Threats to the health of Americans.

Dr. Ardena Flippin

There has been a ten-fold increase in terrorist bombing incidents worldwide between 1968 and 1980, with the events of 9/11 foremost among them.

The US government now spends $100 billion dollars a year on homeland security to protect the American public from terrorist attacks (

But 150,000 Americans die each year from trauma not related to terrorist attacks – is there an imbalance in our priorities? Has the fear of a terrorist attack skewed how public funds are spent?

Here's a round up of the trauma risks to Americans, and how much is spent to mitigate each risk.

Where are we on the “prevention and readiness scale” for these health threats? More importantly, are our emergency facilities getting more or less capable of dealing with the next big threat?

The leading causes of US trauma deaths are: motor vehicle crashes (59%), falls (13%) and gunshot wounds/stabbings (12%). Deaths from terrorist attacks account for a tiny fraction of trauma deaths every year – the highest fraction, obviously in 2001, accounted for about 2% of all trauma deaths. Averaged over 10 years, that's less that a quarter of a percent of the trauma deaths in the country. Yet combined federal and state spending for anti-terrorism preparedness (excluding costs of foreign wars) accounts for nearly 99% of the government funds spent on reducing traumatic deaths (this excludes funds for infrastructure repairs to roads).

Is there an imbalance in how tax dollars are being spent to protect us from trauma?

How much is being spent on reducing traumatic deaths?

Motor Vehicle Collisions

About 88,500 Americans die each year in motor vehicle accidents. From a purely economic standpoint, the estimated yearly cost of traffic fatalities is over $113 billion.

Over the last ten years approximately $4.8 billion (about $480 million/year) was spent by states for motor vehicle collision prevention and “nearly $1 billion in federal funds specifically provided to improve traffic safety go unspent." (Surface Transportation Policy Project, January 30, 2003).


The total lifetime cost of falls is $37 billion (75% occur in the older adult population). By 2020, the annual direct and indirect cost of fall injuries is expected to reach $43.8 billion (in current dollars) (Englander et al. 1996). 

Fall prevention has been an interest area of the Archstone Foundation for almost a decade with more than 25 grants being awarded, totaling over 10 million dollars. (Falls Prevention Center of Excellence)§

Gun Shot Wounds 

GSW’s societal cost is $100 billion a year (Gun Violence, The Real Costs, Phillip Cook and Jens Ludwig).

For FY 2006, the President had requested $74 million for Project Safe Neighborhoods (PSN), but only $15 million was appropriated. The President's budget requests $395 million for PSN in 2007.

Terrorist attacks 

Terrorist bombing incidents have increased ten-fold worldwide between 1968 and 1980. But even at its peak of nearly 3000 on 9/11/2001, the number of people killed and injured by terrorist attacks is small compared to those killed every year by other trauma.

The United States spends roughly $100 billion per year on homeland security, not counting the money spent on wars abroad.

The honest answer seems to be “yes.”

Although motor vehicle collisions constitute the greatest source of annual deaths, the proportion of dollars spent towards prevention is comparatively small (see side bar). This might be because MVC-related deaths generally involve one or two deaths at a time and not hundreds or thousands at a time as they do in terrorist-related incidents. But the cumulative effect is huge both in human lives and financial cost.

General preparedness

More importantly, the country's preparedness for all sorts of trauma, whether motor vehicle or terrorist in source, is degrading: 10-20% of the nation’s 600 regional trauma centers projected to close within 3 years!

A series of three reports from the Institute of Medicine on the future of emergency care in the United States says that Congress should allocate significant funds to ensure that America’s emergency departments, trauma centers, and medical first responders are fully equipped and ready to provide prompt and appropriate care.

But this does not seem to be a major legislative priority. Approximately $1 billion in Federal funds have been authorized for State bioterrorism preparedness – but the nation’s trauma centers have received little or nothing. Emergency medical services received only 4 percent of the $3.39 billion distributed by the Department of Homeland security for first responders in 2002 and 2003.

One wonders why there is not proportionally more spent on MVC prevention (or why available monies go unspent), and why specific federal and/or state funding support for ED’s and trauma centers that will be the site of first responders for increasing and multiple casualties isn’t appropriated.

As baby boomers age there might be acceleration in the number of MVCs and there probably will be acceleration in the number of falls; and in our collective minds we all wonder when/where “the other (terror) shoe will drop”. But regardless of how trauma arrives, it seems we are less prepared than we should be. I think we’re going backwards in trauma prevention and readiness.


Gun Violence, The Real Costs, Phillip Cook and Jens Ludwig

Archstone Foundation

Surface Transportation Policy Project, January 30, 2003

White House Health budget priorities for 2007

White House: National Strategy for Homeland Security 

About the Author:

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital. 


Topics #9/11 #emergency preparedness #falls #gun shot wounds #homeland security #motor vehicle collisions #terrorism #Trauma