HMN 2025: How Gerrymandering in North Carolina limits residents’ access to health care centers

A University of Massachusetts Amherst study has found that gerrymandering in North Carolina resulted in reduced access to health care services. As states across the country grapple with politically charged redistricting efforts, the finding could ultimately offer a new strategy to fight gerrymandering in the courts, the researchers say.

“Access to health care should not be dependent on which party is in power,” says Auden Cote-L’Heureux, lead author of the paper published in the American Journal of Public Health, which also issued an editorial piece on the research. “Health care should be protected from political whims.”

Cote-L’Heureux, a recent UMass Amherst graduate now studying for a master’s degree at the University of Bonn in Germany, carried out the research with senior author David Chin, assistant professor of health policy and management in the School of Public Health and Health Sciences.

They analyzed electoral, demographic and health center data to examine how gerrymandering may affect access to a federally qualified health center (FQHC), which provides primary and preventive health care services regardless of the ability to pay.

Redistricting is the constitutionally mandated practice of redrawing electoral districts as populations shift to ensure equal representation in the federal House of Representatives and state legislative bodies.

Gerrymandering, on the other hand, is the redrawing of electoral districts to benefit a political party or candidate; the current Supreme Court has made gerrymandering difficult to litigate successfully, except in particular cases where it violates the Voting Rights Act.

“This is perhaps not the first, but I think the most rigorous assessment of this simple question—does this representation [created by gerrymandering] translate into either good or harm?” says Chin. “You can use publicly available data to infer political determinants of health.”

The researchers examined ZIP codes as a proxy for communities. A ZIP code split between two or more legislative districts was considered highly gerrymandered, whereas a ZIP code that lies entirely or mostly within a single district is generally less gerrymandered.

The researchers also used recently developed techniques that allowed them to determine the degree to which each individual voter is artificially “dislocated” from like-minded voters, another way of measuring gerrymandering.

Key findings and implications for policy

“We find that ZIP codes that were more gerrymandered between 2004 and 2022 had fewer federally qualified health centers in 2022 and were less likely to gain health centers between 2004 and 2022,” Cote-L’Heureux says. “In addition, those communities had fewer patients visiting those health centers in 2022.”

The researchers noted that residents in communities split evenly between two state senate districts during the 18-year period had to travel about 30% farther to their nearest FQHC in 2022 than individuals in communities lying entirely within a single district. Greater gerrymandering severity of state senate districts was linked with up to a 29% reduction in the number of FQHCs.

“These findings are consistent with the hypothesis that gerrymandering weakens local political representation and can lead to reduced access to vital health care services—a structural issue with far-reaching implications for health equity and national policy reform,” the researchers wrote.

Legal challenges and future strategies

Cote-L’Heureux notes that the Supreme Court ruled in 2019 that partisan gerrymandering—gerrymandering to favor a party—cannot be contested in the federal courts because it constitutes a “non-justiciable political question.”

Chin and Cote-L’Heureux say their findings could offer a potentially legally sound way to contest gerrymandering. “There hasn’t been a compelling argument in our current Supreme Court’s opinion as to how to measure gerrymandering’s harm, and our research provides a way of measuring its harm,” Cote-L’Heureux says.

Chin agrees. “This is a pretty clear illustration of the relationship between political representation as it translates to individuals receiving health care at FQHCs,” Chin says.

“We have laid the groundwork, the empirical pieces, for people who are interested in this.”

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