The High Cost of Premature Death
Here at the Partner Up! for Public Health campaign, we’re always looking for ways to illustrate the high cost of poor health. Recently we began to study the mountains of public health and economic data we’ve collected to see if we could develop a reasonable methodology for putting a price tag on premature death in Georgia.
This is not a new idea, but most of the studies and reports we’ve found rely on complex formulas that most of us can’t understand and produce results that people have trouble relating to. Truth is, those are easy traps to fall into; it’s difficult to deal with data without dealing with data. One formula we found looked like this:
Sorry, not going there. Couldn’t if we wanted to. But after a couple of hours of sifting through the numbers, we came up with an approach we think makes the point in terms most people should be able to wrap their brains around.
As a starting point, it’s worth noting that we’re working with concrete county-level data compiled by the Georgia Department of Public Health and available through its Online Analytical Statistical Information System, aka OASIS, at http://oasis.state.ga.us/oasis/.
Specifically, we know how many people died in every county in Georgia in any given year up through 2010, by age group.
We know what percentage of the county population they comprised, also by age group.
And, because we know how old they were when they died, we can calculate premature death rates and, on average, how far short of age 75 people in each county are falling.
And, from a separate database maintained by the Georgia Department of Community Affairs, we know the average per capita income for each county.
We figured we could stir all that data together to play what-if and develop a reasonable estimate of county-level gains or losses if counties saw either improvements or deterioration in their death rates.
Here’s how it works. In 2010, just over one-half of one percent of adult Georgians (between 20 and 74) died — 34,201 out of a total 6,504,219 men and women. The exact portion was .53 percent.
Only 31 counties beat the state average; most are large and urban. Gwinnett County, for example, has much better results. Only .32 percent of its adult population died in 2010 – 1,708 out of 531,803 men and women between the ages of 20 and 74.
But what if Gwinnett’s death rate had only matched the state average of .53 percent? At that rate, another 1,111 Gwinnett adults would have died that year.
The latest data used by the Georgia Department of Community Affairs to rank Georgia’s counties economically puts Gwinnett’s per capita income at $32,612.67. Multiply that number by the additional 1,111 Gwinnett adults who would have died that year if Gwinnett had only performed at the state average and you get a total of $36.2 million in additional lost income.
But that’s not the end of it. A lot of those people died prematurely. What if they had all lived to the ripe of old age of 75? That’s the hypothetical end-of-life age that public health professionals use to compare premature death rates from one community to another. One of the statistical datasets maintained by DPH is what’s called YPLL 75, for Years of Potential Life Lost before 75.
Based on that data, if the Gwinnett County adults who died in 2010 had all lived to age 75, they would have lived an average of 17.77 years more each.
Let’s apply that number to the extra 1,111 who would have died at the state average and calculate the lost earnings over time: 17.77 x $36,218,189.38 = $643,487,807.36. That’s how much more in gross domestic product Gwinnett County would have lost over what might have been the lifetime of the 1,111 souls who would have died at the higher state average (and that’s without attempting to adjust for CPI or anything else).
Now what if, instead of looking at Gwinnett and other counties that outperform the state average, we look at the underperformers? What would happen if we could bring them up to the state average?
Some 128 of Georgia’s 159 counties lag the state average, the vast majority of them small and rural. The worst is tiny Warren County, located not far from Augusta in east central Georgia. There, a whopping 1.33 percent of its adult population died in 2010 – 51 people altogether. At the state average of .53 percent, only 20 people would have died; 31 more would have survived, and at Warren County’s average per capita income of $25,433.33, you could have had a one-year gain of more than $780,000. Factor in the average YPLL 75 rate for Warren County adults in 2010 (15.8 years per adult) and you get a potential gain over time of $12.4 million.
In the grand scheme of things in a state as big as Georgia, that’s not a lot of money. But let’s look at the totals for all the counties that lag the state average. Do the math for all 128 of those below-average counties and you get a one-year loss of nearly $125 million and a lifetime loss of $1.9 billion.
And, of course, this illustration just looks at one year and how its deaths ripple out over the YPLL time horizon. To build a really comprehensive picture, you need to do this math across a broader time horizon and calculate the year-over-year totals as they pile up on one another. Before long, you’re talking about real money.
As with any analysis, this one comes with caveats. It’s always possible that one of our hypothetical victims in economically vibrant Gwinnett County would have been replaced by somebody else and that you wouldn’t suffer any real loss in cumulative income or productivity (although the individual families of the victims certainly would). And it’s equally possible that in poverty-stricken Warren County the local economy wouldn’t be capable of supporting the 31 extra survivors.
All in all, though, it’s difficult to study the relationships between economics and health and avoid a conclusion that premature death comes with a high price tag – or that it’s the living that have to pick up the tab.