The medical costs of terror: A review of the literature.

CONTEXT: The threat of terrorism is intensifying with a recent rise in the number of death and injuries. Nevertheless, few articles deal with the short and long-term medical costs of treating and assisting the civilian victims of terror. The objective of this article is to review the literature and describe the medical costs of supporting victims of terrorism. METHOD: The authors reviewed the literature on the medical costs following terror attacks in the PubMed/Medline and Google Web sites. Relevant scientific articles, textbooks, and global reports were included in the research. RESULTS: There was a scarcity of data related to the medical costs of terror. The authors review the few articles that describe the hospital and outpatient expenses. The terror attacks lead to increasing length of stay and the use of supplementary medical support. The authors detail the relevant global reports and working papers on terrorism that included the cost of injury and the over-all economic impact assessment. CONCLUSION: The medical costs result from hospital and outpatient treatment support. There is a clear need to track the long-term fate of the victims of terror. The authors recommend that future research should include all sectors of the healthcare system, including the whole rehabilitation process and have a precise tracking system for all victims.

The long-term consequences of 35 years of terror attacks against civilians in Israel: Medical and nonmedical costs, disability.

BACKGROUND: Terrorism is a major threat, which requires operative preparedness, principally for the emergency struc-tures. Similarly, its rising impact on the healthcare system should interest the researchers in health affairs and policy. The number and the nature of disabilities due to terror is insufficiently addressed in the civilian population. In this article, we described the type and number of disabilities in Israel due to war and terror attacks since 1980. METHODS: Descriptive analyses of the National Insurance Institute of Israel (NII) Civilian Victim of Terror database which embraces medical and social information including the number and severity of disabilities and their nonmedical costs (disability pensions) since 1980; the related medical costs (based on hospital and ambulatory invoices) and their principal International Classification of Diseases (ICD 9) diagnoses and comparison to the data coming from the START database (National Consortium for the Study of Terrorism and Responses to Terrorism) Results: There was a surge in the number of disabilities following the years of the second Intifada 2000-2006. Al-though the number of wounded decreased after the end of the Second Intifada, the number of disabled stayed high due to their ongoing care. The costs of disability pensions grew in parallel to the number of disabled and approached 140 M US$ for 2016. CONCLUSIONS: The different waves of terror attacks have an awful legacy as 4,000 disabled whom are supported to-day by the State of Israel. Because of the unique way Israel is tracking and following the -victims, including the number of disabled and their attendant social and medical costs we can assess the broad impact of terrorism in Israel. It is interest-ing to note that when a country supports the victims of terror with an efficient system and dedicated means and re-sources, the social (nonmedical) costs are far more significant than the medical costs.

Medical Spending for the 2001 Anthrax Letter Attacks.

ABSTRACTIntroductionThis paper assesses the total medical costs associated with the US anthrax letter attacks of 2001. This information can be used to inform policies, which may help mitigate the potential economic impacts of similar bioterrorist attacks. METHODS: Journal publications and news reports were reviewed to establish the number of people who were exposed, were potentially exposed, received prophylactics, and became ill. Where available, cost data from the anthrax letter attacks were used. Where data were unavailable, high, low, and best cost estimates were developed from the broader literature to create a cost model and establish economic impacts. RESULTS: Medical spending totaled approximately $177 million. CONCLUSIONS: The largest expenditures stemmed from self-initiated prophylaxis (worried well): people who sought prophylactic treatment without any indication that they had been exposed to anthrax letters. This highlights an area of focus for mitigating the economic impacts of future disasters. (Disaster Med Public Health Preparedness. 2019;13:539-546).

Plausible folk theories: throwing veils of plausibility over zones of ignorance in global governance.

In an age of expertise, where knowledge ostensibly reigns, global governance not infrequently settles for ignorance. To understand this puzzle, this article draws upon extensive empirical research on two sites within the global governance of finance. One is directed to the suppression of money laundering and combating the financing of terrorism by the Financial Action Task Force and International Monetary Fund. Another intends to stimulate the supply of otherwise scarce money to financial markets through global lawmaking by the UN Commission on International Trade Law. In both cases vast enterprises of global regulation and lawmaking proceed on weakly founded justificatory rhetorics designated here as 'plausible folk theories.' Six properties make a folk theory plausible: parsimony, face validity, rhetorical compactness, ambiguity, affinity with extant beliefs, and unexamined premises and logics. Plausible folk theories offer organizational benefits to IOs. They also allow a politics of temporality that may shorten temporal horizons, or weaken and eliminate IO accountability. Finally, three variants of ignorance contribute to choices by international organizations not to get beyond plausible folk theories to justify their regulatory and lawmaking initiatives: inadvertent ignorance, willful ignorance, and strategic or rational ignorance.

