While there continues to be much attention paid to pandemics, that attention is now coming from a variety of different camps: from those who quote the lower overall flu death rate of the past year, to those who point out the high flu death rate among certain demographics (e.g., youth, infants), and a host of others in between.
Fri, 12/31/2010 - 7:00pm
In the spring of 2009, there certainly was a lot of talk about the issue – good, solid conversations that resulted in heightened awareness, improved hygiene, more robust internal HR practices, not to mention a new lens through which to view our continuity planning efforts. Fearing events as dramatic as the Spanish Flu of 1917-1918, alert levels were up, and the public and private sectors were working together more closely than ever before. Pandemic and H1N1 entered the mainstream dialogue becoming topics that were discussed as much at the breakfast table as in any healthcare forum. Without question, we are more conversant in the subject matter and better prepared as a result.
Before I continue, I feel like I should say that what you’re reading here is strictly the writer’s individual opinion and should not be interpreted as anything beyond that. Further, I am not cold-hearted about the subject. The fact is – individuals and their families were impacted, and that hits harder in the home than any metric in the news. But still, the broader view is the total societal impact of what we have seen.
Flu impact always has been measured in a somewhat straight-forward manner with a single metric: fatalities. Annually, flu kills approximately 250,000 to 500,000 people worldwide during a typical flu year and well over 1 million in a “pandemic” year. While the difficulty has been determining with some degree of precision the number of deaths attributable to flu (deaths are often attributable to pneumonia, respiratory failure, etc. with flu as a catalyst), using fatalities as a metric has never been in question. For an excellent perspective on the Spanish Flu, read John Barry’s tremendous book, “The Great Influenza: The Story of the Deadliest Pandemic in History.” Yet even with Barry’s correct claim of the Spanish Flu as the deadliest in history, the book stops short of listing a precise death count.
As of this writing, the World Health Organization (WHO) states that there were fewer than 20,000 confirmed deaths in the past year due to the H1N1 virus. Many would say that these numbers are ultra-conservative and that many more deaths are attributable to flu, but were never officially identified as such. I cannot argue that point, which is actually true during every flu season. However, the clear and obvious fact is that the level of flu fatality this past year is markedly lower than an average year and dramatically lower than a pandemic year.
Given the reduced fatality level, the impact argument seems to have shifted or morphed in some circles – from mere numbers of fatalities to the demographics of the dead. Today, demographics are at the forefront, even replacing fatality numbers themselves as the key issue.
The focus is now on the age of those impacted, with the concern being workforce or productivity losses. I find this focus to be fairly unsettling – as the first step on what could become a very slippery slope. In the process of gauging impact by measuring lost productivity, we have entered a world in which we determine the “value” of a life based on the ability to contribute over time to societal productivity gains. And in looking at the issue of impact through this lens, we fall into the trap of weighing one life against another – assessing that one life is “worth” more than another – based on age, translated into potential economic contribution in the workforce.
Stop for a second and think about the ramifications of such a perspective. Taken further, the number of available/remaining “productive” years would become a factor in determining the value of a given life. Decisions about who should receive limited medicine, food, medical assistance, etc. would be based on factors like age, education, and skill/trade. A glut of plumbers and a shortage of electricians may mean that we would opt to provide better access to medicine and care to the skill that is in short supply. Retired people could, in fact, be completely shut out when it comes to healthcare due to their “economic productivity status” – or more accurately, lack thereof.
Admittedly, I’m taking this to an extreme. But, history has, in fact, seen such a perspective at work – in ancient Sparta (and I am sure elsewhere). The Spartans were notorious for weeding out the sick and frail, leaving them to die since they could not make an effective or productive contribution to society (at least in their opinion). Grade school history brought us the stories of Spartan infants with handicaps or birth defects left in the mountains to die, rather than survive as a “drain” on society. Is tying societal impact of pandemic to lost productivity that much different? In doing so, aren’t we making value comparisons of one life versus another?
Even industrial society, with its focus on economic benefit and gain, does not hold up one life as more valuable than another. For example, look at company benefits such as health insur-ance. Health insurance is in place to protect the employees, their families and ultimately the firm, but the level of protection (typically) does not vary by title or level within the firm. The PPO or HMO offered to the director or vice president is the same option offered to the clerk because the “value” of life does not vary by level within the organization, and as a result the care offered is not tiered or segregated based on position.
