustainability of their businesses. Within this new system, increased administrative burdens required pharmacies to have separate records for drug acquisition costs and other accounting procedures, which increased the amount of time required to fill a prescription and the labor costs associated with the recordkeeping requirements to receive reimbursement.⁵⁸ This was especially burdensome for independent pharmacies; as a result, many pharmacies reported that reimbursements were shrinking, sometimes falling below the acquisition cost of medication.⁵⁹

Additionally, PBMs started contracting with mail‐order pharmacies to provide prescription services, although this wouldn’t gain prominence until the 1980s.⁶⁰ This vertical integration model added convenience for customers in addition to capitalizing on a PBMs’ abilities to keep formulary drug costs down; this likely influenced patient choice and potentially diverted business away from local, independent pharmacies.⁶¹ Amidst the financial changes, chain pharmacies benefited from centralized contracting, advanced technological infrastructure, and corporate‐negotiated reimbursement rates for prescription dispensing; independent pharmacies were left to navigate the growing pharmaceutical complexities.⁶² This disparity resulted in greater financial vulnerability for independent pharmacies, with some owners reporting an inability to remain viable under the new reimbursement structure.⁶³

While the pharmacy landscape shifted in Chicago, neighborhoods continued to feel the effects of systemic racism. The introduction of the Fair Housing Act of 1968 had the potential to address housing discrimination by banning Redlining and prohibiting racial bias in lending.⁶⁴ While the legislation made overt Redlining illegal, many of its intended effects were undermined by continued disparities in lending practices, zoning laws, and urban development priorities.⁶⁵ Banks and financial institutions continued to practice de facto Redlining through exclusionary lending policies, while government policies failed to reinvest in communities that had suffered from decades of disinvestment.⁶⁶ And while the Fair Housing Act of 1968 made blockbusting illegal, the orchestrated practice of fearmongering and white resident egress had long‐lasting impacts, including high rates of involuntary dispossession, many of whom had been first‐time homeowners, which significantly blunted Chicago Black residents’ abilities to build and maintain wealth in these neighborhoods.⁶⁷ As a result, many historically HOLC C and D neighborhoods remained the same, with small businesses continuing to struggle with lower property values and diminished consumer spending power. This ongoing disinvestment included healthcare access; a 2023 study demonstrated the significantly lower odds that current residents of historically Redlined communities have a pharmacy within one mile of their homes.⁶⁸ Specifically, a study found that patients residing in Redlined areas were associated with a 9 percent decrease in pharmacy availability. The disproportionate absence of pharmacies in Redlined communities has led to delays in obtaining prescriptions, lower medication adherence rates, and poorer health outcomes compared to residents in more affluent, non‐Redlined areas.⁶⁹

Yellow Page maps from 1960 to 1983 (available to view at https://go.uic.edu/ChiPharmMap) help visualize how historically Redlined neighborhoods had fewer pharmacy locations, even during periods of population growth and urban redevelopment, while non‐Redlined northern neighborhoods saw steady increases in pharmacy density. Due to a lack of availability of Chicago pharmacy telephone directories for the 1970s, the analysis relied on comparisons between 1960 and 1983. In lieu of directory data, however, research on Chicago’s public healthcare infrastructure supports the continued pattern of decline during the 1970s—disinvestment in public hospitals led to diminished care capacity and fueled grassroots efforts to highlight access to healthcare as a social welfare issue.⁷⁰

Another key historical event during the time were the 1968 riots on Chicago’s West Side, triggered by the assassination of Dr. Martin Luther King Jr.⁷¹ The riots led to widespread destruction of businesses, leaving many independent establishments destroyed or abandoned.⁷² In the aftermath, many businesses were reluctant to reinvest in West Side neighborhoods, often citing concerns over safety and economic viability.⁷³ Yet for the communities that remained, local institutions like independent pharmacies continued to serve as anchors of resilience and memory. One such example comes from North Lawndale, where Dr. King was known to frequent one of the few pharmacies that survived, Del‐Kar Drugs Inc.⁷⁴ According to the owner’s son, Edwin Muldrow, Dr. King would stop in daily to pick up a newspaper before heading to play pool nearby, reflecting his active and grounded presence in the neighborhood.⁷⁵ His routine visits became a symbol of community connection, reinforcing the pharmacy’s role not just as a healthcare provider, but as a trusted gathering place in the West Side communities after the riots and onwards. Del‐Kar Drugs, which still stands in 2025, highlights the community’s resilience despite social and economic hardships that impacted South and West Side communities for generations. Muldrow understands the long‐lasting impact that his father’s pharmacy has on its community and suggests that it might even provide a blueprint for resurrecting the West Side’s long‐neglected economy.⁷⁶

