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Americans die prematurely from a whole host of reasons, and many of the more common causes get a lot of attention and money to prevent some of these deaths in the future.

Here’s something to consider: we pulled together some examples of where we spend a lot of money on preventing American deaths and broke it down to “dollars per death” spent each year.

To get a better sense of the rough numbers, we have a chart here:

Any initial reaction?

Some people might look at  this and say that we spend too much on violent deaths (like terrorism and homicide) and not enough on diseases. Others might argue that without these resources, deaths from terror and homicide might be much higher. And someone might say that diseases like respiratory disease and strokes primarily kill the elderly and that, because we’ll all eventually die from something, it may make more sense to focus money towards causes of death that affect all age groups equally (like violence).

What other factors besides death might be appropriate to look at when considering how much we spend on each of these? Leave a comment with your thought!

50 Comments

  • Daniel Kane, March 6, 2015 @ 6:05 pm Reply

    So…. dollars per death is totally the wrong metric here, especially if you are considering things like terrorism for which there are very few deaths (also note, that in theory we might have other justifications for the wars in Iraq and Afghanistan other than simply saving American lives). For example, consider dollars per death for, say, smallpox. Nobody has actually died from smallpox in decades, but we still spend non-zero money on stockpiling vaccines just in case it ever comes back. Dollars per death is infinity.

    That’s not to say that we don’t spend too much money on the military, just that this is the wrong way to judge. I suppose the correct thing to compare would be cost to save an extra life, which, unfortunately, is much harder to measure.

  • Daniel Hawkins, March 7, 2015 @ 9:47 pm Reply

    I agree with Daniel Kane’s comment; dollars per death might be a good metric if you were trying to kill people, but if you’re trying to save them it’s a bit backwards.

    I think the question you’re getting at is, "does the US have a good threat model, and if so, are we spending accordingly?"

    The first part is nearly impossible to answer; most of the information relevant to building a threat model is classified, so it’s not available to us. We can try to answer the second part based on the government’s own assertions about the threat model (e.g., President Obama saying, "There’s no doubt that al Qaeda will continue to pursue attacks against us. We must — and we will — remain vigilant at home and abroad."). But I would contend that even if we are spending proportionally to our threat model, that doesn’t mean we are spending effectively. How much have we spent on TSA security theater in the years since 9/11?

    I think part of the reason we spend this way is that we are emotional creatures, and we feel collectively undermined and ambushed by terrorism (and to a much lesser extent, regular homicide), while we consider disease to be inevitable and even sometimes our own fault.

  • nathan lachenmyer, March 8, 2015 @ 9:34 pm Reply

    I third the opinion of these are the wrong units to use. It’d be interesting if we could measure how many lives were saved, but terrorism is such a discrete, uncorrelated event that it’s hard to generalize.

    I like Daniel Hawkins’ rephrasing in terms of a threat model. How can be attempt to create a metric for that?

    Assuming equal risk for terrorism attacks on all countries (definitely not a true assessment, but let’s just go with it to get some numbers), we could compare the US’s Counterterrorism budget to that of other countries. A second pass would try to mitigate those numbers by some measure of risk to get a reasonable sense of it the United States is overspending (though this doesn’t account for a bias across the board, which is certainly likely to be an issue).

    I spent about 20 minutes looking for counterterrorism budgets for various countries and didn’t come up with much; I’d be interested to see if anyone else can come up with something.

    To get back to the original point — humans are notoriously bad at estimating risk. We dramatically overvalue impact, without regard to probability — so we spend much more time worrying about freak catastrophic events that medium-impact, medium-probability risks. You can also argue that catastrophic events have much higher emotional impact, making it easier to gather support for preventing them. It doesn’t surprise me at all that catastrophic events get huge amounts of preventative funding while more mundane threats like diabetes and cancer get ignored.

  • nathan lachenmyer, March 8, 2015 @ 9:36 pm Reply

    Of course, another point to be made is what actually constitutes the counter-terrorism budget — is this purely for homeland security, or do aggressive measures like drone strikes in foreign countries fall under this?

    Regardless, the effects of counter-terrorism are far-reaching and affect far more than just the lives saved domestically — there’s a fair amount of foreign policy concerns tied into that, and I imagine that also accounts for some of the over-funding.

