Can Health be Measured?
The obvious answer is that we can, of course, find a way to measure
gains and losses in health; only the will to do so is lacking. In order to
measure subtle changes in health a good reporting and recording
system is needed, together with protection of privacy for the individual
and ongoing biostatistical analysis of the accumulated data. Whole
bodies of statistical theory, such as sequential analysis, used for
product quality control, and system analysis, used to predict the
outcome of a complicated interaction between interdependent
variables, need to be used in the public health sector. This could
provide a public health technology capable of managing military and
industrial technology, able to act as a reality check on predictions and
to give an early warning of dangers arising from within the big-system
and threatening survival of the nation or, indeed, the human
race. Biostatistical detection of problems needs to be followed by
pathological, cytological and other confirmatory studies. No such
serious systematic commitment to public health is evident relative to
this nuclear issue anywhere in the world. Governments seem unaware
that economic and military policies can
be destructive of human health within the nation.
The
radiation issue is further confused by statisticians and public
health specialists who claim that there are some inherent and
insurmountable problems which make it impossible to monitor the
public health effects of
pollution.[38]
These professionals seem to limit
themselves, consciously or unconsciously, to current inadequate data
collection systems and mathematical tools. This is like deciding that
it is impossible to travel to the moon on the basis that the only
transportation possible is a commercial airliner. It will very probably
require grass-roots scientific initiatives to cause governments to begin
to act as strongly in protection of public health as they act to promote
their own economic and military strategies.
Many
people have become aware that national security strategies,
especially nuclear weapon stockpiling, are increasing individual
insecurity. Capital-intensive national economic strategies, designed to
balance import/export dollar flow, can cause havoc with the
individual citizen who is having to cope with the side effects of
inflation and unemployment. Government neglect of health monitoring
relative to economic and military strategies is, however, not yet
perceived by the public as a serious problem.
It
should be obvious that pollution of the environment with fission
products will cause a wide variety of physiological changes in people
exposed to them. There is little disagreement among scientists with
regard to this conclusion.
There
is also little controversy about the tragedy caused by
uncontrolled fission -- whether deliberately or accidentally unleashed,
whether from a nuclear reactor accident or an exploding warhead.
The
question which causes controversy is: which health effects
should be recognised as important for fiscal planning? `Important' may
relate to public acceptance of the problem, or to the money which
must be paid out for damage compensation, or the productive years
lost through premature disability or death of workers. Once the
significant health effects are identified, then quantification of these
effects becomes the primary societal goal. This gives rise to scientific
controversies. Present scientific controversy on low level radiation has
to do with estimating the number of radiation-induced `excess cancer
deaths' that are related to a given dose of ionising radiation. Fiscal
concern has centered on radiation-induced excess cancers, and
scientific concern on predicting this outcome.
These
excess cancer numbers are important to planners who wish
to show that their development schemes are less harmful than an
alternative scheme. They are important to government officials who
have to decide whether or not to assume the financial burden of
ordering evacuation of a danger zone in a reactor accident like that at
Three Mile Island. They are important to insurance companies, since
they allow calculation of theoretical liability due to an accident. They
are important to legislators who need to balance risks (deaths) against
some military or economic benefit. They are important to strategic
planners who calculate `collateral damage', i.e. the number of human
deaths, after an atomic attack.
These
numbers of specifically selected health effects, `radiation-induced
excess cancer fatalities', predicted on the basis of the `average man's'
reaction to a given average dose of ionising radiation, are of little
meaningful use to individuals. Firstly, no one is really
an `average man'. Also, populations may vary in the proportion of
people with above-average susceptibility to radiation
damage. Secondly, a `radiation-induced excess cancer fatality' is
one of the least likely of the health problems to occur with exposure
to low level radiation. More likely scenarios are radiation
acceleration of a cancer caused by some other factor, such as cigarette
smoking[b],
earlier clinical expression of cancer, benign tumours, or
related non-malignant health problems. Thirdly, even if the individual has a
cancer it is almost impossible to present evidence to prove that his or
her cancer is the excess one which would not have occurred without the
radiation exposure. Therefore compensation for damage is almost impossible
to obtain. Only one veteran from the USA exposed to radiation in its nuclear
bomb programme has ever received compensation: Orvile Kelly. About six
months before he died the Veterans Administration admitted that his illness
could be attributed to radiation exposure. About 1,000 veteran claims have
been refused.[39]
The
usual `rational' approach to risk versus benefit planning by
governments is irrational from the point of view of the individual. It
undermines the individual's ability to control and understand his or her
environment and to hold government accountable to its electorate.
The
human body is delicately fashioned and the unique gifts of
each person are meant to enrich the human family. Crude
quantification of random damage to people which is used to justify
political or military gains of the nation may be labelled sophisticated
barbarianism. It is the decadent thinking of those who have accepted
the rule of force and who envision a future earth ruled by a powerful
country (the USA or the USSR) with a monopoly of weapons of mass
destruction, able to terrorise all other nations into co-operating with
some form of global economy and resource-sharing of their choosing.
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