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Key points
- We often overestimate dangers that are unlikely to harm us while underestimating those that pose a threat.
- Different people can encounter the same risk and take different actions because it is our values that determine what we do with data.
- To risk nothing is, in many ways, the biggest risk of all—the risk of looking back on a life that was not fully lived.
Risk is at the heart of the choices we make about how to support the health of populations. We are constantly weighing how we can best reduce the risk of disease and harm. During COVID-19, risk was central to the debates we had and the actions we took. In the face of a novel pathogen, we worked to minimize risk through measures we hoped would keep us safe. And this, as we now well know, led to substantial public discussion and debate about what risks we were, or were not, willing to take. This is what brings me, in part, to musing today about risk.
The Science of Risk
We begin with the science of risk. The science of risk reflects what risk actually is—what the data say about the likelihood of a given harm. We need to be clear about these data so that our thinking about risk is based on an accurate understanding of what poses a threat to the health of populations and what does not.
The challenge to this is that we frequently misunderstand risk. In particular, we have a hard time gauging risk across various potential causes of harm, often overestimating dangers that are, in reality, highly unlikely to harm us, while underestimating—or, at least, rarely thinking about—dangers that genuinely pose a threat. For example, flying is by far the safest form of travel. The odds of dying in a plane crash are about one in 11 million. Meanwhile, the odds of dying in a motor vehicle crash are about one in 93. Yet, each day, millions of people get into their cars without a second thought, while about one in three Americans are anxious about flying.
Or consider the odds of dying from heart disease and cancer—one in six and one in seven, respectively. These odds reflect a risk far greater than risk of death from other hazards, including death by drowning (one in 1,006); death from fire or smoke (one in 1,287); death from electrocution, radiation, extreme temperatures, and pressure (one in 13,176); death from a cataclysmic storm (one in 20,098); death from dog attack (one in 53,843); or death from lightning (according to the National Safety Council, there were too few deaths from this in 2021 to calculate the odds).
Yet, while most people do indeed fear cancer and heart disease, many have feared equally, if not more, any number of these other, far less likely hazards. I have written previously about how feelings shape our decision-making process, often crowding out our more rational considerations. When weighing risks, how we feel can matter as much as what we know, and sometimes more.
All this speaks to the importance of ensuring our engagement with risk is based on a solid understanding of the data. We in public health must be clear-eyed about what genuinely poses a threat to the health of populations, looking at risk dispassionately, guided by our science.
Understanding the Consequences of Our Choices
Then there is the second element of our engagement with risk: our understanding of the consequences of the choices we make about risk. Because risk itself is simply data. What we do with these data is shaped by how we weigh what will happen if we do or do not take steps to mitigate risk.
Consequence is shaped by two factors—first, by the support structures we build to mitigate risk. Imagine two cities of the same size, both of which are struck by an 8.0-scale earthquake. In one city, the death toll is 5,000. In the other city, it is 20,000. Each city was built on the same fault line. Why the difference in death toll? The reason is that the first city had building codes that were shaped with earthquake risk in mind, to ensure the city was as prepared as possible for the worst-case scenario. The second city made no such preparations and suffered the consequences.
Our willingness to make such preparations in the face of risk can prove decisive. This willingness, however, is not just a matter of data alone. Why, for example, did one city prepare and the other did not? Perhaps the city that did not experienced terrible poverty and would have had to divert funds from programs for people living with homelessness to build the necessary earthquake-resistant infrastructure. Perhaps it was a city that valued beauty and felt earthquake-resistant buildings would have been too ugly.
Both cities understood there was a risk, but each city had different values that shaped its priorities in the face of this risk. For one city, the risk of a terrible earthquake happening sometime in the century was enough to motivate action, and they had the means to do so. For the other, the lens of values meant the citizens saw the situation differently. This reflects the second factor that shapes consequence: values. Different people can encounter the same risk and take different actions because, ultimately, it is our values that determine what we do with data. It is not just the odds that matter. It is about how we feel, what we value.
What Health Is For
This brings us to the heart of our engagement with risk, one that animates all we do in public health: What is health for? I have always believed the answer to be that health is for enabling us to live rich, full lives. As individuals, most of us recognize that rich, full lives always entail some measure of risk. To risk nothing is to do nothing, to love nothing, to believe nothing. It has also been observed by many that to risk nothing is, in many ways, the biggest risk of all—the risk of looking back on a life that was not fully lived.
As individuals, we grasp this. As a field, however, we do not always apply this insight to our engagement with policy. Instead, public health has tended to engage in binary conversations about whether to adopt broad policies geared toward the elimination rather than the mitigation of risk. How we philosophically understand health, then, shapes how we view the consequences of risk. We need to deepen this understanding, to view risk through the lens of the philosophical foundations of our field, the heart of why we do what we do.
A version of this post also appears on Substack.
