Balance is needed in assessing risks

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Thursday 19 September, 2002

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PREVENTIVE MEDICINE
Balance is needed in assessing risks

Dr. David Katz

September 16, 2002

Recent media reports indicate how bioterrorism concerns are affecting our public health priorities at the national level.

Massive sums of money are being directed toward bioterrorism-related research and planning. The very mission of the Centers for Disease Control and Prevention (CDC) has been revised, and its leadership changed.

Is a massive shift in federal resources commensurate with the bioterrorism risk, and will this initiative prove a sound investment in the health of the public? Maybe. There is both potential for enormous return on this investment, and for a narrow-minded boondoggle.

There is also an important opportunity to learn something about the way we respond to various risks, real and imagined.

While none can argue against the importance of meaningful defenses against bioterrorism, issues of relative risk and balanced response must be considered. The anthrax attacks on the United States resulted in five deaths nationwide, and not many more cases of illness.

Is anthrax scary? Yes. Was any one of us (even those of us who live in an area that experienced a case) at high risk? No. Other threats to our health, far more common, generally evoke far less fear.

For example, obesity and overweight combined affect as many as 8 in 10 American adults, and contribute to some 350,000 premature deaths each year. That toll translates to 1,000 premature deaths every day. Yet obesity control has not evoked a reassessment of the mission of public health organizations, nor a profound reallocation of public health dollars.

As many as 20,000 people die in the United States each year as a result of influenza, an infection preventable by vaccine. These deaths occur simply because we fail to take advantage of resources already at hand.

Dollars allocated strictly to prepare for and defend against bioterrorism could shrink budgets for obesity control, or for combating influenza, heart disease, diabetes, cancer, AIDS, and the diverse health threats to which we remain commonly subject.

Familiar and potentially controllable risks, such as heart disease or influenza, tend to be discounted.

New and seemingly uncontrollable risks, such as anthrax, tend to be exaggerated.

These reactions derive from fear rather than thoughtful reflection, and are basic human nature.

Most of us fear plane crashes, but don't think twice about driving our cars. Injury and death from use of a car is dramatically more probable than injury related to flying.

Whether the limited resources for public health should be redirected on the basis of our common fear rather than the facts regarding actual risk is very questionable.

Investment that is truly restricted to bioterrorism defense will prove its worth only in the event of a bioterrorist attack. However, a broader vision of protecting the public health makes a generous return on this investment far more probable.

We are all vulnerable to many adverse health events, and the same strands of the same safety net protect us from them all: a well-informed public, realistic assessment of risk, highly trained health care practitioners, effective means of communication, solid public health infrastructure, coordinated emergency responses and adequate resources efficiently mobilized and equitably distributed.

We should not prioritize exotic risks, and ignore those we encounter every day. In public health, familiarity should not be allowed to breed contempt.

Expenditure for bioterrorism defense should not be bound by a narrow vision, but should serve to weave more tightly the many untended strands of the public health safety net.

A robust public health system that attends equally well to common and exotic risks, and to the public's capacity to evaluate both realistically, will prove its worth to thousands of us, every day.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.

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Balance is needed in assessing risks