‘We need to actually do something’: ADA CEO unveils #HealthEquityNow initiative
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The health and economic impacts of the COVID-19 pandemic in the U.S. have disproportionately affected people with diabetes, who are more likely to be unemployed, work in high-risk jobs and ration medications, according to new survey data.
The national survey of 5,000 people with diabetes, conducted by dQ&A in association with the American Diabetes Association (ADA) between June 26 and July 1, revealed alarming numbers — 18% of people with diabetes were unemployed or furloughed, compared with the national rate of 12%. Additionally, among U.S. residents with low incomes living with diabetes, half have lost some or all of their income, whereas one in four people with diabetes have turned to rationing insulin or other diabetes medications or testing blood glucose less often. In March, four in 10 working people with diabetes were in jobs that could not be done from home; only seven out of 10 respondents reported being required to wear a mask at work.
Healio spoke with Tracey Brown, CEO of the ADA, about how the COVID-19 pandemic is worsening health disparities among people with diabetes, particularly people of color with diabetes, and a new initiative, #HealthEquityNow, designed to push for real change.
What led the ADA and DQ&A to conduct this survey?
Brown: We had been hearing stories of medication shortages and concerns within the diabetes community when the COVID-19 pandemic first hit. Early on, data showed a high correlation between people with diabetes and other underlying conditions disproportionately being hospitalized and dying from COVID-19. We wanted to try to quantify this. So many people in this country are affected by diabetes and prediabetes.
The survey data show 18% of people with diabetes were unemployed or furloughed in June, compared with the national rate of 12%, and one-third of people with diabetes working before the pandemic lost some or all of their income. What does this mean in a general sense for health-related outcomes?
Brown: For people living with diabetes, like myself, our No. 1 concern is just staying healthy during this pandemic. Shortly on the heels of that are the financial pressures and burdens that come with living with diabetes. Pre-COVID-19, the costs for someone living with diabetes were nearly 2.5 times that of people who do not have diabetes. Now, layer on top of that people losing some or all of their income. What this does is add a level of pressure on an already serious situation. To thrive with diabetes, you must continue to manage it. That means you must stay on your medication regimen. That means you keep eating the right foods and exercising. When you experience unemployment, often, you have also lost your health insurance. People without health insurance have poorer health outcomes.
How is this pandemic particularly affecting low-income individuals with diabetes?
Brown: Diabetes was a health crisis and an epidemic well before the COVID-19 pandemic. The inequities that exist in the U.S. from a health perspective and otherwise existed well before the eruption of social and racial unrest that occurred after the killing of George Floyd. What both of these things have done is shine a very bright light on an already existing problem. People of lower socioeconomic status — and people of color — have always faced these systemic inequities in the system. One-fifth of Americans are employed in the retail and hospitality industries — all greatly impacted by the pandemic and where a large portion of job losses have come from. These are the jobs that are disproportionately performed by people of color and lower-income individuals, and these are the jobs that cannot be done from home, if not shut down entirely. Half of lower-income people have lost some or all of their income, and 70% of self-employed people have lost some or all of their income. Those of lower socioeconomic status who have not lost their jobs are often considered essential workers, meaning they may not have the opportunity to social distance, putting them at higher risk for exposure to the virus.
How does the pandemic worsen the crisis of insulin affordability?
Brown: This exacerbates the problem. We already know that a quarter of people with diabetes, pre-COVID-19, were rationing their insulin to save money. Now the situation is worse, with an estimated 650,000 people skipping insulin injections or taking less insulin than prescribed. Additionally, we have 3 million people skipping their blood glucose testing. That is horrible. We know when you ration insulin and when you skip your diabetes regimen, whether it is blood glucose testing or taking medications as prescribed, that leads to poorer outcomes. This is making an already bad situation worse.
The data also showed that, unfortunately, people with already poor diabetes management were more likely to ration insulin, skip blood glucose testing and stop taking diabetes medications altogether. This is a problem not just for people living with diabetes. You cannot talk about increasing the wellbeing of Americans without talking about diabetes, because one out of two people in the United States are living with diabetes.
What needs to be done to help people with diabetes during this time, and what is the ADA doing to advance those priorities?
Brown : We don’t need more data. We don’t need more research. We don’t need to keep talking about the problem. We need to actually do something. We started very early.
After the pandemic and the social unrest, we knew it was time to demand change and find partners willing to be a bit more disruptive and a bit more action oriented. The ADA is launching #HealthEquityNow, a national platform to ensure that all people living with diabetes, and those at greatest risk for diabetes, have access to health resources that are too often unavailable to them.
The ADA crafted a Health Equity Bill of Rights as guidance to address these inequities. Ten fundamental rights are outlined in the Health Equity Bill of Rights, including the right to be able to afford the cost of prescribed drugs, access quality health insurance, avoid preventable amputations and access to the innovations needed to manage diabetes.
This says we are no longer going to sit by. We are going to construct a new network, flip the script and bend the curve of the diabetes epidemic. The ADA calls on businesses, policymakers, philanthropies and other leaders across the nation to take immediate steps to address systemic inequities faced particularly by people of color and economically disadvantaged citizens.
We have been aggressively pushing for continuity of health care coverage at the federal level for any person who has lost their job and has diabetes. We are working to get provisions put into the next stimulus package with people on both sides of the aisle. These survey data help.
The next step is pushing for a $0 copay for insulin. There is a bipartisan effort for that. Additionally, we must increase testing for the people who need it. With so many asymptomatic people walking around, we must get testing to those who are most vulnerable and most exposed. Data show that more COVID-19 testing is happening in more affluent, predominantly white neighborhoods.
We cannot let this moment pass us by. Now is the time for us to drive the change that should have happened a long time ago. The consciousness of this country has been awakened, and we ought not miss this moment.
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