How much money are we willing to spend to save a life? Some might say "Sky's the limit," but we don't act that way. We don't spend unlimited amounts on fire protection, highway and motor vehicle safety, health care, non-smoking campaigns, etc…, although it is a simple calculation to convert such expenditure into a cost per life saved. In this paper we consider the question of how much our society is willing to spend to save a life in various contexts.

There are numerous opportunities for highly cost-effective life saving in under-developed countries. The World Health Organization (WHO) estimates¹ that over 5 million childhood deaths could be averted each year at a cost ranging from $50 per life saved from measles in Gambia and Cameroon to $210 per life saved by a combination of immunizations in Indonesia. These costs are for complete programs including providing qualified doctors and nurses, medical supplies, transportation, communication, etc. WHO also estimates¹ that about 3 million childhood deaths each year could be averted by oral rehydration therapy (ORT) for diarrhea. This consists of feeding a definite mixture of NaCl, KCl, NaHCO₂ and glucose with water on a definite schedule. The cost per life saved by complete programs range from $150 in Honduras to $500 in Egypt.

Other low cost approaches to life saving in the "Third World" include malaria control ($550/life saved), improved health care ($1930), improved water sanitation ($4030) and nutrition supplement to basic diets ($5300).

But charity begins at home. We next consider two fertile areas for relatively cost-effective life saving in the U.S.. Table 1 lists the cost per life saved by cancer screeening programs,² including many situations where it is under $100.000. For example, only about 50% of sexually active American women get PAP tests for cervical cancer. In a few localities, there have been active programs, utilizing mail, telephone, and personal visits that have increased this fraction to over 90%. The cost of these programs² is about $50.000 per life saved.

Table 1. Cost per life saved for cancer screening and medical care programs in the United States. Costs are from Ref. 2, but since they are given there in 1975 dollars, they have been doubled.

As another example,² a textile mill in North Calarolina started a program of multiple cancer screening tests for their employees. After several years, they added up the cost of program and the number of lives saved by early detection ; dividing these gave $26,000 per life saved, or corrected for inflation , the $52,000 per life saved in Table 1.

Another fertile areas is highway safety. Table 2 lists some measures covered in the 1984 Annual Report of the U.S. Department of transportation, including the number of lives saved per year and the cost per life saved. Since these measures typically have a service life of about 10 years, these measures taken in a single year will eventually save several thousand lives at a cost of approximately $150,000 per life saved.

Table 2. Evaluation of recent projects undertaken to improve highway safety. From U.S. Department of Transportation, "The 1984 Annual Report on Highway Safety Improvement Programs", April 1984. We assume 1.1 deaths per fatal accident.

With this background, let us consider the price we are paying to save lives from radiation in the nuclear industry. Documents from the Department of Energy (DOE) give the cost per life saved in radioactive waste management activities as $300 million in the Savannah River Plant² and $270 million at West Valley, New York³. But more important is our commercial high level waste management program which is supported by a 0.1 cent/kWh tax on nuclear electricity, or $8.8 million/GWe-yr (GWe=gigawatt-electric). It is estimated that random burial with simple precautions would eventually cause 0.02 deaths/GWe-yr ⁴⁾. If half of the cost of the present program is to avert these deaths, the cost per life saved is ($4.4x10⁶/.05=)$220 million, similar to the Savannah River and West Valley expenditures.

There are some strange aspects to these large waste management expenditures. In the first place, the lives saved are those of people living many thousands of years in the future, who bear no closer relationship to us than those now living in under-developed countries whose lives we disdain to save at one-millionth of these costs. In the second place, there is an excellent chance that a cure for cancer will be found in the next few thousand years, in which case these deaths will never materialize and the money will be wasted. In the third place, if only a tiny fraction of this money were invested even at minimal interest, it could provide enormous benefits to these future potential victims, including the saving of tremendous numbers of lives. Equivalents of such an investment are spending the money on biomedical research, or simply using it to reduce the national debt and thereby making more money available to later generations to spend on themselves.

With any reasonable consideration of these matters, we are spending the equivalent of innumerable billions of dollars per life saved in our radioactive waste management programs.

