Out of Balance
Douglas McCormick
Editorial Director, BioTechniques
Our spending priorities say that homeland security is
thousands of times more important than researching
heart disease. Is it?
The White House released its budget plans for 2009 at the end of January. The total budget proposed for the National Institutes of Health (NIH) was $32.5 billion, up 0.3% from current-year estimates. The NIH allocation for research and development in 2009 is $28.37 billion—flat for the fifth straight year: NIH research funding increases have averaged just 1.59% since 2004, while the cost of living rose by 2.85% last year. We are losing ground.
Trying to understand what our spending says about our priorities, we pulled together some numbers: mortality figures from the Centers for Disease Control and Prevention, disease-treatment spending from the Agency for Healthcare Research and Quality (AHRQ), military appropriations data from the Congressional Research Service (CRS), and budget proposals from the White House Office of Management and Budget. From these data, we tried to build a picture of what factors threaten our well-being and how we allocate resources to protect ourselves.
The figures were not comforting. About 900,000 Americans die each year of major cardiovascular disease. According to AHRQ,
we spend about $118 billion annually treating heart diseases and hypertension. (Private insurance pays for 24% of the bill; federal
healthcare programs cover another 33%.) If we divide the spending by the mortality, we get $131,800 per death; this gives us a sort of “treatment priority index†reflecting the importance we attach to helping those who have already developed problems. The 2009 Federal Budget proposes $2.9 billion for research at the National Heart, Lung, and Blood Institute: that’s a “research priority index†of $3,246 to understand and, we hope, prevent each death from heart or lung disease. (Research can save lives: death rates from heart disease among older American men, for example, fell from 4000 per 100,000 people in 1968 to less than 2000 in 2002.)
In the meantime, U.S. military operations in Asia have cost $609 billion since 2003. The Administration proposes spending $32.8 billion on the Department of Homeland Security in 2009 (up 9.7% from the 2008 request), and distributing another $15.8 billion for security activities in other civilian departments. The total is $48.7 billion.
Direct terrorist attacks killed 3000 people in America in 2001, increasing the national homicide total 16% for that year. Over five years (2003 through 2007), we’ve spent an average of $122 billion per year on war in Iraq and Afghanistan—just a bit more than we spend treating heart disease. That’s a “treatment priority index†of $203 million per 9/11 death over that period, reflecting a priority 1500 times higher than treating heart disease. The $48.7 billion proposal for government-wide homeland security measures in 2009 translates into a prevention priority index of $16 million per terror victim, more than 4900 times what we allocate for heart and lung disease.
These ratios are not meaningful in themselves. They do, however, clearly show that the United States, by its allocation of resources, is treating terrorism as the equivalent of the dominant public-health problem of our times. Our spending says that we regard terror as we would a disease that takes a million lives a year, year in and year out.
And it just isn’t.
We can by no means downgrade our perception of the threat of widespread intentional harm to the level of, say, hernias (responsible for 6300 deaths from 2001−2004). Watchfulness is essential: deaths from terrorism, like those from influenza or natural disasters, are among the very few categories on the mortality table that could suddenly grow by two, three, or more orders of magnitude. It is merely prudent to devote resources disproportionate to the harm already suffered in order to avoid what is clearly the intent of a small number of people to do much greater harm in the future.
But is this really the most important issue facing us today? Is it worth mortgaging the future of science and starving young researchers out of the field? Is it worth accepting that, in the decades to come, members of our families and communities will suffer and die of diseases that research today might have prevented?
Biotechniques Vol. 44 ı No. 3 ı 2008