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

Objectives. To examine how gerrymandering affects federally qualified health center (FQHC) availability in North Carolina. Methods. 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. Results. 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. Conclusions. 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. (Am J Public Health. 2026;116(2):270-277. https://doi.org/10.2105/AJPH.2025.308284).