  • Adam Eisenhut, March 9, 2015 @ 2:51 am Reply

    What I think is worrying is that the United States Government does not want to provide information on the acts of terrorism that have been adverted due to increased precautions and counter-terrorism spending. While this may motivated by perfectly valid national security reasons this also makes it impossible to analyze the costs and benefits of the program. This is highly unusual as nearly every other branch of the government has to conduct, and publicize, this exact type of data. The EPA is an easy example, and they regularly publish their estimates of the impact (usually including costs to the private sector) of additional regulation. As an example, I found a nice chart that purports to show the benefits of prior legislation and projects these benefits into the future. (http://www.epa.gov/cleanairactbenefits/prospective2.html)

    I have to agree with previous commentors who brought up how difficult it is for individuals to accurately assess risk in an objective way. However, I think the first step to try and address this would be to release some data on the number of lives which have been saved due to counterterrorism spending. This would allow Americans to have some basis to form an opinion on the appropriateness of the funding.

    I don’t mean to suggest that the Department of Homeland Security and the Environmental Protection Agency should be treated identically, as it is obviously not an apples-to-apples comparison. However, I am personally astonished to see how the EPA’s funding is consistently threatened despite the enormous number of lives it has saved – while the Department of Homeland Security receives mostly unquestioned funding, without having to provide any concrete information to the public to justify its budgetary needs.

  • Dave Harris, March 9, 2015 @ 5:33 pm Reply

    While this metric is not ideal, I think it provides more value than is being suggested here. Dollars/death is actually a very good metric in terms of assessing risk and assigning public policy. It can break down a bit given funding plateaus and minimum requirements of funding, but for the most part it gives a good indication of where funding should go to maximize the survival of our citizens. If you want to know the efficacy of this extreme spending, then yes you need to know the change in risk (what was the risk of terror before we spent so much? What would it be if we did not spend that money). Regardless of how efficacious that money is, it is still outrageously disproportionate to the risk that terrorism poses (unless like Lindsay Graham, you think that we’re all gonna die back here at home unless this money is spent). But the fact is that you can’t know how much our risk has been reduced. You can look at previous years to see the frequency and lethality of attacks (about 40/year with 0.4 fatalities/attack– http://www.start.umd.edu/sites/default/files/files/announcements/BackgroundReport10YearsSince911.pdf). Now they are about 10/year with 0.25 fatalities/attack. That means that, at its peak, about 15-20 people died/year of terrorist attacks. That’s on par with death by vending machines or ants. According to this site: http://www.worldlifeexpectancy.com/usa-cause-of-death-by-age-and-gender malnutrition kills about 1800 Americans every year. Think about what 100,000,000,000 could do to feed hungry people. We could literally save more lives by just giving out that money to American citizens.

    When you factor in that the tactics and ham-handedness with which we approach these military occupations, you see how outrageously ineffective our attempts our. We have killed far more innocent civilians in our attempt to feel "safe" than have been killed on our soil because of terrorism. At what point do we no longer count as protecting ourselves, when we end up killing civilians and creating more people who hate the US? Are we not the "terrorists" in this situation? Less focus on military intervention and more on aid would not only cost less, but harbor less resentment and create fewer enemies.

    • Daniel Kane, March 9, 2015 @ 6:54 pm Reply

      OK. I second the claim that our national security efforts have been of questionable benefit. Yet still with actual deaths due to terrorism being so low, this ratio is orders of magnitude off from what being a reasonable comparison. For example, consider the possibility of a terrorist nuke. This could lead to say, 10^7 deaths, if it happened. If we had one of these in the next hundred years sometime, it would increase the number of deaths due to terrorism by orders of magnitude. If our anti-terrorism efforts can prevent just one of these, they are going to be orders of magnitude more effective than they appear to be.

      • Dave Harris, March 9, 2015 @ 7:14 pm Reply

        Any one of these causes of death could swell in a single instance to monumental proportions. A massive viral outbreak or infrastructural collapse is vastly more likely than a nuclear terrorist attack. And yet these things that are better combated by throwing money at them receive far fewer funds. Dollar per death puts it in terms of actual amount of risk posed to Americans instead of this speculative fear mongering.

