Equity saves lives

Clearly, advances in medicine and health care save lives. But not everyone has access to advanced medical procedures — or even basic health care — in America today. This leads to the following question: if you had a dollar to spend on health care, should you use it to advance medicine or should you use it to ensure that people have access to existing health care? How many lives would be saved if everyone had eual access to health care?

Steven Woolf of VCU answers this question in a recent article published in the April issue of the American Journal of Public Health (read the press release). He finds that between 1996 and 2002, “eight times as many lives could have been saved by eliminating the higher death rates experienced by Americans with inadequate education.” I found this number to be overwhelming and compelling, but sadly, few people seem interested in talking about it. It is compounded by the fact that nearly all research dollars for the medical field are spent to improve medicine, not to make sure medical resources are used “fairly.”

OR has the opportunity to make a difference here. Many OR applications optimize over the “expected value.” In other words, the solution is optimal on average, but there are some clear winners and losers in the solution. This does not take into account the real-world discrepencies in health care in America — the same groups of people always seem to come out ahead or behind. Looking at expected value isn’t “bad” as long as we understand that the expected value solution may not always be equitable and address the extremes in expected value models.