The Normalization of Covid: Another example of how America is perversely pro-risk

A million souls and counting.

The response of the United States to Covid has been a disaster.  Whether one judges by deaths or by the number of cases, it doesn’t matter.  We failed.  And to add insult to injury, relative to other high-income nations, we failed even more miserably when the Omicron wave struck.  From The NY Times:

The United States has seen more death from Covid than other high-income countries, either in total or per capita, including our close neighbor, Canada.  This fact hasn’t gone unnoticed in the press.  “The U.S. Failed Miserably on COVID-19. Canada Shows It Didn’t Have to Be That Way,” (Time, May, 2022):

646,970 lives.

This is the number of Americans who would be alive today if the United States had the same per capita death rate from COVID-19 as our northern neighbor, Canada.

Reflect for a moment on the sheer magnitude of the lives lost. 646,970 is more than the entire population of Detroit. And it is more than the total number of American lives lost in World War I, World War II, and Vietnam combined.*

There is no one answer regarding why we failed so miserably, although singling out our “free market”—let’s get everyone back to work asap—economy would be a good place to start.  But one factor has been overlooked too often, namely, our perverse attitude toward risk, which has allowed people to rationalize behaviors that are potentially dangerous to themselves and others.

Americans have a love affair with risk.  Or more accurately, a love affair with the idea of risk-taking, whatever their personal comfort levels may be with risk.**  We regularly use it to help explain success.  An obvious example: admired entrepreneurs.  One of their key assets (no pun intended) we are told is their willingness to take risks.  In fact, we are incessantly reminded, “He deserves his wealth.  He was willing to take risks.”***  Then there are the Wall Street traders who are also willing to take risks (“risk-on” in the lingo), and hence deserve the financial rewards of their trades.  How about the so-called conquest of the West?  It was a job for a man’s man, no doubt.  A courageous risk-taker willing to launch himself into unknown territories and face unknown threats.  (Okay, we will leave aside the fact that the West was settled primarily by individuals and families seeking to eke out a living.)

We could add other examples, but the bottom line would still be the same: Americans are often quite happy and eager to attribute their success or the success of others, at least in part, to a willingness to take risks.

However, many Americans (often those in positions of power) are less willing, or simply unwilling, to face the fact that they continually expose their fellow Americans to unreasonable risks.  They often justify or rationalize unnecessary risks by pointing out that life entails risk, that we must learn to live with risk, making it sound as if the level of risk we experience is part of the human condition. But other high-income nations simply do not subject their citizens to as much risk.  If one looks at the risk of death that we are prepared to accept in different contexts, America looks increasingly like it has a pathological relationship to risk.  We actually have a two-fold problem: 1) risk-taking is often mythologized and 2) we fail to address circumstances that increase the risk of injury and death.

Imagine for a moment that insurance companies evaluate entire nations regarding their risk profiles in order to insure them, as life insurance companies do with individuals.  Dollars to donuts, given the amount of risk (leading to death) that we tolerate, our premium as a nation would be higher than other high-income countries.  Notice that I said “as a nation” because Americans typically see risks in personal terms, not in terms of society as a whole.  This can lead to disastrous mistakes.  Take Covid, for example.  We needed to be “all for one and one for all,” and instead we heard, “Oh, not to worry, there isn’t much risk to me personally.”  Cost/benefit analysis, first and foremost in individual terms: The American Way.

America has tolerated high death rates in comparison to other high-income nations, which undoubtedly would affect our nation’s imaginary premium.  Here are a few examples of high death rates—in addition to the Covid catastrophe—that might affect America’s premium.  But first a caveat.

I am not claiming that the attitude of many Americans toward risk is the sole or even the main cause of excessive deaths.  There are clearly multiple forces at work.  I am suggesting that our relationship to risk helps us rationalize, and anesthetizes us to, the unacceptable.  It goes without saying that if most Americans could wave a magic wand and decrease excessive deaths, they certainly would.  The problem here is that while we talk about reducing the carnage, we can’t make it happen.  And another, and another, and another generation of Americans grow up being told, “don’t do what we do, do what we say.”  But we keep doing it.  This is the world they inherit.  It is the world that greeted Covid.  It is the world that currently ignores close to 500 Covid deaths a day.  

Traffic deaths:

The global report from the World Health Organization — which reviewed laws and crashes in 175 nations — explains that U.S.’s traffic fatality rate is 12.4 deaths per 100,000 — or about 50 percent higher than similar nations in Western Europe, plus Canada, Australia and Japan.  (STREETSBLOG USA, December, 2018)

NHTSA projects that an estimated 42,915 people died in motor vehicle traffic crashes last year, a 10.5% increase from the 38,824 fatalities in 2020.  (NHTSA, May, 2022.)

The fact that we drive more miles doesn’t pan out as an excuse for the carnage on our roads.****  Take Canada once again, also a very large country, right next door.

The death rate on Canadian roadways is less than half that of the United States — 5.2 per 100,000 residents versus 11.6 here — and even accounting for the fewer miles driven by the average Canuck compared to John Doe, Canada has 43 percent fewer traffic fatalities per billion kilometers traveled.

If America was more like Canada, about 22,000 lives would have been saved last year, according to the International Transport Forum [PDF].  “Here’s Why Canada’s Traffic Safety Record Is Better Than Ours” (STREETSBLOG USA, August, 2018.)

Maternal Mortality:

We have by far the highest rate of maternal mortality among high-income nations, according to “Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries.”  (Emphasis and chart in the original.)

Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth.

In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries (Exhibit 1). In contrast, the maternal mortality ratio was three per 100,000 or fewer in in the Netherlands, Norway, and New Zealand.