Down a few blocks, the neighboring East Garfield Park neighborhood also experienced similar impacts on its community pharmacies during this time. Sacramento Drugs, a local independent community pharmacy, operating in what was known as the “Heart of the West Side,” filled not only prescriptions, but also served ice cream and other food at a diner in the back. Following the riots and Chicago’s shifting political atmosphere, this community, once home to many small businesses, was gradually stripped away.⁷⁷ And although then‐Mayor Richard J. Daley and the city’s planning commissioner vowed to seek federal assistance to rebuild community buildings, little meaningful action followed. As time passed, vacancies spread, and many residents who had witnessed these transitions reflected that once buildings were vacant and abandoned, there was not “a companion strategy for [their] renewal.”⁷⁸

At the same time independent pharmacies were closing en masse, larger retail chain pharmacies continued to dominate the market, often avoiding historically Redlined neighborhoods in favor of suburban or affluent urban areas.⁷⁹ Community members recognized these shifting policy trends and advocated for the creation of the Community Reinvestment Act (CRA) in 1977; the goal was to encourage financial institutions to invest in these low‐ and moderate‐income areas as a means of counteracting the effects of Redlining.⁸⁰ While the CRA played a role in promoting urban redevelopment, its uneven implementation often prioritized infrastructure and housing projects over healthcare services. Additionally, with the 1980 presidential election of Ronald Reagan, state‐provided incentive programs became one of the only ways to improve economic stability for these disinvested areas. Economic enterprise zones were created in Chicago, where businesses could receive incentives to invest in disinvested areas.⁸¹ But many community members claim these programs had little effect on economic investment in these neighborhoods.⁸² While six zones in Chicago received millions of dollars from the federal government, many of the funds were given to city agencies like the Chicago Park District and Chicago Housing Authority, but no direct economic revival in these specific neighborhoods.⁸³

Contributing to the increasing number of closures of independent pharmacies, community pharmacies also faced mounting financial pressures due to both external crises and regulatory changes. In a July 1975 speech, NARD Executive William E. Woods discussed the need for increased transparency for community pharmacy reimbursement and how it trickles down to patients.⁸⁴ Woods exclaimed that it was:

[T]ime that consumers and the public know that they pay more because all community pharmacies are charged more. It is time the elderly know that the independent pharmacist is working for prescription drug coverage for Medicare home patients. It is time we stop letting independent retail pharmacies be forced into bankruptcy because of the differential pricing policies of too many manufacturers, and then watch [spokesmen] oppose every form of national legislation proposed that would provide home drugs for recipients of Medicare or national health insurance.

This exemplar quote underscores the growing financial strain on independent pharmacies in the 1970s and how their voices continued to be ignored as they struggled with unequal pricing structures, lack of reimbursement transparency, and limited policy support.

As patients started moving away from their local, independently owned pharmacies, so did some of their pharmacists. Highlighted in the April 4, 1983 edition of the magazine Drug Topics a featured series “Inside Today’s Pharmacist,” described some pharmacists reporting that they “sold [themselves] to the highest bidder” with regards to transitioning employment from independent to chain retail pharmacies; other pharmacists expressed the appeal of working at independent pharmacies, in being “close[r] to home,” being their own bosses, appreciating the greater amount of patient contact compared to other settings, and altogether having a “love [for] their customers.”⁸⁵

Table 1 above highlights the continued decline of pharmacies into the 1980s—independent pharmacies fell sharply from 1,212 in 1960 to 703 in 1983. Meanwhile, chain pharmacies also decreased modestly during this period (from 151 in 1960 to 137 in 1983). The table also reflects the decrease of small chains (four or fewer locations), which dropped from 61 in 1960 to just 13 in 1983.

During this time, however, the pharmacy profession was still attempting to expand by trying to involve more aspects of clinical services as extensions of primary care and advanced practice.⁸⁶ This professional shift was conceptualized in 1985 to seek greater patient care orientation for community pharmacy practice and to enhance healthcare needs for stronger communities. But, while the pharmacy profession was aiming for more one‐on‐one patient attention and interaction, the physical buildings where pharmacists practiced were becoming increasingly limited as the century went on.

