Building New York: Putting Health Risks in Perspective

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The Regency Hotel Ballroom
540 Park Avenue
New York, New York

Remarks presented by ACSH President Dr. Elizabeth M. Whelan at a special conference convened by Secretary Andrew Cuomo.

Good Morning. I am delighted to offer you some brief comments on the topic of putting health risks in perspective. I do so from the point of view of an epidemiologist, which as you know is a specialty focused on the study of the cause and distribution of human disease. We epidemiologists start with a basic premise: that those of us who put our health in daily jeopardy and those of us who make health top priority have exactly the same mortality rate: 100%. The difference is in the timing. It is the goal of an epidemiologist to teach people how to die young at a very old age.

The key to successful preventive medicine is setting intelligent priorities, worrying about the real things, not the phantom risks. I would like to briefly look at health priorities first pre-September 11 priorities, then post-terrorism priorities.

What threatens our prospects of long life and good health? I'll give you some ballpark numbers to think about.

Just over two million deaths occur in the United States each year Public health experts estimate that about one million of them are preventable in the sense they are postponeable.

what accounts for those one million premature deaths?

500,000 are due to the use of tobacco, primarily in the form of cigarette smoking. It is remarkable how just one lifestyle factor accounts for twenty-five percent of all deaths and fifty percent of those that are preventable. This is particularly remarkable because many people do not realize how relatively new the cigarette is in our society. While tobacco was the first crop of our fledgling nation, cigarettes did not come on the scene in any commercially viable way until just before World War I.

100,000 are due to misuse and abuse of alcohol. Including about 15,000 alcohol related deaths on the highway. Unlike tobacco use, there is a positive public health facet of alcohol use-when consumed in moderation. The latest estimate being that if all Americans stopped drinking there would be an additional 80,000 premature deaths due to heart disease.

There are other significant causes of premature death, but smaller numbers, which have not been quantified as specifically as tobacco and alcohol. These include:

poor diet, obesity, failure to consume a balanced, varied, moderate diet with generous servings of fruits and vegetables.

failure to use available life saving technology, such as seat belts, helmets and smoke detectors.

failure to use life saving screening tests, for example to detect hypertension and early forms of cancer especially the largely preventable thousands of colon cancer deaths each year.

overexposure to sunlight.

other risky lifestyle factors, including unprotected sex.

And what are the hypothetical risks some may call them phantom risks? Here are a few which might seem controversial to some of you, but I can state as a fact that there is no evidence that any American has ever died from:

exposure to traces of PCBs in the Hudson River.

dioxin in paper towels.

the regulated , approved use of any pesticide.

trace levels of arsenic in drinking water in the United States.

Now to post-September health priorities. Have they changed? No at least not much.

The big killers are still killing us.

We face anthrax not a hypothetical risk to be sure because we have seen nearly 20 cases, and witnessed 4 deaths. But in terms of perspective, the risk for any individual in the U.S. is at this point, very, very low.

Is it possible that there could be a massive, widespread, lethal distribution of anthrax?

Theoretically, yes. But it is unlikely.

Anthrax spores, when inhaled in sufficient quantity, can cause fatalities days or weeks later, as we have seen. But the skill required to get the spores into condition to be widely dispersed is not easily obtained. They have to be of a certain size, electrostatically neutral, and weather conditions would have to be nearly idea.

So what about smallpox?

The last time the disease was seen in nature was in 1977. And as far as we know we have since eradicated it. There is speculation that terrorists have stolen the virus, but there is no hard evidence of this. Should smallpox appear, even one case would be considered an epidemic, a global catastrophe. But we have systems in place for dealing with it. We understand the specifics of its contagious period about the 12th day after infection, when the person is very ill, spiked fever, characteristic rash. We have protocols for dealing with such a catastrophe which include isolation, vaccination of persons who have come in contact with the patient (vaccination conveys a degree of protection from the disease even after infection), case contact follow-up, perhaps use of new antiviral drugs.

In 1947, here in New York City, we had an outbreak of smallpox. A businessman arrived from Mexico, shortly became very ill, was hospitalized, and infected two other patients before he was finally diagnosed. Using standard public health techniques and a program to vaccinate 6 million New Yorkers in the course of a month this outbreak resulted in only 12 new cases and 2 deaths.

The real danger here is fear and panic and spending so much time worrying about small, or hypothetical risks, that we overlook the real killers. Consider the mother who is so concerned about biowarfare that she does not put a seat belt on her child in a taxi, or rationalizes smoking as a means of coping with a hypothetical risk.

This is not to say we should not be prepared for the unexpected. We should be but panic and hyperbolizing about hypothetical risks not only gives the terrorists what they want disruption of our lives but it puts our very lives in danger as we continue to ignore the real, although oh-so-familiar risks while in hot pursuit of the unfamiliar, temporarily exotic ones.