Guns and Murder:

We all know that deaths by firearms in America far exceed other high-income countries.*****  But how does our total murder rate, not only with firearms, compare to other high-income countries?

The homicide rate in the US was 7.5 times higher than the homicide rate in the other high-income countries combined, which was largely attributable to a firearm homicide rate that was 24.9 times higher. (“Violent death rates in the US compared to those of the other high-income countries,” published 2019, data from 2015.)

7.5 times!  What is there left to say?

Well, gun enthusiasts might reply that using high-income countries as a comparison is unfair, because we do better in relationship to poorer countries on this metric, and the definition of high-income has wiggle room.  But once again Canada can help us out here.  It is clearly a high-income country, of similar geographical size to the U.S., with a long shared border, mostly speaking the same language, with a large immigrant population.  (Canada’s immigrant population stands at 21.5% in 2021. In the United States it was 13.7% in 2019.)

There were roughly five homicides in the U.S. in 2019 and 1.95 homicides in Canada per 100,000 residents in 2020  (Statista, 2021).

The homicide rate in the U.S. is approximately 2 1/2 times that of Canada.  (Houston, we still have a problem!).

Given the extent to which America tolerates death and injury in other situations, our response to Covid should come as no surprise.  Currently there are about 500 Americans dying daily from Covid, and what we hear is pretty much, well, nothing.  Actually not nothing.  We hear crickets chirping away about personal responsibility, getting back to normal, and a willingness to take risks. (Notice that some in society, the poorer and necessary workers, are asked to take more risks for less reward. And when they protest, they too hear, “Well, you know, life is full of risks.”)

Why do we tolerate risks that other high-income countries do not?  The answer(s), I’m afraid, would require a book—or several.  There is a undoubtedly a connection between our willingness to live with unnecessary risk and a “free market” economy that consistently applauds risk-takers.  We treat successful risk-takers as rock stars. “Hey, kid, you can’t make big bucks without taking risks, right?” This mentality feeds into the notion that those willing to take risks are going be the big winners. They can then pat themselves on the back.  They had the guts to succeed.  Risk is a good thing.

When we point out that there is a downside to living with risk, we typically will be ignored, because, after all, risk is a good thing, and even if not always good, a natural part of life.  “Live with it!”  But those pushing this line are encouraging a perverse level of risk.  Their judgment has been warped.  They have been socialized into believing that these higher levels of risk are normal.  So, instead of “one for all and all for one” in a public health crisis, we end up getting our wires crossed.  We end up treating a public health risk as a risk to be borne by individuals, not by government or society.  After all, isn’t shouldering risk on one’s own The American Way?

__________________

*The article goes on to point out:

For the many Americans influenced by the powerful libertarian strand in American culture and by its elaborate right-wing media apparatus, masks were a violation of freedom and vaccines a form of tyranny. Canada, which produced a trucker convoy that shut down the nation’s capital, is not immune to such sentiments. But they were far more pervasive in the U.S. and led to a degree of non-compliance with the government and public health officials that had no parallel in Canada; to take but one example, the percent of Canadians wearing masks in January 2022 when the Omicron variant was at its height was 80 percent compared to just 50 percent in the U.S.

** I added this sentence (8/14/22) to avoid possible misunderstandings.  Individual Americans may or may not be as willing to take as much risk as their counterparts in other countries, but I am referring in this post to how we speak and think about risk-taking, and how we collectively respond.  Paradoxically, individuals in countries that are less individualistic, and have more collective support for their citizens, may find that individuals are willing to take more risks (in certain situations), presumably because they have social safety nets to help catch them. This is the so-called “cushion hypothesis,” and it is still being discussed.  For example,

*** We will mercifully leave aside the advantages that many highly successful could take for granted: they started off by inheriting capital, went to the right schools, or they moved in the right circles, etc.

**** UPDATE:  On September 1, 2022 the Governor’s Highway Safety Association published a news release, “Rural Roads Are Disproportionately Deadly, New GHSA Study Finds,” in which we learn, “In 2020, the risk of dying in a crash was 62% higher on a rural road compared to an urban road for the same trip length.”  This speaks to the claim that the high US fatalities can be accounted for simply by miles traveled.  Here we see that the same number of miles traveled, right here in the US, leads to more fatalities on rural roads, so there must be reasons other than miles traveled to account for this difference.

The high rate of crashes on rural roads is caused by several factors, including lack of safety resources, simpler roadway infrastructure, poor emergency medical services and to a significant extent, risky driver behaviors. The biggest culprits are not wearing a seat belt, impaired driving, speeding and distraction.

If rural areas were more like urban areas in the US, presumably we would have fewer fatalities, so this problem can’t be dismissed by only focusing on how much Americans drive.  This is to say, our problem can not simply be chalked up to miles traveled.  It’s clearly more complicated.  Of course, the fact that we travel so many miles in cars is an issue.  Public transportation is much safer.  More travel using it would save lives.

Here’s a chart comparing urban and rural fatalities for the same number of miles driven.

*****Our penchant for death by firearms is well-known, but here is something that is less well-known, namely, deaths of children by guns:

We find that the United States is alone among peer nations in the number of child firearm deaths. In no other similarly large or wealthy country are firearm deaths in the top 4 causes of mortality let alone the number 1 cause of death among children.  “Child and Teen Firearm Mortality in the U.S. and Peer Countries,”  (Global Health Policy, 2022).

____________________

Photo by Win McNamee/Getty Images, NBC Washington, September, 2020.  (Photo cropped at the margins for this post)