Beyond Supply: A New Framework for Identifying Healthcare Deserts in the United States

October 2025
Researcher: Georgetown University Lab for Globalization and Shared Prosperity 

Healthcare deserts are defined as areas with insufficient availability of or access to medical services. Recent analyses have estimated that up to a third of Americans live in these places, with rural areas particularly likely to be underserved.

Authors

N. Rudra

D. Mangalmurti

A. Tarno

S. Chadalavada

D. O’Brien

Executive Summary

Healthcare deserts are defined as areas with insufficient availability of or access to medical services. Recent analyses have estimated that up to a third of Americans live in these places, with rural areas particularly likely to be underserved. Classifying communities as healthcare deserts is a powerful tool for identifying areas of healthcare need in the United States. However, our analysis of healthcare deserts suggests that insufficient healthcare may not be the same as poor health. In many areas deemed healthcare deserts, including by the U.S. government, performance on population health measures is at - or above - the national average.

Life expectancy estimates, which can be regarded as a portrait of the state of health in a community, offer a clear example of this phenomenon. Average national life expectancy at birth is estimated by the Centers for Disease Control as being 78.4 years. A number of areas categorized as healthcare deserts by researchers and government policies have life expectancies at or above this age—suggesting that measures of healthcare deserts may be inadequately capturing population health needs in parts of the country. We posit that this mismatch occurs because measures emphasize supply over outcomes, a specification that undercounts urban healthcare deserts and risks overestimating rural need.

We propose a new measure of healthcare deserts that takes health outcomes into account. Our approach defines a healthcare desert as a geographic area where there are poor health outcomes and a below-average supply of healthcare. We measure health outcomes using life expectancy and focus on areas where life expectancy is meaningfully below the national average. Based on an estimation process, we treat the number of obstetrician-gynecologists (OB/GYNs) per 1,000 people as a proxy for healthcare supply. We perform our analysis at the census tract level, the most granular within country geographic area for which life expectancy data is widely available in the United States.

Our approach identifies 8,539 census tracts as healthcare deserts. These amount to 12.67% of the more than 67,000 census tracts for which life expectancy estimates are available, and contain 20.4 million people, or 7.6% of the nation’s adults. In a departure from existing estimates, our analysis finds that only 22% of healthcare deserts are rural. The remainder are in urban and semi-urban areas. This ratio is much closer to the national ratio of rural to urban population and, we believe, indicates that our approach better captures the reality of healthcare access and outcomes in urban areas. One critical implication of our analysis is that greater focus on workforce quality–that captures actual levels of provided care–can continue to refine this measurement.

The paper is laid out as follows. In section one, we introduce the puzzle of healthcare deserts and review the strategies that have been used to map healthcare deserts in the United States. Section two lays out the case for giving greater weight to outcomes when mapping healthcare deserts and overviews our methodological approach to identifying healthcare deserts. Section three presents our results. We conclude with a discussion of the implications of our findings for healthcare policymaking and funding in the United States, particularly for discerning workforce quality and alleviating high healthcare needs.

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