Saturday, January 6, 2018

To Eradicate or to Manage?

I am lucky that the American Economic Association annual meetings are in my city this year, so I made it easily to the sessions despite the snow and bitter cold. On Saturday, January 6, I attended an excellent 8 a.m. session on central bank communication. I may write more about the session later—I already tweeted some of it—but for now I wanted to share an interesting aside made by Alan Blinder. He said something like, “In life, some problems are solved and some are managed.

The context for his remark was his prediction that cacophony will remain a problem for communication by central bank committees. He asserted that this is a problem that will never go away; we can never hope to solve it, only to manage it. Here’s Blinder’s example of how cacophony can be managed:
This made me wonder which other problems (economic or otherwise) fall into the “solvable” versus “manageable” categories. This taxonomy seems more natural in public health. In fact, a CDC report discusses a “hierarchy of possible public health interventions in dealing with infectious diseases,” which runs along the gradient from manage to solve: control, elimination of disease, elimination of infections, eradication, and extinction.

The report notes that in 1993, the International Task Forcefor Disease Eradication evaluated 80 infectious diseases and determined that 6 were potentially eradicable. The potential for eradication depends on biological, societal, and political criteria. Biological criteria for eradicability can change with technological innovation.

The categorization of a disease along the hierarchy is a weighty one, as “Health resources are limited and resources cross sectors. Therefore, decisions have to be made as to whether the use of resources for an elimination or eradication programme is preferable to their use in nonhealth projects, in alternative health interventions, in continued control of the condition, or even in the eradication of other eradicable conditions.” A failed eradication attempt can come at tremendous costs to credibility and resources. The decision to attempt an eradication effort should depend on careful and broad cost-benefit analysis and consideration of the numerous stakeholders:

“Consensus on the priority and justification for [eradication] must be developed by technical experts, the decision-makers, and the scientific community. Political commitment must be gained at the highest levels, following informed discussion at regional and local levels….Eradication requires an effective alliance with all potential collaborators and partners…The eradication programme must address the issues of equity and be supportive of broaer goalss that have a positive impact on the health infrastructure…should also take into consideration the ideal sequencing of potentially concurrent campaigns.”

The approaches that policymakers and researchers take to public health problems depend on whether they have categorized the problem as one to be eradicated or to be managed. It seems like this should be true of other economic and social problems too, and I wonder if people are thinking about things like homelessness, discrimination, poverty, asset bubbles, etc. in this way. Or even if conflicting views on whether these types of problems are feasible and worthy of eradication are at some fundamental level responsible for conflicts over the appropriate course of action. Food for thought.

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    It's nice to see you still have some time for blogging. I have, sadly, less and less. What Binder says is really very profound and important. A big area where I saw it more and more was foreign policy. Of course, it would be a great achievement to end terrorism, but trying to do so could result extra terrible wars and trillions in cost which could have been spent to do far more good. Unfortunately, terrorism, like crime, is something we may not be able to eradicate completely for a while, but which we can really contain and dramatically minimize by smart and brave efforts.

    Another example is the Soviet Union; we contained them successfully when this was the best option, and eventually the threat was ended (although a new one arose; no need to get into that.) But with the Nazi's, on the other hand, containment was much too costly and not really possible, and it was absolutely best to defeat them completely, even at the cost of World War II.

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