Jonathan Mingle and Sean Rameswaram discuss the tick problem in the US:
Are we not fighting back against the ticks?
Not really. I mean, this is one of the surprising takeaways from my reporting is that we’re barely even trying. One way of understanding that is to think about two numbers. One number is 90 percent. 90 percent of vector-borne disease cases in the US are from ticks.
90 percent?
Yeah. And yet despite the fact that 90 percent of cases of vector-borne illness come from tick bites, if you look at what local city and county health agencies do in terms of vector control, 80 percent of what they do is mosquito control, and only about 10 or 11 percent of these local health agencies around the country do any kind of tick control. So why is that? It’s a familiar story in the public health world. It’s not enough funding or policy support for trying out, testing, and deploying new approaches to controlling ticks. The ticks are winning, Danielle Hewitt and Sean Rameswaram, 'Mother Jones', 1 August 2026
...Or a lack of incentives. This kind of mismatch between the a problem and the incentives devoted to solving it bedevils all policymaking in areas where existing institutions have no incentive to explore new approaches. It's rife in the field of health policy, where those in the profession have little incentive or capacity to think beyond their speciality, and so advise policymakers accordingly.
Given the widespread, and justifiable, distrust of pharmaceutical companies, it would seem that this is the time to move towards rewarding those who achieve favourable health outcomes, rather than those who merely engage in activities purporting to deliver those outcomes. Those currently employed in healthcare are reacting rationally to the incentives on offer, to the detriment of our physical and mental health. And those incentives are to keep funding existing bodies and their approaches; as well, they encourage over-screening and over-diagnosis.
It's time for a new approach. My suggestion is that rather than policymakers' focusing on the means by which they think good health can be achieved, they instead focus on targets for good physical and mental health, and provide incentives for people to achieve those targets. The Social Policy Bond concept, applied to health, would do this, and more: it would inject the market's incentives and efficiencies into all the processes necessary to improve a nation's health, regardless of the vested interests of the current service providers. A short piece on Health Bonds can be found here, and a much longer version, describing Tradeable Health Outcome Bonds is here. A bond regime would channel our scarce resources into the most efficient means of improving our health, including those currently neglected or not even considered by our current healthcare bodies.
Health Bonds wouldn't stipulate how our health goals shall be achieved, nor who shall achieve them. This allows a broader approach. For example: if ticks are agreed to be a much bigger threat to health than mosquitos, then a bond regime would channel more resources into dealing with ticks rather than mosquitos. More broadly, our current narrow, short-term compartmentalised policy approach would not look into the positive health impacts of subsidising advanced courses for young drivers of motorbikes or cars. But holders of Health Bonds would look at such measures, investigate their possible health impacts, and make an informed decision as to whether any improvement they might bring to a population's health is worthwhile, compared to other possible interventions.
Policymakers in general take the existing institutions, with their limited purview, as a given. An outcome-based approach, such as I envisage in a Social Policy Bond regime, would subordinate the composition, structures and all activities of institutions to the outcomes that policymakers target. For more on the new sorts of organisation that this approach would generate, please see here.