As another example from the nuclear industry, consider reactor safety. Since the mid-1970’s, the Nuclear Regulatory Commission (NRC) has been tightening regulations to reduce the risks of reactor accidents. This program of "regulatory ratcheting" has increased the cost of a nuclear power plant by a factor of 4-5 over and above inflation, an increased cost per plant of well over $2 billion. How many lives does NRC hope to save at this cost?According to its own studies⁵, plants built prior to this regulatory ratcheting could be expected to cause an average of 0.8 deaths over their operating life. Thus, according to their own calculations, NRC is knowingly spending ($2billion/0.8=) $2.5 billion per life saved.

An ironic aspect of these NRC reactor safety-upgrading activities is that the cost increases they have caused have forced utilities to build coal burning power plants instead of nuclear plants. A typical estimate⁵ is that the air pollution from 1 GWe of coal burning plants kills 25 people per year, or about 1000 people over its operating lifetime. Considering the fact that the nuclear plant is expected to kill 0.8 according to NRC⁵ (or 100 according to the anti-nuclear activist organization, Union of Concerned Scientists⁷), that means that every time a coal burning plant is built instead of a nuclear plant, something like 1000 extra people are condemned to an early death.

As a result of this NRC program of regulatory ratcheting, about 100 GWe of coal burning plants will eventually be built instead of nuclear plants, causing about 100,000 needless deaths. The 60+ nuclear plants in the USA that will eventually be completed have cost an average of at least $1.6 billion extra each, for a total cost of 100 billion in an effort to save these (60x0.8=) 50 lives. If this money were spent, instead, on cancer searching and highway safety measures, it could have saved something approaching a million lives.

There are additional indirect consequences of this NRC regulatory ratcheting. Essentially the same nuclear power plant costs about 2 1/2 times as much in the United States as in France and since projected costs for coal-burning electricity and nuclear electricity in the United States are about equal, this means that electricity will probably be twice as expensive in the United States as in Western Europe and Japan. This puts a direct bite on our standard of living. But more important, many economists believe that a large part of the reason for past U.S. economic success has been our relatively low cost of energy, so it is not unlikely that the reversal of that advantage will contribute substantially to our unemployment problems. It is estimated⁸ that a 1% increase in unemployment in the United States causes an extra 37,000 deaths per year, including about 20,000 from cardiovascular failures, 900 suicides, 650 homicides, and 500 deaths from alcohol-related cirrhosis of the liver. In addition to the deaths, it causes 4200 admissions to mental hospitals, and 3300 admissions to state prisons.

Returning to our principal theme, we see that our society is spending $2x10⁹/life saved from nuclear hazards while it could save a life for each $2x10⁵ spent on cancer screening or highway safety. This policy is clearly causing the needless loss of thousands of lives and the waste of billions of dollars every year. Why is this insanity taking place? It's easy to find out. Just ask the government officials who make these decisions. They tell you that the primary responsibility of a government official is to be responsive to public concern. In a democracy, that is the way it should be, we want our government to be responsive to our concerns. The problem is that public concern is driven by media coverage rather than by rational scientific analysis. The media have driven the public insane over the fear of radiation and of nuclear power accidents.

Why do the media do this? They are basically in the entertainment business. One point in the Nielsen rating for network evening news brings $11 million per year in increased advertising revenue. They must therefore do everything possible to attract an audience, and discussing hazards is much more useful for that purpose than discussing good, smooth, routine operation.

The entire problem can be viewed as one of natural selection, survival of those who adapt best to their environment. A TV producer who would value presenting problems in the proper perspective rather than emphasizing dangers to attract an audience would not survive, and a government official who would value doing what is right rather than being responsive to public concern would not survive. Laws of natural selection are hard to beat. But when the results lead to the needless deaths of many thousands of Americans every year, and to the impoverishment of our nation, we must do everything we can to try to beat them.

Pr. Bernard L. Cohen, Pittsburgh University, USA

http://www.phyast.pitt.edu/faculty/cohen.htm

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SOURCE : this article was initially published by "Physics and

Society", vol. 16, n° 3, july 1987.

Available on the internet :

http://www.ecolo.org/DOCS.WORD/cost_of_lives_saved.eng.doc

French translation by Michel Noraz / EFN, 1999 :

http://www.ecolo.org/DOCS.WORD/cout_des_vies_sauvees.fr.doc

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Physics and SOCIETY, Vol. 16, N° 3, July 1987