Public Choices Between Lifesaving Programs how Important are Lives Saved?

Uma Subramanian

Jan 1995 · World Bank Publications

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Abstract: August 1995 - Do funding priorities for health and safety policies reflect irrational fears? the disaster of the month - rather than address more fundamental problems? A thousand people were surveyed to gauge popular feelings about funding choices between environmental and public health programs. In developing and industrial countries alike, there is concern that health and safety policy may respond to irrational fears - to the disaster of the month - rather than address more fundamental problems. In the United States, for example, some policymakers say the public worries about trivial risks while ignoring larger ones and that funding priorities reflect this view. Many public health programs with a low cost per life saved are underfunded, for example, while many environmental regulations with a high cost per life saved are issued each year. Does the existing allocation of resources reflect people's preoccupation with the qualitative aspects of risks, to the exclusion of quantitative factors (lives saved)? Or can observed differences in the cost per life saved of environmental and public health programs be explained by the way the two sets of programs are funded? Cropper and Subramanian examine the preferences of U.S. citizens for health and safety programs. They confronted a random sample of 1,000 U.S. adults with choices between environmental health and public health programs, to see which they would choose. The authors then examined what factors (qualitative and quantitative) seem to influence these choices. Respondents were asked about pairs of programs, among them: smoking education or industrial pollution control programs, industrial pollution control or pneumonia vaccine programs, radon eradication or a program to ban smoking in the workplace, and radon eradication or programs to ban pesticides. The survey results, they feel, have implications beyond the United States. They find that, while qualitative aspects of the life-saving programs are statistically significant in explaining people's choices among them, lives saved matter, too. Indeed, for the median respondent in the survey, the rate of substitution between most qualitative risk characteristics and lives saved is inelastic. But for a sizable minority of respondents, choice among programs appears to be insensitive to lives saved. The interesting question for public policy is what role the latter group plays in the regulatory process. This paper - a joint product of the Environment, Infrastructure, and Agriculture Division, Policy Research Department, and the Environment and Natural Resources Division, Asia Technical Department - is part of a larger effort in the Bank to see what can be learned about efficient environmental policy by examining the U.S. experience with environmental regulation. The authors may be contacted at mcropper@@worldbank.org or usubramanian@@worldbank.org.