        • Daniel Kane, March 10, 2015 @ 3:54 am Reply

          And a massive flu outbreak or a major infrastructure collapse will not increase the number of deaths from disease or traffic fatalities by orders of magnitude. A single terrorist WMD could do that for terrorism related deaths. Heck, ignoring 9/11 might decrease the number of civilian deaths due to terrorism by an order of magnitude over the last decade depending on how you count. I’m saying that cost per death is a particularly bad measure when the vast majority of the deaths are dominated by individual events.
          OK. How many dollars per death should we be spending to prevent climate change? Ideally, a lot. We put in a bunch of effort now to cut carbon emissions so that thing don’t get so bad that people are getting killed by crop failures and severe weather.
          On the other hand, yeah, we probably should be spending more money on heart disease. On the other hand, where exactly would this money go? I imagine that if we doubled our research spending, we would have completely run out of reasonable projects to spend money on.
          Dollars per death is fine as a very rough proxy for what we want, but what we actually care about is marginal dollars per marginal death (or maybe marginal Quality Adjusted Life Year).

  • Erik Fogg, March 9, 2015 @ 7:23 pm Reply

    I really like the back-and-forth here: hopefully everyone’s appreciating the deep complexity of these kinds of questions and learning from each other (I know I am).

    A quick reminder: we are of course not trying to be definitive or tell anyone what to think–we’re leaving things intentionally open-ended to provoke curiosity and even skepticism. The challenging of these perspectives is awesome, and my challenge to everyone is "what might be the best alternative?"

    I think everyone’s recognizing that the "ideal" alternatives are difficult to attain, and also recognizing that having some data to drive management/accountability is important. Any thoughts on what a really accurate, practical measurement system might be?

    • Daniel Hawkins, March 10, 2015 @ 1:26 am Reply

      This is a good challenge; I probably criticize without presenting better alternatives too often, so it’s good to be called on it once in a while.

      It’s the GAO’s job to measure this sort of thing (http://www.gao.gov/about/index.html), so I searched there for "terrorism spending" and found these:

      http://www.gao.gov/products/NSIAD-98-39
      http://www.gao.gov/products/GAO/T-NSIAD/GGD-99-107

      I’m interested to read those, but I was more interested in why I couldn’t find anything about counterterrorism spending written after 9/11. I guess that just means congress didn’t ask, because it would have been unpopular? The GAO did complain a few times that the national strategies relating to terrorism lacked end-state goals and performance measures:

      http://www.gao.gov/products/GAO-03-519T
      http://www.gao.gov/products/GAO-04-408T

      But beyond that, they seem to have focused mostly on the management of various operations instead of the big picture question, "should we be spending so much money/effort on this?" Perhaps we should ask our representatives to ask the GAO to take another look.

    • Eric Gemme, March 10, 2015 @ 12:20 pm Reply

      I agree with all points about the metrics made so far in terms of it not being ideal… but I doubt the graph of $$ spent per life saved would look much different given the magnitude of the $$ being spent in each category. I think there are two points worth mentioning on this:

      1. With the war on terrorism we are only considering American lives. I would wager that we’ve saved many times more than that with countries closer to where we have ‘boots on the ground’. How do you factor this into the equation?

      2. To a previous comment about some of the disease fatalities being our own fault… absolutely, and that doesn’t mean we shouldn’t look at raising awareness of how it can be prevented. Right now its easier to eat unhealthy than it is to eat healthy for most Americans (gross generalization). But comparing the amount of $$ that it took (or will take) to prevent 1 additional life due to terrorism, how many lives could you save from diabetes (or even prevent from getting in the first place) by spending it on educating others, improving school lunches, subsidizing healthy foods, etc. I’m not saying I agree with all of the ways we could do this or that one of those is the biggest lever to pull… but ~hundreds of millions of dollars seems like it should save many more than a single life.

      • Daniel Kane, March 10, 2015 @ 6:31 pm Reply

        1. This is a good idea. We should probably be spending more money on prevention. On the other hand, I suspect that the reason we are not has more to do with people not wanting the government telling them how to behave than on a lack of funding. Then again, there’s also the problem of not really having a good understanding of nutrition to begin with.
  • Chris McAdam, March 10, 2015 @ 3:42 pm Reply

    I am going to, generally, agree that dollars per death is not a useful figure. Dollars per lives saved is much more meaningful, but of course is much harder to quantify.

    We are really looking at dollars per perceived threat. We are also looking at, in the case of terrorism, peace of mind. The airline industry shuts down if people are afraid to fly. We spend money on that kind of security not simply because those people died, but so that nobody else is afraid they might die next.

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