With respect to H1N1, the good news is that the expected level of fatalities did not materialize. But there is a growing after-the-fact shift to raise this new impact flag centered on productivity impact.
This shift in perspective (from assessing known fatalities to assessing the productivity impact of these fatalities) is somewhat analogous to the development of user acceptance test (UAT) criteria for a process or software project. I have always been a firm believer that actual criteria need to be documented up front, as part of project requirements during the initial needs assessment and well before the actual work is underway. Otherwise, testing criteria will be developed by those who are closely associated with the work effort and with an eye toward what is actually being delivered and functional, rather than what was initially needed. We will ask ourselves questions to which we know the answers rather than asking those questions which are most relevant or critical. In this case, the user validation process becomes more of an exercise of blessing what was built rather than what was needed.
Shifting the argument of pandemic impact from fatalities to productivity, as a result of not seeing the anticipated level of fatalities, does the same thing – supporting a perspective that keeps the issue alive and in the forefront for no good reason except to do so and to benefit those associated with the effort. Like the old saying goes, “If the only tool you have is a hammer, everything looks like a nail.” Measurement and assessment criteria need to be defined, understood, and agreed in advance of the work to be undertaken. I thought we did that regarding pandemics – and that the agreed upon, understood measurement was fatalities.
My concern is that we were focusing on a given metric – fatalities – but that metric is now being reassessed and challenged based on the results. Right or wrong, fatality metrics have been the acknowledged and understood method for comparing health risks of all types, including driving, flying, disease, etc., and that metric has not failed us.
The fact is, this past flu season was milder overall than most – and resulted in fewer fatalities. And that is the goal, whether it is due to increased hygiene or a milder flu strain (or anything else). Please, call this past year a win and let’s not get sucked into the productivity impact argument. It is self-defeating. If you sold a remedy for treating an illness and the illness were actually prevented or eliminated such that you have no market, is that a good thing? Well, of course it is – maybe not to your firm but certainly to society as a whole. The worst thing you can do is continue to beat the drum for what was your valuable product but is now nothing more than a placebo. In other words, put away the hammer.
Applying this to the H1N1 scare, we didn’t do the equivalent of yelling “fire” in a crowded theater, but we did raise the issue in anticipation of a much more significant impact. And while we are all proud of our preparedness and thankful for this impact not materializing, we should not, as a community, defend our reaction by shifting the impact measurement to meet our goals. Once you cry wolf, the worst thing you can do is rationalize that it was not an actual wolf while you keep crying.
So, why the title, “Logan’s Run”? Well, those of us who grew up in the 1970s will certainly recall one of the most memorable movies of that era, Logan’s Run (1976). This futuristic movie centers on an idyllic society where everyone lives a happy and carefree life until the age of 30, upon which your life is terminated. It is this age-based constraint on societal resource consumption that allows the happy and carefree life to exist until that age. While we are, thankfully, a very long way from euthanizing those not in the labor force, it does apply to how we assess the “value” of a life.
To close this out on a more personal note, my grandparents both died in the Spanish Flu epidemic of 1917-1918, leaving my Dad in an orphanage. I bet he never gave a thought to the loss of productivity or the societal value lost, only to the impact of the fatalities. CI
Mark Carroll is the former vice president of business continuity for enterprise operations at Fidelity. During his Fidelity tenure, in addition to BCP, he had responsibility for risk management in the areas of records, vendor risk, and technology risk. Prior to this, Carroll served as director of global business continuity for Procter & Gamble with responsibility for Gillette business continuity plans worldwide. Carroll also held the position of director of worldwide IT audit with Gillette. He holds certifications at the highest levels in the industry including business continuity (MBCP and FBCI),information security (CISSP), IS audit (CISA), IT governance (CGEIT), project management (PMP), integrated resource management (CIRM), and production and inventory management (CPIM). Additionally, he is a Six Sigma green belt. Carroll is a regular speaker at industry conferences and is on the Continuity Insights editorial advisory board. He is a graduate-level instructor in risk and organizational continuity at Boston University and serves as faculty coordinator and key architect of the University’s graduate program in business continuity, security and risk management. He is also the 2010 recipient of the University’s Deveau award for teaching excellence. Carroll is a magna cum laude graduate of Boston College with undergraduate degrees in both economics and political science. He has an MBA in finance from Babson College. He can be reached at email@example.com.