The Cost of Inaction

Launched by the FXB Center in August 2008, this landmark initiative will explore the “cost of inaction” of a failure to respond appropriately to children. With Professors Amartya Sen and Sudhir Anand directing the project, economists and public health researchers will address the complex challenges of enumerating and quantifying the multiple social and economic costs that follow when societies fail to address the pressing needs of their most vulnerable members, viz. children. This three-year project will respond to hitherto unaddressed questions in public health: what are the costs of inaction, and is the cost of inaction greater than the cost of action? 

Inaction can lead to negative consequences for individuals, families, the community, the economy, and society as a whole. These negative impacts can be financial or economic, but more generally will also include health impacts, education impacts, social impacts, and consequences for labour-force functioning. We aim to identify, quantify, and measure the costs of inaction. Some impacts are quantifiable in monetary terms and others in metrics that relate to the area of the impact (e.g. mortality or morbidity increase, school enrolment, decline in the health workforce, etc.). There will be some, especially social, impacts that are identifiable only in qualitative terms – e.g. the implications of increase in drug use, violence, crime, other anti-social behaviours, and prostitution.

The first phase of the Cost of Inaction project will focus on developing and applying a methodology to consider the consequences and costs that arise from a failure to respond to the needs of children affected (or infected) by HIV/AIDS. To this end the project team has developed a conceptual framework and has begun to undertake detailed country case studies.

The conceptual framework is critical to the project. It is necessary to be clear on what exactly is meant by the “cost of inaction” and how alternative meanings shape the implementation of such a study. The conceptual framework highlights the need to identify and justify the actions against which inaction is to be evaluated.

Case studies are necessary to illustrate the choice of counterfactual actions which may be more or less desirable. Different counterfactual actions will give rise to different costs of inaction, and to different direct benefits of action. Given the initial focus on children affected by HIV/AIDS, case-study countries were selected from the region with the highest HIV prevalence, viz. eastern and southern Africa. The selected countries differ not only in HIV prevalence but also in availability of and access to resources for investment. This is important because the actions that are identified as desirable in one context may not be desirable in another. Initial visits have been undertaken to four countries – South Africa, Rwanda, Tanzania, and Angola. Data collection visits have been undertaken in Rwanda and Angola. In-country meetings with government officials, international non-governmental organizations (NGOs), and local non-profit organizations have helped identify candidate actions against which the cost of inaction can be assessed. Special attention has been given to developing distinct research plans for the two countries because they have differing political, geographical, cultural and religious structures which present different challenges for implementation and delivery. For the case-study countries, the team is identifying unimplemented actions which the evidence suggests may be desirable. It is against these actions that the costs of inaction will be assessed – and compared to the costs as well as the direct benefits of action.