Triple Exclusion: A Geospatial Analysis of Healthcare, Food, and Banking Deserts

Background: Healthcare deserts, food deserts, and banking deserts are defined as specific geographic areas with limited options for residents to access essential healthcare services, affordable and healthy foods, and appropriate financial services, respectively. The overlaps and spatial patterns of these three deserts not only present a geospatial structure of social determinants of health but also reflect aggravation of social exclusion from which residents in these areas suffer. Research on this typically examines only one form of these service deserts at a time – and research among these deserts has been uneven. There is greater literature on food deserts than banking deserts. Within healthcare deserts, more attention has been given to primary care deserts than pharmacy deserts. This study contributes to the literature by taking into account all three types of service deserts and the combined patterns of their geospatial distribution.

Methods: Data on healthcare deserts were collected from Homeland Infrastructure Foundation-Level data and HSR.health. Food desert data came from the Food Access Research Atlas, while banking desert data were obtained from the Banking Deserts Dashboard of Fed Communities. All geospatial data are at the census tract level. Hospital deserts exist where driving time from the population centroid exceeds two standard deviations above the state mean. Food deserts have 500 people or 33% of a tract's population over 1 mile from a supermarket in urban areas, and over 20 miles in rural areas. A banking desert is defined as an area with low or very low access to bank branches. This study analyzes spatial clustering using Ripley's K function and visualizes distribution patterns with choropleth maps and kernel density estimation.

Results: There are 84,002 census tracts in total of which 7,001 are identified as hospital deserts, 6,789 as pharmacy deserts, and 6,798 as medical deserts. There are 6,688 food deserts and 6,697 banking deserts among all census tracts. Furthermore, 233 census tracts are in a triple exclusion zone, 628 are in a food-hospital desert, and 699 are in a banking-hospital desert. The choropleth maps also show that areas with triple or double exclusion are often surrounded by other census tracts with at least one service exclusion. A large population in the United States, especially racial minorities, low-income populations, and rural residents, live in an area of different combinations of healthcare, food, and banking deserts.

Conclusions and Implications: Health and well-being are largely shaped by social and environmental conditions where people are born, live, work, and interact with others. The spatial patterns of healthcare, food, and banking deserts present a unique perspective on geospatial attributes of multidimensional social exclusion as a key determinant of health. Study results show that the limited access to essential healthcare, affordable food, and/or appropriate financial services creates a critical health challenge. Building on the research findings, a potential intervention, inspired by the operation model of Meals on Wheels, can be considered to address all three needs of healthcare, nutrition, and financial services by sending a service vehicle to needy individuals and families in triple excluded service deserts.