[W]e spend $500 million for every death from terrorism and only $2,000 for every death resulting from strokes. That means we spend 250,000 times more per death on terrorism. Anti-Terrorism Spending 50,000 Times More Than on Any Other Cause of Death, Mike P Sinn, October 2011We can quibble a bit about the numbers, but these figures do seem to indicate an inefficient way of improving the health outcomes of American citizens. There would be nothing necessarily wrong with such spending patterns if this disparity were the result of an informed populace deciding for itself where its taxpayer dollars should be channelled. But, this isn't the case, and the Economist this week reminds us that 'defence' - that is to say, the military - is one of those industries notorious for cronyism. (Others identified by that journal include telecoms, natural resources, construction, which all 'involve a lot of interaction with the state, or are licensed by it'.)
Of course, it's unrealistic to ask people exactly how every health dollar should be spent. But we can engage the public in such decisions by focusing not on the pathways to improved health - which are complex and ever-changing - but on the outcomes we should like to see. For instance, we could express health goals in terms of Quality Adjusted Life Years, and then answer questions as to whether some x percent improvement in QALYs should be weighted more heavily than others. If the consensus is 'yes', and we judge terrorist deaths, for example, to be more negative than deaths caused by strokes, then we can allocate spending accordingly. Even then, we're unlikely to see the sort of disparities outlined above, which are more a consequence of emotional reactions to television footage, lobbying and cronyism than rational thinking.
My short piece on applying the Social Policy Bond principle to health goes into more detail.