by Alison Snow Jones, PhD
This issue of Family Violence Prevention and Health Practice is devoted to economic aspects of intimate partner violence (IPV). This is an important topic because IPV represents very real monetary costs, not just for victims and their children, but for society. Wendy Max and her associates (Max et al, 2004) put IPV annual costs in the United State at $8 billion (in 2003 dollars) with 70% of these costs attributed to physical violence. For comparison, consider that NCI’s total budget in 2003 was around $5 billion (NCI, 2005). Other studies in healthcare settings have also demonstrated higher medical costs among IPV victims reflecting significant economic and disease burden (Ulrich et al., 2003; Glass, Dearwater & Campbell, 2001; Wisner, Gilmer, Saltzman, & Zink, 1999; Jones et al, 2006; Rivara et al, 2007).
As an economist, I am strongly in favor of economic methods such as CEA and cost-benefit analysis (CBA) that make explicit the costs, effects, preferences, and distributional effects of disease prevention and health promotion programs and policies. If we do not make these aspects of programs and policies explicit, we run the risk of wasting money and failing to achieve our prevention objectives. Economic methods assure that our choices will be informed and efficient.
In this issue, Vos and colleagues document the disease burden associated with IPV in Australia and call for cost-effective methods aimed at primary prevention. In the perfect companion article, Richard Norman, Anne Spencer, and Gene Feder provide a very solid introduction to cost-effectiveness analysis (CEA), a method used by economists to determine and select programs that yield the most gain in outcome per dollar expended. The authors provide a good overview of the components and advantages of CEA as well as some of its pitfalls. They point out that CEA is fast becoming a required tool for health policy decision makers. As IPV researchers, we must all familiarize ourselves with this tool, use it judiciously, and understand clearly its strengths and weaknesses. Their article provides an excellent starting point.
If there is a drawback to the use of economic methods, it is that they can sometimes obscure what is really at stake. It is easy to fall into the trap of thinking that IPV prevention is just about financial losses and cost savings. A “thought experiment” may help put this into perspective. Suppose that we were somehow magically able to fully compensate all IPV victims, their medical care providers, their children, and society for the productivity losses and the medical expenses attributable to IPV. Let’s even assume that we could restore all fatalities to life. In other words, eliminate all monetary costs and losses associated with IPV. Under these circumstances, would victims be willing to be abused now that they would incur no monetary costs from it? I think not. Would we be willing to have certain members of our society systematically brutalized now that all monetary costs have been removed? I think not.
In economists’ lingo, the amount we would be “willing to pay” above and beyond the monetary costs of IPV to eliminate it is the true societal valuation or “net benefits” of eliminating IPV. For this reason, costs saved, costs averted, productivity lost, mortality costs, or all taken together provide a very limited metric by which to measure the economic value of eliminating IPV. It is a lower bound, if you will. And a very biased lower bound at that, if productivity and mortality losses are based on female and minority wage rates that may reflect entrenched cultural prejudices (GAO, 2003). It is certainly not clear that economic costs alone will provide an accurate metric of the intrinsic value of women’s lives and safety.
IPV must be prevented, not because its monetary costs are high (which they are), but because it is a violation, not just of victims, but of the larger society. Even if IPV were costless in monetary terms, it is ethically and morally wrong and we are all diminished by it. Yes, we must perform economic analyses if we are to build the case for public monies directed to ending IPV. Yes, we must use economic methods to assure that we choose programs that are most effective in preventing IPV for the least expenditure. But we must never lose sight of the fact that IPV is ultimately a violation of basic human rights and we would be obligated to prevent it even if there were no monetary costs associated with it at all.
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GAO (2003) Women’s Earnings: Work Patterns Partially Explain Differences Between Men’s and Women’s Earnings. Report to Congressional Requesters # GAO-04-35. October, 2003. Washington, DC: Government Accounting Office. Downloaded from http://www.gao.gov/new.items/d0435.pdf on May 3, 2007.
Glass, N. E., Dearwater, S., & Campbell, J. C. (2001). Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments. Journal of Emergency Nursing, 27, 141-149.
Jones, AS, Dienemann, J, Schollenberger, J, Kub, J, O’Campo, P, Gielen, AC, Campbell, J., 2006, Long-Term Health Costs of Intimate Partner Violence, Women’s Health Issues, 16: 252-261.
Max, W, Rice, DP, Finkelstein, E, Bardwell, RA, Leadbetter, S (2004) The Economic Toll of Intimate Partner Violence Against Women in the United States. Violence and Victims, 19(3): 259-272.
NCI (2005) http://plan2005.cancer.gov/budget.html accessed May 3, 2007.
Rivara FP, Anderson ML, Fishman P, Bonomi AE, Reid RJ, Carrell D, Thompson RS. (2007) Healthcare utilization and costs for women with a history of intimate partner violence. Am J Prev Med. 32(2):89-96.
Ulrich, Y., Cain, K., Sugg, N., Rivara, F., Rubanowice, D., & Thompson, R. (2003). Medical care patterns in women with diagnosed domestic violence. Am J Prev Med, 24, 9-15.
Wisner, C., Gilmer, T., Saltzman, L., & Zink, T. (1999). Intimate partner violence against women. Do victims cost health plans more? J Fam Prac, 48, 439-443.