How much is a nice Christmas lunch with your family worth? Can you ever measure the moments that make life memorable? Well, here’s a way to think about how much value you see in that plate of turkey: how many human deaths are you happy to accept in exchange for it?
The UK’s various authorities have agreed to relax Covid-19 restrictions for five days over Christmas. The result will be that some people will die who would not otherwise have died.
I don’t say this as criticism — either of the policy, the people who made it, or the people who will make use of it. Because there’s actually nothing unusual about a policy choice to accept some deaths in exchange for something else. Policy decisions that kill people are made all the time. Which is why we need to get better, and more honest, about the process of deciding when to let people die.
How much is a human life worth? Philosophers and theologians would give answers in words. Civil servants and — though they never say so explicitly — politicians have a simpler answer: £1.6 million.
That is the current Value of a Prevented Fatality, according to Her Majesty’s Treasury. This is not, technically, the value of a single life. It’s just the maximum sum that HMT says is worth spending to avert a death that would otherwise take place. The figure exists to help officials and politicians decide whether any given policy is justified by the lives it would save — and, by implication, to decide when deaths are acceptable because it would cost too much to prevent them.
That figure of £1.6 million is potentially hugely important. It is baked into all sorts of choices, made by government and the private sector — which transport safety improvements are justified, for example, or how much money to spend reducing the chances of nuclear power stations blowing up. But there’s a tiny problem with that “VPF” figure. It’s nonsense.
The VPF is essentially based on some numbers plucked out of the air by a few dozen random members of the public in 1997; 167 members of the public, to be precise. They were responding to the Carthy Study, which asked how much they thought it was worth paying to prevent a minor and then major injuries. The Carthy authors calculated each respondents’ implied answer about the value of a death prevented. Then they averaged out the results and came to the remarkably neat figure of £1 million, which has subsequently grown with inflation.
And according to some academics, it’s far too low. Professor Phillip Thomas of Bristol University reckons it should be between £16 million and £22 million. If that’s even vaguely accurate, we’ve been spending far less on making safe reactors and railways than we need to in order to reflect the value people actually place on the lives of their fellow citizens.
But the trouble is, this is a crude measure that takes no account of the differences between people. Have you ever wondered why the accidental deaths of children get much more media coverage than the comparable deaths of adults? Of course you haven’t: we all instinctively recognise that there is something more viscerally upsetting about the passing of a child.
Part of that gut reaction has a sound economic basis: a child stands to live longer than an adult, so the death of a child means a greater loss of life-years. If we must put a cash figure on lost lives to reflect our collective valuation of life, shouldn’t that figure vary with the amount of life foregone? That would certainly accord with our instinctive gut feel about life, death and loss. But it could take us down a dark path, which we have occasionally caught sight of during the pandemic. Some lockdown sceptics have come close to arguing that the lives of older people are simply less worthy of preservation, meaning the case for precautionary measures that do economic harm to younger people are less justified. Some older people have made the same point. “Should we die, we deserve fewer tears than do those who come after us,” wrote 74-year-old Max Hastings in March.
Those arguments make me uncomfortable, because what happens when their underlying logic is applied on a population-wide scale to things such as healthcare: do we really want to formally declare that older people’s lives are less worth saving than those of the young? And if life expectancies determine our value, are rich southerners’ lives worth more than those of poor northerners?
But the answer to this stuff isn’t to shy away from the issue; it’s to debate it properly and systematically.
The good news is that the Whitehall machine is, slowly, moving to replace that nonsensical VFP figure with something that might just capture the different weights we give to deaths at different ages. Over the summer, the HSE published a comprehensive “scoping study” describing how government could better calculate the values that we collectively assign to human lives.
As the paper concludes:
“Applying such values would lead to better and more informed policy decisions and would have major implications not only for efficiency of government spending but also for equity in population well-being.”
Unsurprisingly, there is no sign of politicians engaging with that study or its implications, even though it’s their job to balance “efficiency” and “equity”. That’s probably because explaining clearly and openly how you strike such a balance would mean telling some painful truths to voters. Truths such as: sometimes we decide that a few deaths are a price worth paying in order to keep the traffic moving, keep your taxes down or let you spend Christmas with your relatives.
What value has been assigned to the lives that might be lost from that festive relaxation? How does it compare with the benefits for the vast majority who don’t die? If the ministers who advanced the policy — or the opposition parties who accepted it — have answers to those questions, they aren’t sharing them. No doubt in due course a SAGE estimate for the number of additional deaths expected from those five festive days will come to light. But only after the fact, rather than as part of the Government announcement, the scandalously limited political debate about it, or any individual’s decision-making about whether to get together with others for Christmas.
The pandemic has been a test of our thinking about the value of life. Yet we have largely taken decisions that can have life-or-death consequences without a proper conception of how much we are prepared to give up to prevent deaths. And despite the evidence that it will kill, and polls showing the electorate is split on the case for it, the five-day Christmas Covid amnesty is effectively going through on the nod. It’s a stunningly casual way to enact a policy with potentially fatal consequences.
To repeat, I don’t criticise people who chose to travel and mingle at Christmas and in so doing marginally increase the transmission, symptomatic or otherwise, of the virus. Because we all routinely do things that marginally and sometimes indirectly increase the chances that other people will come to harm. If you drive at 80mph instead of 60mph, you make it more likely that someone will die if you have an accident; you also contribute more to both air pollution and climate change, both of which are associated with some additional fatalities. (And yes, I have driven at 80mph and may well do so again.)
The state that acts in our name, uses our shared resources and sets the rules for all sorts of activities, makes similar decisions of life and death on a regular basis, and generally on the basis of shoddy evidence and limited, if any, debate.
Household mingling over Christmas will mean more people die than would otherwise have died. And that’s a perfectly defensible choice, both for individuals and the people behind the policy that allows and encourages it.
But those are choices that should be based on a clear and open discussion of their consequences, not least since those consequences are likely to fall on others. If our representatives have concluded that having a nice lunch with your family in late December is worth contributing to the risk that someone’s gran dies in January, they should set out that calculation calmly, explicitly and openly, rather than by mute implication.
People choosing to make use of the freedom to mix might want to give it some thought too. Enjoy your turkey.