Maps showcasing pharmacy locations in 1991 and 1997 highlight the widening disparities in pharmacy access (available to view at https://go.uic.edu/ChiPharmMap), with dense clusters in North Side and suburban neighborhoods and fewer locations in South and West Side neighborhoods. In the 1980s and 1990s, ongoing structural disinvestment, marked by public service cuts, policy neglect, and the erosion of neighborhood institutions, further reduced community access to essential services.⁸⁷

The demolition of public housing on Chicago’s South and West Sides in the 1990s led to significant population displacements, which in turn contributed to the decline of community‐serving businesses, including independent pharmacies. High‐rise public housing complexes, such as Cabrini‐Green and the Robert Taylor Homes, were home to thousands of residents who relied on local businesses for essential services.⁸⁸ As families were displaced and scattered across different parts of the city or relocated to suburban areas, the customer bases that had sustained these neighborhood businesses rapidly declined. As disinvestment in the South and West Sides increased, chain pharmacies continued to establish new locations to cater to the growing, wealthier population.⁸⁹

By 2000, East Garfield Park and other parts of the West Side had undergone significant physical and economic decline for more than 30 years. Figure 7 and Table 1 depict the community pharmacy landscape in Chicago in 2000.⁹⁰ Large retail companies like Walgreens (110 pharmacies), Osco Drug (55 pharmacies), and Dominick’s (20 pharmacies) constituted 43 percent of the city’s pharmacies. And even more broadly throughout the US, the number of chain drug stores expanded as there were now bigger stores that offered a wider variety of products, drive‐through windows, expanded hours, and other conveniences that often drew customers away from their community establishments.⁹¹ In response to this increased competition, many independent pharmacies partnered with advertising co‐ops and group‐purchasing organizations to help increase their pharmacy sales and drive down costs.⁹² Additionally, in order to continue their strong community ties, they doubled down on their highly personalized and localized care to maintain their importance in the community.

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Figure 7.

Chicago Community Pharmacies—2000. Source: University of Illinois Chicago Instance of ArcGIS Software by Esri; Base Map and Layers include City of Chicago, Esri, TomTom, Garmin, SafeGraph, FAO, METI/NASA, USGS, EPA, NPS, USFWS; https://go.uic.edu/ChiPharmMap. Red points indicate independent pharmacies; green points indicate small chains; blue points indicate retail chain pharmacies.

Chicago is no stranger to access “deserts”; a 2006 study examining the impacts of food deserts on public health in Chicago found that African Americans were the most disadvantaged regarding access to balanced food choices—they were required to travel the farthest distance to any type of grocery store.⁹³ The report went on to state that Chicago’s food deserts, for the most part, were exclusive to African‐American communities (measured by census tracts). Mirroring pharmacy, a 2007 study also found disproportionate access to chain supermarkets across neighborhoods (measured by census tracts).⁹⁴ Within the US, the availability of chain supermarkets has been directly associated with higher fruit and vegetable intake, healthier diets, and lower rates of obesity.⁹⁵ The study found that neighborhoods with higher proportions of African American residents had significantly fewer chain supermarkets than their white neighborhood counterparts.⁹⁶ Specifically, the availability of chain supermarkets in African American urban neighborhoods was only 41 percent compared to that of white urban neighborhoods. Additionally, 1982 to 2017 saw a decline in independent grocery retailers—their market share decreased from 53 percent to 22 percent.⁹⁷ The limited accessibility of chain supermarkets as well as reduced independent grocery stores, meant these communities were left in a “desert” of healthy food options. While not documented, it is possible that during the early 2000s, chain pharmacies expanded their front‐end grocery items to drive sales in these uncompetitive markets.⁹⁸

The 2000 map (Figure 7) reinforces patterns observed in previous decades, showing a persistent concentration of pharmacies on the North Side and surrounding suburban areas, while historically Redlined neighborhoods on the South and West Sides remained underserved. A 2014 study found that segregated Black and Hispanic neighborhoods in Chicago had significantly fewer pharmacies per capita than segregated white and integrated communities, with Black communities having the lowest pharmacy density.⁹⁹ In 2000, the mean number of pharmacies per census tract was 0.67 in segregated white communities and 0.83 in integrated neighborhoods, compared to just 0.56 and 0.55 in segregated Hispanic and Black communities, respectively.¹⁰⁰