Elites are people, too: The effects of threat sensitivity on policymakers' spending priorities.

Recent research suggests that psychological needs can influence the political attitudes of ordinary citizens, often outside of their conscious awareness. In this paper, we investigate whether psychological needs also shape the spending priorities of political elites in the US. Most models of policymaking assume that political elites respond to information in relatively homogeneous ways. We suggest otherwise, and explore one source of difference in information processing, namely, threat sensitivity, which previous research links to increased support for conservative policy attitudes. Drawing on a sample of state-level policymakers, we measure their spending priorities using a survey and their level of threat sensitivity using a standard psychophysiological measure (skin conductance). We find that, like ordinary citizens, threat sensitivity leads even state-level policymakers to prioritize spending on government polices that are designed to minimize threats.

Lessons From Analyzing the Medical Costs of Civilian Terror Victims: Planning Resources Allocation for a New Era of Confrontations.

Policy Points: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror. CONTEXT: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. Based on an 18-month follow-up of the Israeli civilian population following the 2014 war in Gaza, we describe and analyze the medical costs associated with rocket attacks and review the demography of the victims who filed claims for disability compensation. We then propose practical lessons to help health care authorities prepare for future confrontations. METHOD: Using the National Insurance Institute of Israel's (NII) database, we conducted descriptive and comparative analyses using statistical tests (Fisher's Exact Test, chi-square test, and students' t-tests). The costs were updated until March 30, 2016, and are presented in US dollars. We included only civilian expenses in our analysis. FINDINGS: We identified 5,189 victims, 3,236 of whom presented with acute stress reactions during the conflict. Eighteen months after the conflict, the victims' total medical costs reached $4.4 million. The NII reimbursed $2,541,053 for associated medical costs and $1,921,792 for associated mental health costs. A total of 709 victims filed claims with the NII for further support, including rehabilitation, medical devices, and disability pensions. CONCLUSION: We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror.

Federal Funding for Health Security in FY2017.

This latest article in the Federal Funding for Health Security series assesses FY2017 US government funding in 5 domains critical to strengthening health security: biosecurity, radiological and nuclear security, chemical security, pandemic influenza and emerging infectious disease, and multiple-hazard and general preparedness.

Efficient Allocation of Resources for Defense of Spatially Distributed Networks Using Agent-Based Simulation.

This article presents ongoing research that focuses on efficient allocation of defense resources to minimize the damage inflicted on a spatially distributed physical network such as a pipeline, water system, or power distribution system from an attack by an active adversary, recognizing the fundamental difference between preparing for natural disasters such as hurricanes, earthquakes, or even accidental systems failures and the problem of allocating resources to defend against an opponent who is aware of, and anticipating, the defender's efforts to mitigate the threat. Our approach is to utilize a combination of integer programming and agent-based modeling to allocate the defensive resources. We conceptualize the problem as a Stackelberg "leader follower" game where the defender first places his assets to defend key areas of the network, and the attacker then seeks to inflict the maximum damage possible within the constraints of resources and network structure. The criticality of arcs in the network is estimated by a deterministic network interdiction formulation, which then informs an evolutionary agent-based simulation. The evolutionary agent-based simulation is used to determine the allocation of resources for attackers and defenders that results in evolutionary stable strategies, where actions by either side alone cannot increase its share of victories. We demonstrate these techniques on an example network, comparing the evolutionary agent-based results to a more traditional, probabilistic risk analysis (PRA) approach. Our results show that the agent-based approach results in a greater percentage of defender victories than does the PRA-based approach.

Portfolio analysis of layered security measures.

Layered defenses are necessary for protecting the public from terrorist attacks. Designing a system of such defensive measures requires consideration of the interaction of these countermeasures. In this article, we present an analysis of a layered security system within the lower Manhattan area. It shows how portfolios of security measures can be evaluated through portfolio decision analysis. Consideration is given to the total benefits and costs of the system. Portfolio diagrams are created that help communicate alternatives among stakeholders who have differing views on the tradeoffs between security and economic activity.

