Threats to the health of Americans.
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 (Whitehouse.gov).
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?
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.
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
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.