What we worry about at night
A lot of people worry about terrorism. And, based on the level of tax dollars being spent to deal with terrorism, it is a preoccupation of our country at large. While we are not unconcerned about terrorism – particularly those ÆGIS editors who live inNew York City– we don’t stay awake at night worrying about it.
Instead, we stay awake at night worrying about public health issues. We note that on11 September 2001, when roughly 3,400 people died in the horrific event we saw out our window, roughly 5,200 Americans also died that day from just the top 10 leading causes of death.
In the last while – certainly within our lifetime – we have seen the arrival of something approaching thirty new diseases, including AIDS and Ebola. Depending on your inclination, these diseases either seem to be a man made conspiracy (see http://www.finalcall.com/artman/publish/article_1597.shtml or http://www.umoja-research.com/strecker_memorandum.htm), or a punishment from the Intelligent Designer – the deity formerly known as God (http://www.oprah.com/tows/vintage/past/vintage_past_20010727_b.jhtml#s mall), or here for reasons we don’t yet understand, and may never understand.
But you don’t have to look at exotic diseases to become concerned. In an average year 36,000 Americans, mostly old and young, die from the flu. And we mean the normal garden variety flu, not the flu pandemic of 1918 which killed 675,000 Americans, and was most deadly for people ages 20 to 40, or the avian (bird) flu which is feared might become a pandemic, killing, if the death rate is the same as it was in 1918, 900,000 Americans.
However, even scarier than disease is the fact that about a third of American deaths are preventable, at least for when and why they happen (we grudgingly finally recognize that we will all – even us – die eventually). These displaceable deaths are the whopping 435,000 deaths from smoking (of which 35,000 are the result of second hand smoking, and 1,000 are infants dying as a result of maternal smoking, with the WHO saying that smoking kills nearly five million people worldwide each year), and an even whopping-er 500,000 from obesity, referred to in the trade as poor diet and physical inactivity. These make the flu seem like a minor problem.
While the potential of a pandemic has stirred the government to finally start taking steps to strengthen our ability to manufacture vaccines, the funding emphasis has remained on terrorism rather than public health.
And what of corporations, where the bottom line suffers when employees get sick? It is not uncommon to go into a corporate office that has “high security,” yet does not make flu shots available to employees. In many cases the expenditure on security is significant, although in most cases it is unclear what the security is for: We doubt whether anyone has asked the five questions that must be asked of any policy or measure:
1. What problem is the policy or measure trying to solve?
2. How can it fail in practice?
3. Given the failure modes, how well does it solve the problem?
4. What are the costs, both financial and social, associated with it, and flowing from its unintended consequences?
5. Given the effectiveness and costs, is the policy or measure worth it? Until concerns switch from trendy problems to statistically significant problems, we will continue to lose sleep.