Free The Price of Everything by Eduardo Porter Page A

than the poor, the poor value each dollar they have more than the rich. For a family that subsists on the fringe of poverty, an investment in a doctor’s visit could signal a lower tolerance for risk than all the pricey medical treatments of a corporate executive.
    This method of self-valuation ignores the fact that people’s choices are not always freely chosen. If one were to measure people’s worth by their willingness to trade money for safety in the workplace, one would conclude that blacks believe they are cheaper than whites. They suffer more workplace fatalities in almost every industry and the extra wages they get for the extra risk are lower. One study concluded from this data that a white blue-collar worker’s life was worth $16.8 million, more than twice the value of that of a similar black worker. But we would have good reason to mistrust this valuation. Rather than reflecting a higher appetite for risk among blacks, it suggests that blacks have fewer job opportunities and so must settle for less.
    By this metric, life in the poor world is very cheap. A 2005 study based on wages of Mexico City workers valued their lives at a maximum of $325,000. A 2005 study of what Chinese were willing to pay to avoid sickness or death from air pollution calculated that, at the official exchange rate, the median value of a statistical life could be as little as $4,000. This kind of valuation would lead to some untenable decisions about allocating resources across the world. Representatives of developing countries were outraged when a report of the Intergovernmental Panel on Climate Change in 1995 assessed the impact of global warming valuing statistical lives at $150,000 in poor countries and at $1.5 million in rich ones. Did this mean, they asked, that protecting people in poor countries from climate change provided less bang for the buck than protecting citizens of the rich world? So the panel backtracked, threw out its sophisticated economic analysis, and settled for the politically tenable notion that we are all worth the same, $1 million whether in rich countries or poor.

THE PRICE OF HEALTH
    Cervical cancer is one of Mexico’s most lethal ones, killing 8 out of every 100,000 women every year. When GlaxoSmithKline and Merck Sharp & Dohme developed vaccines against the human papillomavirus, the leading cause of cancer of the cervix, Mexico was among the first countries to consider a program of universal vaccination for twelve-year-old girls.
    It appeared to be extremely cost-effective. At some 440 pesos a dose, about the price quoted by Glaxo, offering a three-dose course to 80 percent of girls would cost just over 42,000 pesos per each healthy year of life that would be saved by the procedure, according to a 2008 analysis by researchers at the Mexican national health department. This is less than half Mexico’s gross national product per capita, and thus considered a good investment by experts at the World Health Organization.
    But because Mexico is a relatively poor country, these findings produced a conundrum. A universal vaccination plan would cost about 1.4 billion pesos, almost as much as the entire budget for the government’s series of seven mandatory childhood vaccines. So the government took a Solomonic approach. It decided to offer the vaccination program only in poor areas of the country with a relatively high incidence of cervical cancer, which would cut the total outlay by more than half. More controversially, rather than provide the three doses within a period of six to eight months, as suggested by the pharmaceutical companies, the health ministry chose to provide the third dose only after five years.
    “All our studies of the vaccines’ effectiveness were based on a plan of three doses—the third must be taken eight months after the first,” said Miguel Cashat-Cruz, the head of vaccines for Merck’s Mexican subsidiary. But Eduardo Lazcano-Ponce, a researcher at the National Institute of Public