We are all terrible at judging risk. Most people are more scared of plane travel than cars, even though in the UK we have only a one in 44,135 chance of dying in the former compared to a one in 240 lifetime chance of a fatal car accident. Sharks scare us more than mosquitos, but the latter kill around 725,000 people a year – by transmitting malaria, yellow fever and dengue fever – while there are only around ten fatal shark attacks annually. Most women fear the stranger in a dark alley, but on average two women a week are killed by their current or former partner – domestic violence, not random attacks, is by far the greater danger and a leading cause of death for young women in Britain.
Jaws-style scenarios, plane crashes and axe murderers evoke such an emotional reaction that we tend to over-estimate the risk of them happening. Ebola falls into a similar category. It is a scary, dangerous disease: there is no known cure and it is a terrible way to die. The death toll has reached over 1,000, making it the most deadly outbreak of the disease since it was discovered in the 1970s. At its most virulent, 90 per cent of infected patients die – the death rate for this current outbreak is around 60 per cent.
If you’re a health worker in Guinea, Liberia or Sierra Leone, three hotspots for the virus, work really has become more dangerous. Thankfully ebola doesn’t spread through the air, but it is transmitted via contact with bodily fluids and so those treating victims are vulnerable. But, if you’re living in Guinea, Liberia or Sierra Leone, three countries with weak and under-developed healthcare systems and high poverty rates, Ebola is one of many immediate and very real health risks.
In June and July, around 5,000 women and children in Sierra Leone died of diseases that were largely preventable – deaths that didn’t make international headlines. As a Liberian woman you face a one in 24 lifetime chance of dying in childbirth. Sierra Leone has the highest rates of under-five mortality in the world, with Unicef estimating that 182 in 1,000 children won’t reach their fifth birthday. The leading causes of infant death in the country are malaria, pneumonia and diarrhoea. As James Ball points out in the Guardian, since the Ebola outbreak began in February, around 300,000 people are likely to have died of malaria.
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In some ways, it’s good that Ebola is so feared. Fear is a powerful motivator. It might have prompted the notoriously slow-moving WHO to declare this outbreak an international emergency, and to fast-track the use of experimental new drugs. The World Bank has pledged $200m to help fight the disease, although the Sierra Leonean president called on more help from the financial community. This international effort – as well as the actions of national governments to improve public awareness and introduce travel restrictions – will undoubtedly make it easier to contain the spread of the virus, making it much less scary than it could be.
But the fear surrounding Ebola also creates new problems. People in affected countries have become so fearful of local medical centres that they are not seeking treatment for illnesses such as malaria and diarrhoea, and so are more likely to die of these illnesses. The head of the WHO, Margaret Chan, has said that the actual Ebola death rate is likely to be higher than reported because the “fear factor” leads to denial or reticence. One writer described how, after returning to the UK from Nigeria, (where there had, at the time, been only one case of the disease) her midwife refused to see her in case she was infected. The midwife directed the writer to her GP surgery instead, which seems illogical.
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And while an individual’s inaccurate perception of risk can have nasty consequences, it’s much worse when policymaking is affected. If only we could generate the same international excitement around other diseases. 350,000 women die in childbirth or pregnancy each year, but the UN is failing to meet its maternal health targets. 627,000 people died of malaria in 2012, but the Global Fund reported that funding for malaria was only half of what is needed. 1.6 million people died of AIDS-related illness in 2012, but UNAIDS argue that HIV/AIDS charities are still under-resourced. Sometimes it might help if we were a little more afraid of the very real risk that the gains we have made in reducing maternal mortality, HIV transmission and malaria deaths will be reversed.