Of blood, bullets and priorities

ADDRESSING AN international conference in Kingston a week ago, Prime Minister Andrew Holness publicly agonised over one of the recurring dilemmas for politicians: how to prioritise the allocation of limited resources when there are many needs.

In this case, Mr Holness’ concern was Jamaica’s very bad, and worsening, problem of crime, especially homicides, on whose deterrent his government wants to spend more. That will mean diverting funds from other areas, which will cause displeasure among affected interests.

“That’s the problem that politicians face,” lamented Mr Holness, “how to convince the public that the threats that are critical to them should align to the budgetary allocations.”

In this circumstance, the predicament may not be as complex as Mr Holness assumes if, as he did in that speech, he recognises the economic impact of crime and the costs it extracts from the society. For instance, Jamaicans know intuitively that the country’s crime problem stymies investment and growth. Indeed, there are often-quoted studies that if Jamaica had a homicide rate in the low double digits, the island would add perhaps seven per cent to its annual growth rate.

Should they give the matter serious thought, the trade-offs on spending priorities, to achieve such gains, ought not to be as difficult as policymakers fear. And the returns are likely to be far faster than they presume.

Yet, if these promises seem not hard and tangible enough to ensure the embrace of officials, we recommend to the administration Thursday’s presentation to the parliamentary committee reviewing the Government’s latest crime bill by Drs Ann Jackson-Gibson and Elizabeth Ward.

Dr Jackson-Gibson is an anaesthetist at Kingston Public Hospital (KPH), which probably deals with more trauma patients than all hospitals outside of Jamaica in the Englishspeaking Caribbean combined. Dr Ward is a well-known epidemiological researcher. The gravamen of their argument was that it is more expensive to treat crime-related trauma in Jamaica’s hospitals than to spend on the community social interventions that would prevent them in the first place. More, treating the victims of criminal violence siphons a disproportionate amount of resources from other patients.

SOCIAL INTERVENTION PROGRAMMES

For instance, Dr Jackson-Gibson, using World Health Organisation methodologies, and extrapolating from the economic cost for delivering various services at KPH, calculated that so far this year, up to mid June, the price tag for treating gunshot victims was approximately J$80 million. That, as she starkly put it to the parliamentarians, was around J$400,000 a day, which will put it at nearly $80 million by half-year. That cost does not include the displacement of other patients by these emergency cases, requiring expensive intensive care.

But there is, according to Dr Ward, a broader study – covering the island’s 22 hospitals – which, in 2014, put the cost for treating victims of violence, excluding at private institutions, at J$3.68 billion. Looked at another way, that figure is seven per cent of the health ministry’s non-capital budget for the current fiscal year, and nine per cent of the 2014-2015 recurrent spend.

More significantly, it is nearly three times the J$1.3 billion which Dr Ward said was required for social-intervention programmes in the socalled hotspot communities that contribute much of the violence that burdens hospitals.

Funding has declined. When these projects were being better funded, KPH, said Dr Ward, saw up to 50 per cent fewer gunshot patients. She asked: “Where are we spending our money?”

Well, Prime Minister Holness need not look too far to determine where we should be. Or, why.