Is saving lives overrated?

Almost all major policy issues revolve around saving lives. People frame their arguments in terms of the number of lives that can be saved. On the surface level this makes perfect sense. No one likes premature deaths, so why shouldn’t we prevent them? For instance, if a 22-year-old man is killed during a gang showdown, that’s plainly a premature death. Stop the shooting and you save a life.

For other issues, it’s not so clear. The murkiness comes from the understanding of the concept of “premature” death. Consider the topic of obesity. The common figure is that obesity causes 450,000 deaths in America each year. Yet many question the statistic. In an article in Scientific American late last year, one group of researchers suggested that the issue is strongly affected by age. Among old people, it may actually be advantageous to be somewhat overweight (according to the official classification), because cushions of fat can protect major organs from damage in some circumstances.

Suppose that an 85-year-old who weighs 250 pound has a heart attack and dies. We might classify that as a premature death due to obesity, but is it really? There’s a chance that the person in question might have died before reaching age 85 if he or she wasn’t overweight. Thus it’s not clear whether obesity really caused a premature death. Yet the focus on saving lives by tackling the biggest causes of death ignores such subtleties. If we only look at the number of deaths, then this person has contributed to the numbers which motivate people to tackle obesity as a major issue.

I think we could prioritize better if we stop looking at the number of lives saved by a policy, and start looking at the amount of life extended. In other words, we estimate how much longer people would live on average, rather than just whether they would live longer. Thus, issues such as murder, suicide, and car accidents, which strike mainly at the young, would move up in the list of priorities. Obesity, hitting mainly old people, would move down. I say that this gives a more sensible approach to setting policy; what say you?

In general things like obesity are ranked based on “years of preventable death” or something like that (I forget the technical term.)

I’m not sure though what ranking obesity lower as a legislative concern has to do with increasing concern with young deaths, nor what any of that has to do with “saving lives being overrated” as you simply seem to be suggesting a different order for saving them.

As to whether or not it is more important to deal with people getting mugged versus getting them to live healthy…well okay. Personally it is coming through to me as someone overweight trying to throw out a big obfuscator that will have people piss off and leave him to his hoagie (though this is entirely unfounded on any evidence.) But sure. At some point you need to decide who you’re going to spend the money to save, but I think personally that in the long run a balanced attack that tried to do it’s best for people of all ages, and particularly in areas where greater good could be done with less funds, is going to do better. If you just concentrated on keeping the young alive–well yes we would have a nice virulent society, but we also wouldn’t be living as long since we wouldn’t be spending the budget to figure out fighting the diseases of older age.

Not sure how a world of all 0-40 year olds would be.

I think quality of life is more important than amount of life gained. Granted, avoiding a car accident to add 50 years to a life or cutting childhood mortality to add 75 years to a life is preferable to adding 3 years to a life by ending cancer but none of it matters if life sucks and you want to die all the time. I don’t have the stat but I’ve read if we cure CVD, cancer, diabetes and perhaps alzheimers it will only add 10-16 years to life expectancy, so people who are 65 can expect to live to about 96 instead of around 82.

It’s a simple metric. You can also use years of life gained/lost.

Some prefer to use QALYs, or Quality Adjusted Life-Years. Go ahead, google it.

oh, man, i thought this was going to be about existentialism.

I don’t know if I’d say that obesity hits “mainly old people.” Something like a quarter of people under eighteen are obese. But I agree with your point. It sickens me that we spend millions of dollars trying to get an old rich white man four more years of life, while younger people without as much money but who have problems which might be more easily fixed go without care, because they’re not as well off and have fewer resources. I’m not saying older people have less of a right to life than younger people, but what’s the point of pushing the life expectancy from a hypothetical 86 to 94? People that age usually have so many cumulative health problems that they spend millions of dollars on stopgap measures designed to keep them clinging to life, and it’s not like they are totally healthy even after all that–many old person’s diseases are chronic and require constant care. I would much rather see that money go towards fixing diseases that would have a greater chance of being totally cured and returning the person to perfect health, not to mention saving lives by decreasing violence, automobile accidents, and suicide.

If we could fund everything, great, but since we don’t I would rather see medical dollars go toward funding curable conditions and young people. Not necessarily in that order. I’ve already said that if I ever develop metastatizing cancer or any other infiltrating disease I don’t want to have any further care; I would rather see that money go toward something else than giving me a marginal life where I would have to take dozens of pills every day and be constantly under a doctor’s supervision. I don’t see the point of living like that.

That’s the motivation for the Quality Adjusted Life Year metric (QALY). An extra year of health is weighted more than a year of intensive care.

On the other hand, it’s been observed that the disabled report having more satisfactory lives than is imagined by the abled.

Well, obesity deaths may occur mostly in the old, but that doesn’t mean they weren’t triggered by obesity in youth. The life-saving qualities of obesity in old age, well, that’s something I’ve never heard of but if it’s true (it sounds like the issue could use more scientific attention) it certainly muddles up the issue. But it’s one thing for someone to gradually gain weight until they’re 85 and 250, and another thing entirely for someone to weigh 300/400 pounds at age 25, which I see a pretty large amount of in this corner of the world. What’s the difference, in terms of health risk? I’m no doctor and I’m no scientist, but I’d bet the house that the 85/250 guy has had a much better life.

Me too!

There is a book called “Disease Control Priorities in Developing Countries: 2nd Ed” that addresses healthcare in the developing world using this mindset. They examine what all healthcare initiatives provide the most years of life per spent since money is limited in the developing world they want the most years of life and best health interventions per spent.

Cost effective interventions are things like condoms, vaccines, aspirin (for heart disease), better nutrition, insecticide laden bednets for malaria, etc.