A framework for analyzing the economic tradeoffs between urban commerce and security against terrorism.

This article presents a framework for economic consequence analysis of terrorism countermeasures. It specifies major categories of direct and indirect costs, benefits, spillover effects, and transfer payments that must be estimated in a comprehensive assessment. It develops a spreadsheet tool for data collection, storage, and refinement, as well as estimation of the various components of the necessary economic accounts. It also illustrates the usefulness of the framework in the first assessment of the tradeoffs between enhanced security and changes in commercial activity in an urban area, with explicit attention to the role of spillover effects. The article also contributes a practical user interface to the model for emergency managers.

Beyond Value-at-Risk: GlueVaR Distortion Risk Measures.

We propose a new family of risk measures, called GlueVaR, within the class of distortion risk measures. Analytical closed-form expressions are shown for the most frequently used distribution functions in financial and insurance applications. The relationship between GlueVaR, value-at-risk, and tail value-at-risk is explained. Tail subadditivity is investigated and it is shown that some GlueVaR risk measures satisfy this property. An interpretation in terms of risk attitudes is provided and a discussion is given on the applicability in nonfinancial problems such as health, safety, environmental, or catastrophic risk management.

[Khat (Catha edulis): is it "coffee" or "cocaine"?]. / Khat (Catha edulis): "kávé" vagy "kokain"?

Regular consumption of khat's (Catha edulis) fresh leaves seriously affects the health, the social and economic life of the subject. Therefore, it is hazardous both to the individual and to the community. According to the latest reports, consumption of chat may exert some unknown and unreported gastrointestinal and hepatic effects. On the basis of studies performed by the authors, it seems that khat (cathinone) has no gastric or duodenal ulcerogenic effect. However, it does cause a significant enlargement of the hepatic mitochondria. In addition, a concern arose recently that the profit of illegal traffic of the plant may reach some illegal (terrorist) organisations. Therefore it seems that the so-called "khat-problem" needs further and more effective control.

Toxics, Toyotas, and terrorism: the behavioral economics of fear and stigma.

Economists have traditionally viewed the behavioral response to risk as continuous and proportional. In contrast, psychologists have often contended that people have little control over their response to risk that is dichotomous, nonproportional, visceral, and fear based. In extreme cases, this automatic response results in the stigmatization of a product, technology, or choice, which seemingly cannot be eliminated or reduced. In resolving these contrasting perspectives, we review four recent studies that blend behavioral economics and psychology. Together, they provide evidence for a dual-process decision model for risk that incorporates both reason and fear. They show consumers' responses to perceived risk as a mix of proportional and dichotomous (safe/unsafe) responses that are relatively more continuous in situations where deliberation is possible, and more dichotomous in emotional or stressful circumstances. These findings reconcile mixed results in past studies, and, more importantly, the dual-process model allows a clear definition of stigma, and suggests new ways to mitigate stigma and to help manage potentially damaging overreactions to it.

Assessment of the regional economic impacts of catastrophic events: CGE analysis of resource loss and behavioral effects of an RDD attack scenario.

We investigate the regional economic consequences of a hypothetical catastrophic event-attack via radiological dispersal device (RDD)-centered on the downtown Los Angeles area. We distinguish two routes via which such an event might affect regional economic activity: (i) reduction in effective resource supply (the resource loss effect) and (ii) shifts in the perceptions of economic agents (the behavioral effect). The resource loss effect relates to the physical destructiveness of the event, while the behavioral effect relates to changes in fear and risk perception. Both affect the size of the regional economy. RDD detonation causes little capital damage and few casualties, but generates substantial short-run resource loss via business interruption. Changes in fear and risk perception increase the supply cost of resources to the affected region, while simultaneously reducing demand for goods produced in the region. We use results from a nationwide survey, tailored to our RDD scenario, to inform our model values for behavioral effects. Survey results, supplemented by findings from previous research on stigmatized asset values, suggest that in the region affected by the RDD, households may require higher wages, investors may require higher returns, and customers may require price discounts. We show that because behavioral effects may have lingering long-term deleterious impacts on both the supply-cost of resources to a region and willingness to pay for regional output, they can generate changes in regional gross domestic product (GDP) much greater than those generated by resource loss effects. Implications for policies that have the potential to mitigate these effects are discussed.