Unlike wealthier communities, where pharmacies are often within walking distance or a short transit ride away, residents in pharmacy deserts rely on limited bus routes or extended train commutes to reach their nearest pharmacy.¹⁰¹ The added transportation burden is particularly detrimental to elderly and disabled populations, who face mobility challenges and require consistent access to prescription medications.¹⁰² The continued expansion of the Loop and North Michigan Avenue transit circulation projects, including the Circulator proposal of the 1990s, largely focused on business‐driven goals, with little community input from impacted neighborhoods. These public transportation challenges further compounded the issue of healthcare accessibility, forcing already marginalized populations to travel greater distances to obtain necessary care.¹⁰³ For example, areas like North Lawndale and Garfield Park still face substantial gaps in reliable transit, further isolating them from pharmacy services and broader healthcare systems.¹⁰⁴

Summary of Pharmacy Access Shifts (1950–2000)

Table 2 below summarizes major trends, described thus far, in pharmacy access, composition, and structural influences over time.

Key Factors Behind the Shift

• Redlining, Blockbusting, and Urban Renewal: Excluded minority neighborhoods from loans or utilized exploitative real estate practices for Black residents, displaced pharmacies and other essential services.

• Medicare/Medicaid Pressures and Emergence of PBMs: Reimbursement challenges harmed the financial sustainability of independent pharmacies.

• Chain Expansion & Consolidation: Advertising, bulk purchasing, and standardized services favored chains.

• Transit & Infrastructure Inequities: Poor transit access limited pharmacy reach for disinvested communities.

• Social Unrest: Riots and civil disinvestment discouraged reinvestment in South and West Side neighborhoods.

Looking Forward: Addressing Pharmacy Deserts and Public Health Implications

Independent pharmacies in Chicago’s historically Redlined neighborhoods faced unique challenges, including lower profit margins due to Medicaid reliance, limited access to capital, competition from chain pharmacies, as well as crime and safety concerns in these neighborhoods, which together served to discourage both investment from pharmacy chains and residents’ utilization of existing pharmacies. Research shows that individuals who have personally experienced theft or property crime are significantly more likely to bypass their nearest pharmacy in favor of one located farther away, often in perceived safer neighborhoods.¹⁰⁶ Moreover, the 2018 Neighborhood Crime and Access to Health‐Enabling Resources in Chicago study found that residents in high‐crime neighborhoods were significantly more likely to lack pharmacies within a one‐mile radius, reinforcing the structural barriers to healthcare access in these communities.¹⁰⁷ As a result, pharmacies in high‐crime areas saw reduced foot traffic and lower profitability, leading to further closures and reinforcing the cycle of pharmacy disinvestment in the South and West Sides of Chicago. This aligns with broader trends in commercial disinvestment, where systemic Redlining and economic neglect have historically deprived these neighborhoods of essential services, including grocery stores, banks, and healthcare providers.¹⁰⁸

The public health consequences, as a result of increasing pharmacy closures throughout many parts of Chicago, have implications for exacerbating health disparities and hindering effective management of chronic conditions like diabetes and hypertension. In a 2023 article, researchers hypothesized that individuals living in these “less desirable” neighborhoods continue to face challenges contributing to the eventual development and progression of kidney disease, including a higher prevalence of diabetes.¹⁰⁹ Historical policies of Redlining and disinvestment have impacted and continue to impact those same neighborhoods in Chicago today, largely due to restricted access to consistent care, medications, and preventative services.¹¹⁰ Communities like those on the South and West Sides of Chicago have long been medically underserved, with fewer healthcare providers, delayed diagnoses, and limited access to pharmacies that had long served as key disease management centers.¹¹¹ Research into structural barriers like segregated neighborhoods, lack of insurance, and institutional mistrust has also contributed to higher cancer mortality rates among racial and ethnic minorities.¹¹² These historical undertones persisted throughout the gradual disappearance of Chicago’s independent pharmacies. And while many of these reasons were due to a lack of fiscal capabilities from independent pharmacy owners, it was also caused by exclusionary policies established in specific neighborhoods in the city.

