GoodBehavior: Homeland Security and Public Health

Homeland Security and Public Health


	GoodBehavior! archives

A B O U T_U S

The Center for the Advancement of Health translates to the public the latest research on prevention, chronic disease management and health care, with an emphasis on how social, behavioral and economic factors affect illness and well-being. The Center is an independent nonprofit corporation that receives core funding from the John D. and Catherine T. MacArthur Foundation and The Annenberg Foundation.

D I S C O N N E C T

Although patients generally prefer
to be home instead of the hospital to recover from serious illness, a new review of studies finds that “hospital-at-home” programs common in Europe and Australia do not save money and may not affect health outcomes very much. The review also shows that the higher patient satisfaction may be offset by evidence that the burden on caregivers is greater. One effect researchers found is that while the hospital-at-home reduced how long a patient stayed in a hospital at the outset of an illness, the overall length of care increased for the patients treated at home, possibly negating overall savings.

T O P_M E D I A_H I T S

The Center’s partnership with the Cochrane Collaboration paid off with the publication in more than 300 media outlets and Web sites of 25 stories in July and August. The Washington Post Health section, under the rubric “Do This, Not That,” wrote about the results of a Cochrane article on For Back Pain: Exercise, Not TENS.

The awful events of Sept. 11, 2001, hold many lessons for those of us devoted to thinking about the role of human behavior on our physical, mental and public health. But as the old joke goes, “If anyone knows what they are, please speak up.”

The United States is spending $50 billion a year to make us safe from terrorism, which is about twice as much as what is spent on federal medical research to keep us safe from bad germs, bad genes and bad behavior. But there is plenty of evidence that the money is being spent out of all proportion to risk.

Four years ago, 3,000 Americans were victims of terrorism, but 150,000 died from lung cancer and 44,000 from auto accidents. Today, 90 percent of spending by the Transportation Security Agency goes to protecting airline travel, which benefits 630 million passengers a year. Virtually nothing goes to protecting public transit, which carries 9.4 billion people. Over the past four years, the airline industry received $18.1 billion for security, but public transit received $250 million.

Baltimore Mayor Martin O’Malley, who heads the U.S. Conference of Mayors’ homeland security task force, says the reason airline security gets priority, instead of subways or ports, is “because it’s been attacked, and that allowed us to muster up the courage to make the investment, because we could see that on television.” He goes on to state the obvious: “The way dollars should be distributed is according to risk and the vulnerability assessments, as if it was the United States without any borders between states.”

It is a sentiment that defines homeland security properly as a public health issue.

And it isn’t just some big city liberal mayor saying this. The conservative American Enterprise Institute concluded in a paper earlier this year “a large portion of homeland security spending decisions are made on a political basis rather than on a sound cost-benefit analysis … As a result, homeland security funding is likely to be misallocated, resulting in a less than optimal level of security in America.”

So here is one lesson. To the degree possible, keeping Americans secure absolutely must be based on cold-eyed evaluation of real risk, as, theoretically, are the prescription of antibiotics, care after a heart attack or routine examination of the eyes and feet of diabetics. The application of what works is only effective and efficient when it responds to the specific risk in medicine and in public health.

A second lesson is that homeland security – like health – is too important to be left entirely to the politicians and the experts. We all have a stake in our own well-being and often have a better idea of how to achieve it.

In both health and homeland security, it is our dollars and our lives at stake, and in both, the judicious use of evidence-based risk assessment and of effective remedies are better solutions than frisking shoeless kindergarteners at the airport.