Why Are We Failing to Address the Issue of Access to Insulin? A National and Global Perspective
Why Are We Failing to Address the Issue of Access to Insulin? A National and Global Perspective
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DOI：
10.2337/dc17-2123
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发表时间：
2018-06-01
期刊：
影响因子：
16.2
通讯作者：
Yudkin, John S.
中科院分区：
文献类型：
--
作者：
Beran, David;Hirsch, Irl B.;Yudkin, John S.
胰岛素于1921年被发现，并很快在高收入国家广泛使用。然而，目前许多需要这种救命药物的人无法获得它。这是一个全球现象，不仅影响低收入和中等收入国家的人口，而且影响美国的低收入人口。糖尿病酮症酸中毒的发病率在某些亚群中仍然很高，胰岛素的费用是主要的诱发因素。在全球范围内，1型糖尿病儿童死亡的主要原因是缺乏胰岛素，在撒哈拉以南非洲，1型糖尿病儿童的预期寿命可能低至1年。考虑获得保健和药品问题的一个透镜是将社会视为一个三脚凳。在这一模式中，公共部门的作用是为其所服务的人口提供“保护”;私营部门由“负责任的企业”组成，提供人们所需的许多商品和服务;多元部门由社区和非营利组织组成，提供所需的“社会联系”。就艾滋病毒/艾滋病而言，这两条“腿”中的每一条都在改善获得服务方面发挥作用。民间社会提高了对这一问题的认识，并倡导获得治疗。各国政府在国家和全球两级提供资金和对策。最后，私营部门在民间社会和政府的压力下发挥了作用，降低了药品价格，并制定了扩大可及性的方案。在这里，我们使用这个框架来描述从美国和全球角度获得胰岛素的缺点。
Insulin was discovered in 1921 and soon became widely available in high-income countries. However, many people currently in need of this life-saving medicine are unable to access it. This is a global phenomenon, impacting not only populations of low- and middle-income countries but low-income populations in the U.S. In the U.S., the rate of diabetic ketoacidosis remains high in certain subpopulations, the cost of insulin being the main precipitating factor. On a global level the main cause of mortality for a child with type 1 diabetes is a lack of access to insulin, and in sub-Saharan Africa the life expectancy of a child with type 1 diabetes can be as low as 1 year. One lens for considering the issue of access to health and medicines is to consider society as a three-legged stool. In this paradigm, the role of the public sector is to provide "protections" to the population it serves; the private sector is made up of "responsible businesses" that supply many of the goods and services people need; and the plural sector comprises communities and not-for-profits providing the "social affiliations" that are needed. For HIV/AIDS, each of these "legs" played a role in improving access. Civil society raised awareness of the issue and advocated for access to treatment. Governments provided funding and responses both nationally and globally. Finally, the private sector played its role, under pressure from civil society and governments, in lowering the price of medicines and developing programs to expand access. Here, we use this framework to describe the shortcomings in access to insulin from a U.S. and global perspective.