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From: cg7495@m.cc.utah.edu
Newsgroups: alt.folklore.urban
Subject: Re: Kenny the Flashlight Man
Date: Mon, 12 Jan 1998 18:24:34 GMT

In article <34B66E65.5173@mindspring.com>, RM Mentock <mentock@mindspring.com> 
wrote:
>Ben Walsh wrote:
>
>> They're not criminals, just breaking the law. You're being hysterical.
>> But anyway, yes. I don't want my TAXES used to the pay for medical
>> treatment of imbeciles with easily preventable injuries.
>> 
>I would love to see a cost/benefit analysis really set out.
>

I'm so excited. I actually get to be useful around here for a bit. The University of Utah has an enormous database of auto injuries and fatalities related to the use/non-use of seatbelts. In brief, and from memory since I don't have access to the dataset at this moment, the mandating of seatbelts and child restraint seats in Utah has created a statistically significant dip in the number of fatalities related to car crashes; injuries have also gone down in severity and scope. The reduction of costs however, is a matter of debate since in terms of plain money it's cheaper to bury a dead non-seat-belt wearing person than to treat a living but hospitalized seat-belt wearing person. This is the argument one usually hears from people decrying the mandating of seatbelt usuage. When the model is expanded however to include total costs (which I'll get to below) it's less costly to society to mandate their usage. The numbers are still being hammered out, but I will find them out for you and report back.

To get some definitions straight, an analysis of just the costs in dollars of various scenarios without considering outcomes is called cost-identification. This is the simplest analysis of cost and is an important first step to get where you want to go, but it ain't the whole picture. The next step is what you said you wanted above, the cost benefit analysis, which determines the net costs and benefits (such slippery terms) of different scenarios. The final step for people interested in this sort of thing is cost-effectiveness, a model which assists in determining the best way to achieve a specific pre-determined goal. This is the one we hear the most about and the one most people claim to have done when they start health or community campaigns. But people have such a poor grasp of what cost-effectiveness entails that the term is frequently abused. When it's done right (as David Eddy is trying to do) it results in things such as immunization schedules (for children and geriatrics), and recommendations for early and frequent pre-natal visits. True and reliable cost-effectiveness analysis have demonstrated that these two measures in particular are incredibly effective at reducing both disease and poor outcomes in specific populations. As an example of the abuse of the term cost-effectiveness, you hear a lot of claims for the frequent use of cancer screening programs in non-high-risk populations. The jury is still out on a number of these screening schedules, and there is not enough data to support such recommendations at the frequency with which they are performed in populations without risk factors for the specific disease. This is not the case with pre-natal services or immunizations . . . but I digress.

The trap I see a number of people fall into is a too facile definition of cost benefit analysis. Cost benefit analysis is *much* more complex than a simple tabulation of days spent in hospital/ICU/off of work, and takes into account things like years of productive life lost or, in simpler terms, years of work a person could expect to contribute to society which are now lost to society. When this model really starts to grow, it takes into account the months of lost time accounted for by grieving spouses who are going to be out of commission for awhile, the impact on any offspring, and the impact on the community's's perception of its health . . . you see where this is going, we can spend years building a cost benefit model that comes even close to capturing the impact of one non-seatbelted fatality.

The long and the short of it is that the tax dollars we spend caring for non-seat-belt wearing people paralyzed in accidents is a small portion of the costs associated with non-usage. There is the cost in lost work years, the burden on the spouse, family and the community to recover from the loss or permanent injury of the victim, and the societal costs associated with families suing car companies, the city for not maintaining the roads, the bar for serving the drink, the insurance company for not paying out enough, etc., etc.. The costs add up, believe me. The benefits of not wearing a seat-belt, well, you tell me, because I don't see any. All the anecdotal stories about Joe Bean being thrown from the car and surviving while everyone else who was wearing a seat belt was crushed to death seem to only hold up when there's no data to back the stories up. I've never met Joe Bean, even though I've asked more than one person to get me in touch with him. Seatbelts help not only to keep one from being flung headlong through the windshield, they keep that person from losing consciousness due to a concussion. Alert people can unbuckle and escape a car, unconscious people can't.

The real crux if the issue here if we're being honest, isn't data, it's emotion, and it depends entirely on which side of the fence you come down on: is seatbelt usage an individual rights issue or a public health issue? In my opinion, it may start out as individual preference, but the impact that such deaths and injuries have on a family and a community's sense of security and well-being makes it ultimately a societal issue. Why can I guarantee that every USAan in this froup have at least one high school yearbook memoriam to the kid who died in an auto accident that year? Because it's the number one reason teenagers die in our country. They run stop signs, they race, they fall asleep while driving late at night, they don't wear seat belts and they die in pretty high numbers. That is a cost, plain and simple. It's emotional and fuzzy, it's hard to categorize and put a hard number on, but all of trauma surrounding the school assembly, the memorial service, the suicide ideation that follows are real costs, put into real models which spit out real findings that seatbelt usage reduces costs.

Public health and safety issues are just that, public. Yes individuals make up the public and no, I don't like a lot of public health campaigns which surreptitiously target the individual while claiming the public good, but to-date the societal costs and benefits of wearing seats belts definitely seem to outweigh the costs and benefits of not wearing them.

Christine "public servant announcer" Gazak