Map of life expectancy at birth from Global Education Project.

Tuesday, September 05, 2006

Keeping us Safe

The talking heads are predicting Democratic gains in the fall elections, possibly even capture of a majority in the House. But, as White House Political Director Sara Taylor told Jill Zuckman of the Chicago Tribune: ""There's no question that this will be a tough cycle," said White House political director Sara Taylor. Still, she added, "I'm confident we'll retain our majorities." When it comes to handling the war on terrorism and guiding the economy, Taylor said, Americans are more likely to trust the GOP. "I think Americans have confidence in the Republican Party and the president to keep them safe," she said."

So, what does it mean to be safe? I guess most people would say, at least in this context, that we're talking about not dying before your time, as they say. So what makes us not safe? The leading causes of death don't really tell the story, because most people die when they are old, and, well, sorry to say, it can't be helped. So the question is not what's likely to carry people off in the end, but what costs the most in total years of life, which gives more weight to things that kill younger people. This is called Years of Potential Life Lost, or YPLL, and in the most basic method, it consists of subtracting the age of decedents from 75 and counting up the total years for each cause of death. (People who die at 75 or older just aren't counted -- they're presumed to be on bonus time.)

There are various complications and adjustments, and different methods can yield slightly different results, but CDC does this exercise every year for important causes of death. You can find it all in Table 30 of the annual report Health United States, but I'm not going to bother with a link, it's in a PDF hundreds of pages long. Anyway, in 2003, the leading causes of YPLL per 100,000 population were actually the leading causes of death -- cancer and heart disease -- because they can strike relatively young people. Heart disease was responsible for 1,187.9 YPLL/100,000, and malignant neoplasms for 1,586.9. Of course cancer is really many different diseases. Lung cancer was #1 among all cancers, at 412.2. Unintentional injuries were the third leading of the very broad categories, at 1,084.6, with motor vehicle injuries accounting for more than half of that total. Homicide was pretty low on the list, but ahead of HIV (thanks to antiretroviral medications) at 274.3.

So where is terrorism in this picture? Believe it or not, we can estimate the answer from Table 30. In 2000, the YPLL due to homicide was 266.5; in 2002 and 2003, it was 274 and change. In 2001, with the inclusion of the 9/11 victims, it was 311.0. If we'd had a smooth increase from 2000 to 2002, the number would have been about 270, so as a reasonable guess, the 9/11 attack caused an increment of 41 YPLL/100,000 population, which means it wouldn't even have appeared on the list if it were broken out separately. (I'd need to be able to get the raw numbers from which the table was prepared, plus the ages of all the 9/11 victims, to compute the actual YPLL from the attack. But the visible spike looks like it's probably a decent approximation.)

It's less than half the YPLL due to influenza and pneumonia, 1/4 the total from cirrhosis of the liver, less than 1/6 the total due to diabetes, 1/9 the total due to suicide, and 1/14 the total due to car crashes. And of course, those other causes go on year after year after year. Even if we had terrorist attacks comparable to 9/11/2001 every single year, they wouldn't amount to a tiny drop in the bucket of what makes us not be safe.

Just something to think about if you're interested in who's going to keep you safe.

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