Over the last couple of months, the COVID-19 pandemic has had significant cost implications for global economies, education and public health systems. When confronted with an event that has so many competing priorities for limited resources, how should we make decisions to move vision care forward? And, how can we ensure that our work continues to be prioritized?
We recently asked Dr. Kevin Frick, Professor and Vice Dean for Education at the Johns Hopkins Carey Business School and VII Advisory Board Member, for his thoughts about how to answer these questions through the lens of the economics of choice. These answers represent his own points of view.
VII: Much of your work focuses on the economics of public health. What are the key factors that the public and private sectors should consider when developing a balanced approach to the well-being of their citizens?
KF: I always like to begin my discussion of the economics of any choice with a basic concept – opportunity cost. A simple definition is the answer to the question, “What is the value of the next best alternative use of resources?” Another way of phrasing the question is, “Given that we face a finite budget, what is not going to get done?” While those two questions are distinct, they get at a single point—recognizing the implications of our choices.
Take our current global situation. If we are going to spend public health resources on COVID-19 testing centers, what is not going to get done? If we tell people to stay home to limit the risk of transmission, what preventive health care measures are not going to be undertaken? If we ask an entire population to stay home to limit the potential spread of COVID-19, what implications will that have for the mental health of the population and our financial well-being?
We have to remember that a focus on preventing this pandemic alone is driven primarily by a focus on physical health and the resources that will be strained if too many people become physically unhealthy at the same time. Developing a well-balanced approach to the tradeoffs, in either the public or private sector, requires that we think broadly. We must consider the different aspects of well-being and how each is impacted by decisions about both individual and public health in the private and public sectors, and the long-term consequences of foregone prevention and the related impact on mental health.
At the business school where I am faculty, we talk about teaching students how to conduct business with an unwavering sense of humanity. This implies that we focus our thinking on the whole person and the whole of society, as opposed to a singular focus on the bottomline. While the private sector must ultimately make sure that any business is profitable, we encourage our students, who will eventually be private sector leaders, to also consider the implications for humanity around them (their customers and employees and their community). For its part, the public sector also needs to take a very broad view that is driven by more than simply a desire to retain control.
VII: Vision care is a good example of an area of public health where there’s a direct economic cost to businesses and government if people can’t see well. Explain what the impact is?
KF: Poor eyesight affects business and government in a number of ways. Individuals with poor eyesight have the potential to be productive with appropriate accommodation. One question is who will provide that accommodation? Will that come from government sector regulation without funding? Does it require government funding? When accommodation is lacking, those with poor eyesight are less likely to be employed, work fewer hours and make less money when they are employed, and require more resources for support. These resources can be the time and effort of friends and relatives, often called informal support that still has economic value, even if it is not being paid for, and formal home care or other care brought on by the impacts of poor vision.
As a result of all these factors when accommodation is lacking, individuals with poor eyesight will have less money to spend. In their old age, they provide less potential informal care for others. Thus, they have multiple impacts on the economics of the societies in which they live.
When individuals with poor eyesight do work and do not have appropriate accommodation, the rates of errors being made can increase. Thus, it can benefit employers to invest in accommodation.
Overall, poor eyesight without accommodation impacts the ability to produce, the income to consume, and the demands on others.
Myopia (particularly high myopia) is an interesting example, as it can impact learning at an early age, productivity in adulthood, and higher risk for medical care spending at older ages with its complications.
VII: There’s an obvious productivity benefit to all of society when good vision is prioritized. In your opinion, what’s the best way to encourage a shared responsibility when it comes to shouldering the burden of the cost of care?
KF: Advocates for funding for vision care have been struggling with the question for some time. While I can make a logical mathematical argument for why society as a whole can benefit from having individuals with good vision, the benefit to society is not as clear as it is for other types of public health priorities.
Poor eyesight is not like an infectious disease that can be spread to others. Poor vision does not lead to huge expenses all at once. Poor vision can take a long time to manifest. Yet poor vision does affect lots of individuals. In addition, the costs (particularly when it comes to correcting refractive error or cataract surgery) are relatively low, so there is often a concern with why society needs to help.
Encouraging shared responsibility for this problem requires making the argument about the long-term costs, the multiple impacts, the need for investment from an early age, and the recognition that not everyone has even the small amount of money to spare for a simple pair of glasses.
VII: Many people are hesitant to visit an eyecare professional for vision care now. Yet to keep these access points available for the future, we need to ensure they remain open. How do we ensure that reduced use now does not lead to a lack of access later?
KF: In some places around the world, the government has been providing funding to keep small businesses going. Most licensed eye care professional practices are small businesses.
Businesses like these also have to think about how to continue to cover the fixed costs of doing business even when demand is relatively low. I think that keeping practices open has the same requirements as keeping any other business open—owners must work to increase demand and ensure that transactions will be safe. This means reminding the population of the importance of preventive care (including preventive eye care) and reminding the population of ways of decreasing the risk of COVID-19 transmission. When people feel safe enough and recognize the benefits of prevention, then there is a greater chance that the perceived benefits or ongoing eyecare will outweigh the perceived risks and the demand will increase again.
VII: As vision care advocates what’s the best way to approach governments to encourage them to integrate vision care into public health systems?
KF: This is an ongoing question. Governments can be reminded of several things:
First, the cost of primary eye care is quite low.
Second, the benefits to society of minimizing the problems that can be treated with primary eye care (particularly uncorrected refractive error) are substantial at both the social and individual levels.
Third, while we often think of eye health as separate from the health of the rest of the body, there are systemic conditions that influence the eye. Providing the opportunity to receive multiple types of care in one place is likely to have a positive impact on all types of care and public health prevention.
VII: On a personal note, what concerns do your students bring up about the future when it comes to how to pay for public health interventions (like vision care) going forward?
KF: Students are worried about societies having enough resources for public health and the tradeoffs that we will face, not just between public health and individual well-being, but also between different parts of private health interventions. It almost always comes back to making sure that we have enough money and the apparently increasing costs of care.
VII: What is it about your students, the health and economic leaders of the future, that gives you hope?
KF: Whenever I ask for solutions, students are creative and think outside the box. It is always good to train people to be disruptors. Many of us can be disruptors early in our career because we don’t understand that someone is likely to say that our idea won’t work. We need to remain the type of people who will continue to ask, “Can we try something new?” and put the constraints of “We have always done it this way,” or “No one has ever done it that way,” out of our minds. The Carey Business School’s values include not only unwavering humanity, but boundless curiosity and relentless advancement and our students bring both with them every day.