Political Boundaries, Health Care Gaps: The Link Between Gerrymandering and Federally Qualified Health Center Availability.

Abstract

<b>Objectives.</b> To examine how gerrymandering affects federally qualified health center (FQHC) availability in North Carolina. <b>Methods.</b> We used data from 2004 to 2022 and spatial regression models to correlate gerrymandering metrics with FQHC availability and utilization at the zip code level. <b>Results.</b> Gerrymandering severity is inversely associated with FQHC availability and utilization. For example, individuals in communities split evenly between 2 state senate districts in this 18-year period (from the end of 2004 through 2022) traveled about 30% farther to their nearest FQHC in 2022 than individuals in communities entirely within a district, and they were up to 20% less likely to visit an FQHC. Increased electoral competitiveness also reduced FQHC availability and utilization. Residential segregation was not linked to FQHC availability or gerrymandering severity. <b>Conclusions.</b> Gerrymandering weakens local political representation and may lead to reduced access to vital health care services-a structural issue with far-reaching implications for health equity and national policy reform. (<i>Am J Public Health</i>. 2026;116(2):270-277. https://doi.org/10.2105/AJPH.2025.308284).