By supporting community pharmacies and incentivizing pharmacy establishment in underserved areas, policymakers can mitigate the impacts of pharmacy deserts and promote more equitable healthcare access. Especially in neighborhoods where community pharmacies and pharmacists were once pillars of the community, serving as centers of long‐standing and trusted relationships with patients, now that they are gone and displaced, patients have few places to turn.¹¹³ Communities that have gone decades without targeted investment have faced long legacies of trauma and deprivation, which have compounded risk and undermined public trust in healthcare systems as a result. W. B. Simmons, in his July 1968 article in the American Medical Association (AMA) News, wrote that he believed in the stability of retail pharmacy because of its base in the community:

If you give the people in your community the type of service they desire; if you make yours a drugstore where they can depend upon an every‐ready supply of quality medicine . . . your pharmacy, and thousands like it, will continue to have a substantial place in community life throughout the country, 5, 10, 20 or 50 years from now.¹¹⁴

Simmons’ reflection highlights the enduring value of community pharmacies (as compared with chains) as they are not only sites of healthcare access, but also integral pillars of neighborhood life. His belief that pharmacies thrive by remaining deeply responsive to local needs reinforces the idea that investing in these pharmacies is supportive of both public health and community cohesion. Beyond dispensing medications, such pharmacies serve as trusted gathering spaces that always promote stability, trust, and social connectedness, which are elements critical in historically disinvested neighborhoods.

Targeted strategies that address historical inequities, such as subsidies or tax incentives for pharmacies in Redlined neighborhoods, could play a crucial role in improving health outcomes for Chicago’s marginalized communities. These incentives, paired with improved Medicaid and Medicare reimbursement rates and public transportation investments, are essential for reducing access barriers. For example, in 2014, the Cook County Health and Hospital Systems expanded Medicaid for adults in Cook County, which helped to expand insurance coverage to more than 180,000 residents.¹¹⁵ The main goal was to ensure increased healthcare access for their patients, of which 75 percent were uninsured, but also reinvest back into the healthcare system for the community through state and federal subsidies. This is just one example of the impact of a targeted investment in healthcare, just over 10 years ago.

Another broader healthcare policy that may have an impact on pharmacy services is through Medicare and Medicare Advantage Network Adequacy Standards.¹¹⁶ Network adequacy means that the number of healthcare providers, specialties, and facilities is “sufficient” or “adequate” to meet the needs of the population covered by the insurance policy network in a timely manner. The Centers for Medicaid Services (CMS) sets strict quantitative standards for access to individual provider specialties and facility types. For example, in 2023, a Medicare insurance provider was required to demonstrate that a metropolitan county had adequate providers such that 90 percent of their covered population lives within 45 minutes or 30 miles of an urgent care facility.¹¹⁷ These standards capture geographic proximity but not the size of the insured population. For example, Cook County, Illinois (which includes Chicago) is 234 square miles with over 100,000 enrollees living within its boundaries. A Medicare network could theoretically satisfy the 90 percent metric with just a few providers, not accounting for the large number of patients each provider would have to see. Notably excluded from the federal Network Adequacy Standards healthcare facilities are pharmacies.

Centers for Medical Services does require Medicare Part D plans to maintain pharmacy networks that are “sufficient” such that 90 percent of their beneficiaries in urban areas live within two miles of a network retail pharmacy.¹¹⁸ However, CMS waives these requirements if a Medicare Advantage plan can provide patients with access to their covered drugs through pharmacies owned and operated by the Medicare Advantage organization (e.g., mail order pharmacy—problematic in neighborhoods with high mail theft rates).¹¹⁹ The State of Illinois has its own Network Adequacy Act, which includes pharmacy, however the regulations do not include specific criteria that Medicare plans must meet to ensure “sufficiently adequate” care.¹²⁰ Policy and law makers, especially for state Medicare services, may consider enforcing stricter and more rigorous standards for access to pharmacy services that meet the needs of urban cities like Chicago.

Looking to the future, community‐based pharmacy models and public‐private partnerships could help restore trust and care continuity for improving healthcare equity in historically underserved communities. More broadly, these solutions invite reflection on the systemic structures that have and continue to shape health equity in Chicago, and more broadly, the United States. Historically, in the US’s market‐based healthcare system, resource allocation is often dictated by profitability, usually excluding communities deemed less economically viable. In comparison, countries with more socialized health systems, such as Sweden and the United Kingdom, have demonstrated stronger performance in equitable access to care. Socialized models ensure that healthcare is distributed based on need rather than ability to pay, promoting equitable, universal coverage, and public trust in service delivery.¹²¹ Dr. Ernst B. Chain, Nobel Prize in Medicine winner, said in the 1960s, “When we talk of drugs, can their effect be measured in money value? What is the price of a man’s life?”¹²² These hypothetical systems also emphasize transparency and collective responsibility, with strong oversight mechanisms that align healthcare delivery with broader social justice goals. Considering the rich history of community and social justice in Chicago, comprehensive, community‐based services have been associated with better disease and patient outcomes with fewer gaps.