The Conveniently Missing Racial Politics of EpiPen Access
The availability of essential lifesaving tools like the EpiPen never rises to being a crisis until the price hits white people’s wallets. Foreclosures and the lack of affordable housing drew Big Short condemnation when idyllic Caucasian suburbs went into meltdown. Drug wars go into cease-fire and even Republican presidential candidates, of all people, view addiction as a mental illness once it’s their kids strung out on opioids.
The price of milk, gas, rent and everything else in between never really hits the conscience of white mainstream privilege until injustice finally translates into an inconvenience. It’s as if these disturbances, these almost unfathomable wrinkles in routine, never existed until they wrought destruction on the otherwise uneventful lives of white PTA moms. Few understand, even when they’re aware, that less-fortunate populations have dealt with such nasty disruptions for years—and while expecting little in policy change or political intervention.
Outrage over the insanity of EpiPen price gouging is, of course, welcome. And necessary. Unbearable, however, is the typical comedy of delayed racial reaction. Lack of access to an affordable EpiPen was never a new thing, especially when it’s been a quiet issue for underserved populations of color for some time. It just seems like a new thing when, for example, the daughter of the ranking member of the Senate Judiciary Committee’s antitrust subcommittee, Sen. Amy Klobuchar (D-Minn.), uses EpiPens for allergies, too.
But few salaries (save those of the 1 percent) can reasonably accommodate an eight-year 400 percent increase in the price of anti-allergy EpiPens, including the six-figure salaries of sitting U.S. senators. That critics of the increase in the price of EpiPens didn’t say anything back in 2009 when it was $100 seems a bit laughable and disturbing on some levels. Where was the talk show fury then?
Public-health-care Robin Hoods don’t really show up strong until the threat of disappearing EpiPens suddenly looms large for white and/or more-affluent kids. So, justifiably, we can wonder out loud if black witnesses will even get an invitation to testify before Congress once hearings erupt. Researchers at Northwestern University had already peeped the correlation between food allergies in poor kids and lack of access to affordable medicine to treat them.
“Children in the lowest income stratum incurred 2.5 times the amount of emergency department and hospitalization costs as a result of their food allergy than higher-income children,” was thefinding in the journal Pediatrics earlier this year.
“Affordable access to specialty care, medications, and allergen-free foods are critical to keep all food-allergic children safe, regardless of income and race,” the report concluded.
“This shows disparities exist in care for low-income children with food allergy,” lead researcher Dr. Ruchi Gupta told Science Daily. “The first-line management for food allergy is prevention, but costs for special foods and epinephrine auto injectors can be a barrier for many families.”
Sadly, but obviously, those barriers are the steepest for black families, particularly black children burdened by two factors: poverty and the growing disparity in allergy occurrence, especially food and skin allergies. As the Centers for Disease Control and Prevention discovered while conducting a 14-year national study, “the prevalence of food and skin allergies increased in children under age 18 years” with greater skin-allergy impact on “non-Hispanic black” kids.
A year before that study dropped, Practice Fusion was well-aware of significant racial differences in allergies, with African-American children “80 percent more likely” to get hit with a peanut allergy than their white peers. Add lower income and residence in highly distressed urban areas like, say, Detroit and it gets worse, as an earlier Henry Ford Hospital survey of Motown metro-area kids found. “Racial disparities in allergic disease outcomes have been reported, with African Americans suffering disproportionately compared to white individuals,” wrote researchers.
As the prevalence and disparity of allergens rose, EpiPen manufacturer Mylan couldn’t resist the lure of adding coin to its already bloated bank account—for, pretty much, the same epinephrine that’s been in use for over a decade. As NBC reported, in 2008 and 2009, Mylan raised the EpiPen price by 5 percent and, by the end of 2009, another 19 percent. And between 2010 and 2013, the company raised the cost 10 percent each year.
Unsurprisingly, that resulted in a not-so-unusual and disproportionate “black tax” of sorts on EpiPen access, highlighting a disparity in black and brown access to medicine that’s been around long before the dime dropped on Mylan’s immoral price hike. It’s just that none of it was making the kind of noise an outraged soccer-mom lobby made by blowing up phones on Capitol Hill. Low-income and, especially, black kids don’t get that level of representation in Washington, D.C. Yet they’ve spent nearly triple the calculated cost on emergency medical response because, all this time,they’ve been the least likely to have an EpiPen on hand when allergies strike.
But race and economic status are always underlying constants once ugly patterns are uncovered. Most times, they are root causes—and for as long as EpiPens haven’t been readily available to poorer kids of color, it’s only now, when middle-class white kids can’t get it as easily, that the shock is palpable. Policymakers didn’t care enough about obvious demographic trip wires happening under their watch.
Perhaps that’s rooted in a general hesitation to admit that America’s health care system has been deliberately dysfunctional when applying care to black populations forced into need. Let’s not act as if the EpiPen scandal is so new that it’s any less racist—or any less different from those during centuries of bigoted business as usual.