And health justice for all

For the 2024 Emroch Lecture, Amy Kapczynski — professor of law and faculty co-director of the Law and Political Economy Project and the Global Health Justice Partnership at Yale Law School — spoke about law and political economy. Below is a lightly edited excerpt.

Law and political economy is an intellectual framework and network, made up of people coming to the conversation with different kinds of questions about our economy. My entry point was health justice

[There are people in the United States] who died a few years ago because they had Type 1 diabetes and couldn’t afford insulin. These were young people, often poorly insured, and predominantly people of color. Their stories were gathered by [the activist group] T1 International.

Their work highlights a disturbing reality. The price of insulin, a life-saving drug for those with Type 1 diabetes — a drug that you absolutely need lest you risk grave disability or death — has skyrocketed by 400% over the past decade despite no changes in the drug itself. In [the United States], the wealthiest country in history, people face co-pays of hundreds, sometimes even $1,000 a month.

I got into these issues working not on access to medicines in the United States, but working on global access-to-medicines issues. When I entered as a law student, I was already connected with AIDS activists who were working on access to HIV medicines. Those medicines, as activists then taught me, cost $10,000–$15,000 per person per year to buy from patent-holding companies, even though they cost less than $100 to make.

In grappling with these issues, you immediately confront questions about the structure of our economy. One of the things I learned through that advocacy work was that there were a lot of arguments being offered about why the state of the law had to be what it was, [arguments] that actually were not well-founded or persuasive.

Often one justification for the high cost of drugs is the “expense of innovation.” However, this didn’t explain why the price of insulin, an old drug, had increased so dramatically. The same was true for other medicines. There [have] been no new drugs for diseases like tuberculosis or malaria in decades. Something didn’t line up.

These were the issues that got me interested in questions of political economy and to really feel the urgency of understanding and challenging the standard narrative about the economy, how it works, and the radical disconnect with peoples’ experiences with the economy.

Watch the full lecture here: