The poor bear the personal cost of diabetes
March 12, 2010
Terrence Belford
SPECIAL TO THE STAR
There are nights Dawn Clarke cannot sleep from the worry. She sits in her basement apartment in Scarborough — the one she shares with her 29-year-old daughter — and stares at her Ontario Works drug card.
When it expires in May, the burden of paying for her diabetes medication and blood-testing supplies will fall completely on her own slim shoulders. When it does, she will face a monthly expense equal to about 10 per cent of her earnings.
Clarke is not an isolated case. The Canadian Diabetes Association estimates 57 per cent of Canadians with Type 2 diabetes fail to follow treatment guidelines because of the cost of their medication and testing supplies.
That number is certain to grow over the next decade, as 1.2 million more people are diagnosed and join the 2.5 million we already know have the disease.
Clarke, 57, is a home care provider for the elderly who earns just over $20,000 per year. She and her daughter would love to move out of their basement apartment and have been saving and looking for something more suitable.
Now, however, that bright dream may have to be put on hold.
She knows she may not be able to pay for the medication necessary to control and manage her Type 2 diabetes. It will likely come down to a choice of what she must do without: medication or a home where the view is better than people’s ankles walking by.
Without proper management, complications for her health are sure to follow. Diabetes is a leading cause of adult blindness and amputations. It marches hand-in-hand with cardio-vascular disease, and can cause other ailments.
“I worry so much,” she says. “I got my Ontario Works card when I came back to Canada in 2008. But once I got a job, they told me my drug benefits would end. I have talked to my social worker and she says maybe I can apply to the Trillium Fund.
“It helps people like me who can’t afford their medication. But if that does not work, I just don’t know what I will do.”
Ram Krishna knows first-hand the cost of diabetes medication. He suffers from Type 2 and is the founder of the Greater Toronto Area South Asian chapter of the Canadian Diabetes Association.
His best guess is that it is at least $2,200 a year for simple Type 2, without any complications. Add in things such as medication to control blood pressure and protect the kidneys, cholesterol-lowering drugs and perhaps heart medication, and the cost can easily double. Lipitor for cholesterol control, for example, is about $276 for a three-month supply.
Then there is the cost of blood glucose test strips, which are only meant to be used once. A container of 100 is about $90. You put one in a blood-glucose test meter, prick your finger and place a drop of blood on the strip. The meter tells you what your blood glucose level is. Good management of your blood sugar to avoid long-term health complications requires you to test your blood three to five times a day.
“For many people, especially new Canadians struggling to establish themselves here, the cost of managing diabetes — including those test strips — can be so high, they have to choose between their supplies and food on the table or shoes for the kids.”
New Canadians are not alone in that struggle, says Gary O’Connor, Ontario director for the CDA. Those most at risk are the genetically prone, such as blacks, Hispanics, aboriginals and Asians, and the poor.
“Those living at or near the poverty line have lower literacy rates, higher stress levels, lower incomes and tend to live in areas where there are more fast-food places and fewer grocery stores and free recreation outlets,” he says.
When it comes to the three pillars of diabetes management — medication, healthy diet and exercise — they either cannot afford, or have little access, to any of them. The result is not only rising rates of diabetes among the poor and new Canadians but also an alarming increase in complications.
“The rate of diabetes among the poor is rising three or four times faster than among the general population,” says Dennis Raphael, professor of health policy and management at York University. He has been studying diabetes management among men and women living on public assistance in four areas of Toronto: South Riverdale, Regent Park, Lawrence and Dufferin, and the downtown west.
“What I am coming to believe is that there is a direct link between poverty and diabetes,” he says. “I think Type 2 has less to do with genetics and more to do with poverty.”
As most provinces do, Ontario covers the cost of medication and testing supplies for those on various disability and public assistance programs, and for those aged 65 or older. It also offers a subsidy of up to $820 per year to those with Type 1 diabetes for supplies.
But there is no respite from the cost of diabetes for the working poor or those who do not have third-party drug plans, says O’Connor.
“The end result may be a rising incidence of complications and an even greater burden on the health-care system,” he says. “The problem of affordability, especially for new Canadians and the working poor is certain to rise.”
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