I'm going to do a series on some of the fundamentals of public health. I'll start with a concept called the Rule of Rescue, a term coined by bioethicist Albert R. Jonsen in 1986.[i] When a child falls down a well, and the rescue is difficult, the attention of the entire country may focus on a remote small town until the drama is resolved. But children in low income countries die of preventable causes every five minutes, and few Americans seem to care. You might chalk this up to racism, and you’d be partly right, but white American children also die of preventable causes every day, and it gets little attention.
The Rule of Rescue applies when a specific, identifiable individual is in mortal danger. People instinctively feel that everything possible should be done to save that person, without regard to cost or even, to some degree, immediate peril to others. This instinct is usually fairly egalitarian. It applies to old as well as young, and with little regard to people’s station in life or perceived worthiness, so long as the individual is within the category that is attributed human rights. (Of course, historically some groups of people have not ascribed humanity to some others, but that’s another matter.)
It might cost tens of thousands, or a hundred thousand dollars, to save little Molly from the well. It doesn’t matter. Anyone who tried to say it wasn’t worth it would be regarded as depraved. But that money could be invested in ways that would save dozens of children. Their misfortune is that they are not specifically identifiable, they are only statistical. We don’t know which child will die from contaminated water, or a preventable infectious disease, or a car crash, or violence, because we haven’t taken measures that could have prevented it. In political debates, the cost of investing in public health and safety is always an issue, and politicians often decide that we just can’t afford some investment that is proven to prevent death and disease.
As we continue, I'll discuss how public health researchers evaluate policies and practices. They do indeed consider cost, but they also consider what we get for the money. They don't conclude that we shouldn't save Molly from the well, but they do come to some conclusions that many people find difficult to understand, or accept. We'll wrestle with them.
[i][i][i] Jonsen, A. R. (1986). Bentham in a box: Technology assessment and health care allocation. Law, Medicine and Health Care, 14, 172–174.
1 comment:
To misquote Stalin "One man's death is a tragedy.... a million deaths are a statistic."
The problem comes down, I suspect, to how we identify another human in the first place. We recognize faces and identify individuals. Mathematics, as critical it may be to civilization, is fundamentally unnatural. I see reflections of this in online behavior - we have a tendency to let slip our Id because the social discipline mechanisms are absent. On some lizard-brain level we believe the screen is a mirror and that we are ranting to ourselves.
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