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The Price of Health

Pharmaceutical companies in the United States have contributed to the enduring crisis of overpriced prescription drugs. The absence of free market competition has granted almost exclusive market control to a handful of pharmaceutical monopolies. These monopolies continue to reap profits from unabated price gouging. The pharmaceutical industry insists that high drug prices fund necessary innovation; however, recent studies prove that high drug prices are primarily replacing the profit that is lost to generic competition and older drugs. High drug prices impact virtually everyone. Studies report that Latinos within the U.S. are disproportionately affected by longstanding health and economic inequities pertaining to prescription drug prices.

Latinos are historically more likely to suffer from chronic health conditions, such as diabetes, and are more likely to be uninsured. This diminishing coverage, coupled with high drug prices, can put medications out of reach and leave the Latino community susceptible to significant harm. As medicines become inaccessible, more people are sent to the emergency room and many families find themselves facing life-or-death choices. There is also a broad impact beyond the health of the individuals: frequent visits to the ER render people unable to work and pay bills, further contributing to the overall decline in their financial security and their health. Latinos in the U.S. are often left with difficult trade-offs to help make ends meet.

A recent study by UnidosUS Action Fund (2021) reported that “while the Latino population is diverse, demographic data show that they fall squarely into the group most vulnerable for reliance on high-cost prescriptions” (p. 6). The study also found that Latinos, as a racial/ethnic group, have the highest life expectancies in the U.S. despite “having worse socioeconomic indicators like income and wealth that are tied to a shorter life expectancy” (UnidosUS, 2021, p. 6). The elevated life expectancy and an increased percentage of chronic conditions that require medications mean that high drug prices can impact Latinos for longer periods than other demographic groups.

The prevalence of chronic diseases adds another layer of concern: medication adherence. According to Munder Zagaar and Uche Anadu Ndefo of Pharmacy Times (2017), medication adherence refers to the extent to which a person’s behavior corresponds with the recommendations they receive from their health care provider. Moreover, adherence relies on the patient’s active involvement in their own care. Poor medication adherence is common among those with chronic illnesses, however, there is a significant adherence disparity between Latinos and the rest of the American population. An internet survey revealed that Latino patients have the poorest medication adherence in the nation (Zagaar & Ndefo, 2017). Out-of-pocket costs and past medication experiences often contribute to patient non-adherence. Other modifying factors include socioeconomic status, acculturation status, and perceived social support. Non-adherence is influenced by patient-related factors and is also directly linked with the healthcare provider and health care system.

The COVID-19 pandemic has only exacerbated preexisting inequities and expanded the consequences of poor drug adherence. The pandemic has impacted both Latino health and economic wellbeing. The U.S. Centers for Disease Prevention & Control found that Latinos are more likely to contract and die of COVID-19 at higher rates than their white counterparts. Recent studies also shows that Latinos are four times as likely to be hospitalized for COVID-19. The pandemic also deepened economic concerns for Latinos. More than half of all Latino households have lost work or income in the wake of COVID-19. Latinos have also experienced job losses exceeding national averages during the pandemic. In April 2020, Latino unemployment spiked to 18.9 percent and later settled at 8.8 percent in November, which is considerably higher than the 6.9 percent national average. Economic disparities unique to Latinos are a direct result of historical occupational segregation. Latinos are overly concentrated in low-wage jobs, “with 42 percent of working Latinos earning poverty-level wages” (UnidosUS, Jan. 2021, p. 11). Slow wage growth in the U.S. intensifies financial insecurity as drug companies increase prices faster than inflation. This economic crisis increases stress on Latino budgets, which encourages non-adherence practices, such as delaying doctor visits or skipping prescription refills. Thus, this pandemic has aggravated the vicious cycle of inequity and incited renewed demands for government regulation and policy change.

Political Director of UnidosUS Action Fund Rafael Collazo said, “Support for progressive measures to reform the pharmaceutical industry is extremely high among Latinos” (KOLD, 13 Jan. 2021). This organization is just one of the many groups advocating on behalf of Latinos and asking leaders to make changes. Their three primary demands are lowering prescription drug costs, limiting drug companies’ power in setting drug prices, and granting Medicare negotiation authority for prescription prices.

This is not the first instance in which the public has demanded the government to hold Big Pharma accountable. The long-running debate questions whether the federal government should directly intervene to regulate drug prices. Big Pharma maintains that high drug prices are necessary for innovation and research advancement. However, major pushback and investigations render this justification null. It is past time for the government to take responsibility and hold drug companies accountable for high drug prices.

How should we as Christians understand this call for reform? Michelle Kirtley, a consultant on bioethics and public policy, outlines this conversation in terms of shalom. In Hebrew, shalom refers to “universal flourishing, wholeness and delight—a rich state of affairs in which natural needs are satisfied and natural gifts fruitfully employed, a state of affairs that inspires joyful wonder as its Creator and Savior opens doors and welcomes the creatures in whom he delights” (Kirtley, 2018). Kirtley explains that although shalom is fundamentally eschatological, it nevertheless orients our efforts on Earth to participate in God’s ongoing redemption. Moreover, physical and mental health are intrinsic to shalom as God created us as whole, integrated creatures. Our mission as Christians is to restore shalom even when in exile, making the broken physical, spiritual, and communal whole. Human flourishing, then, ought to be the foundation for healthcare reform.

This flourishing, as Kirtley states, requires access to medical care, communal action, personal and collective stewardship—all of which fall under the umbrella of valuing every aspect of human life. Expanding healthcare coverage and access demands creative public policies at all levels of government. Further, collective action is necessary to mobilize this movement, overcome barriers, and reframe healthcare as a common good. If human flourishing is the goal of healthcare reform, then the debate surpasses just the provision of health insurance. Rather, it expands to include our overall contribution to the health of our neighbors and communities.

We must confront high drug prices that cause health and economic inequity. Pharmaceutical companies continue to place profits above people and sacrifice the nation’s health. Latino health and economic disparities restrict access to medication and require a disproportionate share of Latino income—all of which puts their health at greater risk. Further, the COVID-19 pandemic will only deepen inequity and cause Latinos disproportionate suffering. It is time that Congress addresses this crisis by regulating pharmaceutical companies, lowering drug prices, and cutting monopoly power that deters a free market. As Christians, we should advocate for dramatic healthcare reform on behalf of our Latino brothers and sisters so that we might all experience shalom.