Expensive design - who can afford to hide diabetes? (on class and access)
Promotional materials for the first pens (NovoPen from 1986) mostly showed white people in suits working in offices. One Black woman in business attire - and that was it. The rest were white middle- and upper-class people in offices or elegant homes. One photo shows an older white woman in a domestic setting, another - a white male construction worker. But the pattern is clear: the ideal pen user is white and class-privileged.
This is a series of my articles; check out the previous ones too:
A pump with an MP3 player? Bigfoot Biomedical's strange patent
Discretion at a price - how insulin pens protect against stigma
AutoSyringe - the beginnings of insulin pumps and the story that changed diabetes treatment
Rentschler and Nothwehr leave no room for doubt here. "The Black woman is the only person of color shown using the device in the set of NovoPen materials we reviewed from the Smithsonian Institution archive". This is no accident. It is deliberate image-building.
Prices that hit hard
The article gives specific numbers. In 2015 (the year of the study), the cost of an insulin pump in the US was about USD 6,000. Annual supplies: from USD 3,000 to USD 6,000. For comparison: the US minimum wage then amounted to about USD 15,000 a year. A pump and supplies could therefore consume half the annual income of someone working for minimum wage. Without good insurance - out of reach.
In Canada, the system looks somewhat better, but it is still far from ideal. Rentschler and Nothwehr cite data from 2015: all provinces cover pumps and supplies for children up to age 18 (some up to 25). But only one province, Alberta, covers pumps for adults over 25. The rest do not.
"Many adult Canadian pump users do not have private insurance to cover the costs of pumps and their supplies, and cannot afford the costs on their own, forcing some to have to abandon pump therapy for injections" - the article says.
This is not theory. It is an everyday tragedy. Someone gets a pump as a child, learns to live with it, and when they turn 25 - they have to go back to pens or syringes because they cannot afford to continue.
Passing as privilege
Rentschler and Nothwehr make a strong argument: discretion and "pretty diabetes" are available mainly to those who can afford the right devices. Poorer people, without good insurance, often stay with syringes. And syringes are more visible and more stigmatizing.
"Diabetics who are able to afford the pump and its related costs have, in turn, more access to preferred treatment regimens than those who cannot" - this is obvious, but it needs repeating. Discussions about diabetes technology often forget money. People talk about convenience, discretion, and modernity - while ignoring the fact that most people with diabetes in the world cannot afford it.
In Poland, the situation is better than in the US, but worse than in Canada. The National Health Fund reimburses pumps for children and young people (up to 18 or 26, depending on the program). Adults have to obtain reimbursement through individual decisions - possible, but not easy. Many Polish adults with type 1 diabetes pay for pumps and sensors out of pocket.
My opinion
Manufacturers and healthcare systems should act so that access to modern technologies does not depend on the thickness of someone's wallet. Design is about aesthetics, but it is also about social justice. For now, "pretty diabetes" remains a privilege. Poorer people, people with worse insurance, and those in less stable financial situations are pushed toward more stigmatizing forms of treatment. That is neither fair nor efficient for the system.
Rentschler and Nothwehr do not propose specific solutions, but they openly admit that they benefit from the privilege of being white middle-class people in Canada. It is good that the situation in Poland has improved significantly recently: CGM is also reimbursed for adults, and pump availability is increasing...
