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A life's value, in dollars

The Census Bureau reaffirmed this week that Maryland is the wealthiest state in the nation, yet when it comes to the health of its citizens it's almost embarrassingly run-of-the-mill. According to a report this month by an advocacy group that tracks state public health policies and clinical data, Maryland ranked just 21st overall on a list of key health indicators nationally. That's disturbing news, but not nearly as troubling as the reasons behind it.

Those reasons aren't hard to find: Although it is home to some of the best primary care physicians and hospitals in the country, the state hasn't done nearly enough to deal with the enormous public health crises that affect its neediest citizens, many of whom are concentrated in urban areas whose problems have long been considered intractable. High rates of infant mortality, HIV- AIDS and juvenile violence take the lives of hundreds of Maryland residents every year whose deaths could have been prevented.

Yet it's not as if we don't know how to prevent the terrible toll these deaths take on Maryland families and communities. Rather, the biggest obstacle facing policymakers is the daunting challenge of intervening effectively in hard-hit communities at a time when the recession has stretched state budgets to the breaking point and cost-benefit considerations have forced social service agencies to make decisions that, in effect, put a dollar sign on the human lives entrusted to their care.

Just how great a moral and ethical dilemma that poses can be seen in Baltimore City, where health officials have launched initiatives aimed at improving birth outcomes for pregnant women, curbing HIV transmission rates and reducing juvenile violence. The programs vary in cost and the number of people directly served, but they all share the goal of reducing preventable deaths.

One program, for instance, targets public service ads that teach new mothers about the dangers of sleeping with their babies to the 12 city neighborhoods with the highest infant mortality rates. It's a message officials hope will change attitudes toward behaviors that caused one in five of the city's 125 infant deaths last year.

The program cost a relatively modest $7.5 million in federal, state and private funds, and health officials hope it will help cut infant deaths in the city by a third over the next three years. But even assuming that all 25 of last year's infant deaths related to unsafe sleep could have been prevented by the campaign, the cost of saving each baby would have come to roughly $300,000 apiece. Would it have been worth it? Certainly to the parents and their families, and perhaps eventually to many more people who might benefit from each child's contributions to society as an adult. But the taxpayer who's footing the bill today can't know if that will ever happen.

Or take the city's Safe Streets program, a juvenile violence reduction initiative that employs street-wise community outreach workers to persuade adolescent boys and young men to choose nonviolent alternatives for settling disputes. A pilot program in one East Baltimore neighborhood produced a total cessation of youth homicides there for a period of two years during which Hopkins researchers monitoring the project had projected that at least four murders would occur based on recent trends. Today there are four young men walking the streets who might not still be alive had it not been for the project's intervention.

But again, at a cost of nearly $400,000, the program managed to save those lives at a price of about $100,000 each. The city's AIDS awareness and prevention programs would probably produce a cost-benefit equations of a similar order of magnitude. All three intervention programs give new meaning to the truism that life is precious; they also demonstrate the hefty price tag attached to most preventable deaths.

Implementing such programs in communities across Maryland clearly would save lives, but it would also potentially cost the state billions of dollars it obviously doesn't now have and may never be able to raise. Yet doing nothing presents an equally stark question: Can we really afford to accept the preventable deaths of thousands of our fellow citizens every year merely as the cost of doing business?

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