Implications Done Right

Clean water source. Hygiene. Ebola containment.  These public health priorities and crises often seem like issues that only matter for developing countries.  Indeed, the CDC and other authorities have issued ample assurances that given the quality of our healthcare system and our very different cultural practices, the risk of an ebola outbreak in the US is very low.  That doesn't mean that we've learned our lessons.

As Aaron E. Carroll of the New York Times points out in an excellent article, Guinea worms (and ebola) aside, we are still battling issues of clean water, hygiene, and quarantine in the US.  And we pay for not learning such lessons with illnesses, deaths, and high costs.  As he writes:

The Centers for Disease Control and Prevention estimates that 48 million Americans become ill from food-borne illnesses each year. More than 125,000 hospitalizations are caused by food-borne illness, and about 3,000 deaths. Many, if not most, of these illnesses could be prevented if people properly stored, cleaned, cooked and refrigerated their food correctly. 

Between 1976 and 2007, deaths from influenza ranged from 3,000 to 49,000 a year. The vast majority of deaths from influenza occur in people who are 65 years of age or older. Proper hygiene and staying home during the infectious stage of the illness are still mainstays of flu care. But we also have a vaccine for this illness. Too few people get it. It’s estimated that two years ago, if we had just gotten the influenza vaccination rate up to 70 percent, up from the 45 percent we achieved, we could have prevented an additional 4.4 million illnesses and 30,000 hospitalizations.

Carroll connects global health crises with your health and deftly demonstrates the importance of persuasive communication as well as practicing what we preach.  We know what the answers are and we need to be compelled into putting them into practice.  Lives and dollars are at stake.

Shot in the Arm

Though I only spoke Mandarin Chinese growing up, I found it cathartic, whenever I was angry, to curse in strings of expletives in Mandarin, Taiwanese and English under my breath.  But at the age of 10, I gave it all up.  It’s the only resolution I’ve kept 96% successfully for so long, to the point that when I do swear aloud now (usually to quote someone), it sounds stilted and unnatural.  I usually liken my loyalty to flu shots to my non-swearing habit: I get why you’re not like me.  No judgment here.  (Exceptions being doctors, elderly people, and others high-risk folks: the benefits outweigh costs for them and they should almost always get vaccinated). 

Our decisions to engage in protective actions like buckling up and buying insurance depend on the costs and likelihoods of the harm we want to avoid.  For many, their flu shot consideration (however brief) is something like this: 

Effectiveness x Cost of flu shot (pain, time, copay, etc.) > Risk x Cost of flu (medical expenses, lost wages, etc.)

Simply put, people choose not to vaccinate when cost > benefit.  Though getting the flu is miserable, costly, and leads to tens of thousands of deaths annually, it’s usually unlikely to touch healthy, attractive people like you.  However, the flu season is the worst in at least a decade.  Hospitals in Boston were so overwhelmed by influenza patients (more so than during the H1N1 outbreak) that the mayor declared a public health emergency.  The flu is now widespread throughout the US.  For those following the math, the risk of getting the flu is much higher than usual.  If you haven't gotten a shot: it's time to rethink your equation*.  

(The intensity this year surpasses the previous peak from H1N1.  
Click on the map to play with the google trends yourself.)

Of course, the risk of flu isn’t the only part of the equation that changes.  The cost of vaccination can be lowered to make shots more attractive.  Public Health likes that since the more people are vaccinated, the less likely it is for anyone to get the flu.  This is why flu shots are fully covered by many insurers, why employers set up workplace clinics, and why retail pharmacies don’t require appointments.   At Bowdoin College, the health center further sweetened the deal by giving Halloween goody bags with candies and toys, forever changing my attitude toward flu shots.  Whatever incentive works for you, the risk of flu is high this year and the cost of vaccination is low.  So for f*ck’s sake: get a flu shot.

*There is so much straightforward information on flu shots out there that I don't need to argue it here; the shot is effective and will not give you the flu.

Policy Implications:  Though the public benefit of flu shots is greater than that for individuals, incentives can spur individuals toward disease prevention.