Risk Savvy Citizens

Risk Savvy Citizens

In Risk Savvy Gerd Gigerenzer argues for changes to the way that financial systems, healthcare systems, and discourse around public projects operate. He argues that we are too afraid of risk, allow large organizations to profit from misunderstandings of risk, and that our goals are often thwarted by poor conceptions of risk. Becoming risk savvy citizens, he argues, can help us improve our institutions and make real change to move forward in an uncertain world.

“The potential lies in courageous and risk savvy citizens,” writes Gigerenzer.

I think that Gigerenzer is correct to identify the importance of risk savvy citizens. We are more interconnected than we ever have been, and to develop new innovations will require new risks. Many of the institutions we have built today exist to minimize both risk and uncertainty, unintentionally limiting innovation. Moving forward, we will have to develop better relationships toward risk to accept and navigate uncertainty.

A population of risk savvy citizens can help reshape existing institutions, and will have to lean into risk to develop new institutions for the future. This idea was touched on in Bruce Katz and Jeremy Nowak’s book The New Localism where they argue that we need new forms of public private partnerships to manage investment, development, and public asset management. Public agencies, institutions we have relied upon, have trouble managing and accepting risk, even if they are comprised of risk savvy citizens. The solution, Katz and Nowak might suggest, is to reshape institutions so that risk savvy citizens can truly act and respond in ways that successfully manage reasonable risks. Institutions matter, and they need to be reshaped and reformed if our courageous and risk savvy citizens are going to help change the world and solve some of the ills that Gigerenzer highlights.

Risk literacy and Reduced Healthcare Costs - Joe Abittan

Risk Literacy & Reduced Healthcare Costs

Gerd Gigerenzer argues that risk literacy and reduced healthcare costs go together in his book Risk Savvy. By increasing risk literacy we will help both doctors and patients better understand how behaviors contribute to overall health, how screenings may or may not reveal dangerous medical conditions, and whether medications will or will not make a difference for an individual’s long-term well being. Having both doctors and patients better understand and better discuss the risks and benefits of procedures, drugs, and lifestyle changes can help us use our healthcare resources more wisely, ultimately bringing costs down.
Gigerenzer argues that much of the modern healthcare system, not just the US system but the global healthcare system, has been designed to sell more drugs and more technology. Increasing the number of people using medications, getting more doctors to order more tests with new high-tech diagnostic machines, and driving more procedures became more of a goal than actually helping to improve people’s health. Globally, health and the quality of healthcare has improved, but healthcare is often criticized as a low productivity sector, with relatively low gains in health or efficiency for the investments we make.
I don’t know that I am cynical enough to accept all of Gigerenzer’s argument at face value, but the story of opioids, the fact that we invest much larger sums of money in cancer research versus parasitic disease research, and the ubiquitous use of MRIs in our healthcare landscape do favor Gigerenzer’s argument. There hasn’t been as much focus on improving doctor and patient statistical reasoning, and we haven’t put forward the same effort and funding to remove lead from public parks compared to the funding put forward for cancer treatments. We see medicine as treating diseases after they have popped up with fancy new technologies and drugs. We don’t see medicine as improving risk and health literacy or as helping improve the environment before people get sick.
This poor vision of healthcare that we have lived with for so long, Gigerenzer goes on to argue, has blinded us to the real possibilities within healthcare. Gigerenzer writes, “calls for better health care have been usually countered by claims that this implies one of two alternatives, which nobody wants: raising taxes or rationing care. I argue that there is a third option: by promoting health literacy of doctors and patients, we can get better care for less money.”
Improving risk and health literacy means that doctors can better understand and better communicate which medications, which tests, and which procedures  are most likely to help patients. It will also help patients better understand why certain recommendations have been made and will help them push back against the feeling that they always need the newest drugs, the most cutting edge surgery, and the most expensive diagnostic screenings. Regardless of whether we raise taxes or try to ration care, we have to help people truly understand their options in new ways that incorporate tools to improve risk literacy and reduce healthcare costs. By better understanding the system, our own care, and our systemic health, we can better utilize our healthcare resources, and hopefully bring down costs by moving our spending into higher productivity healthcare spaces.
Risk Literacy Builds Trust

Risk Literacy Builds Trust

In his book Risk Savvy Gerd Gigerenzer writes about a private medical panel and lecture series that he participated in. Gigerenzer gave a presentation about the importance of risk literacy between doctors and their patients and how frequently both misinterpret medical statistics. Regarding the dangers this could pose for the medical industry, Gigerenzer wrote the following, recapping a discussion he had with the CEO of the organization hosting the lectures and panel:

“I asked the CEO whether his company would consider it an ethical responsibility to do something about this key problem. The CEO made it clear that his first responsibility is with the shareholders, not patients or doctors. I responded that the banks had also thought so before the subprime crisis. At some point in the future, patients will notice how often they are being misled instead of informed, just as bank customers eventually did. When this happens, the health industry may lose the trust of the public, as happened to the banking industry.”

I focus a lot on healthcare since that is the space where I started my career and where I focused most of my studies during graduate school. I think Gigerenzer is correct in noting that risk literacy builds trust, and that a lack of risk literacy can translate to a lack of trust. Patients trust doctors because health and medicine is complex, and doctors are viewed as learned individuals who can decipher the complexity to help others live well. However, modern medicine is continuing to move into more and more complex fields where statistics and risk play a more prominent role. Understanding genetic test results, knowing whether a given medicine will work for someone based on their microbiome, and using and interpreting AI tools requires proficient risk literacy. If doctors can’t build risk literacy skills, and if they cannot communicate risk to patients, then patients will feel misled, and the trust that doctors have will slowly diminish.

Gigerenzer did not feel that his warning at the panel was well received. “The rest of the panel discussion was about business plans, which really captured the emotions of the health insurers and politicians present. Risk-literate doctors and patients are not part of the business.”

Healthcare has to be patient centered, not shareholder centered. If healthcare is not about patients, then the important but not visible and not always profitable work that is necessary to build risk literacy and build trust won’t take place. Eventually, patients will recognize when they are placed behind shareholders in terms of importance to a hospital, company, or healthcare system, and the results will not be good for their health or for the shareholders.

Risk Literacy and Emotional Stress

Risk Literacy and Emotional Stress

In Risk Savvy Gerd Gigerenzer argues that better risk literacy could reduce emotional stress. To emphasize this point, Gigerenzer writes about parents who receive false positive medical test results for infant babies. Their children had been screened for biochemical disorders, and the tests indicated that the child had a disorder. However, upon follow-up screenings and evaluations, the children were found to be perfectly healthy. Nevertheless, in the long run (four years later) parents who initially received a false positive test result were more likely than other parents to say that their children required extra parental care, that their children were more difficult, and that that had more dysfunctional relationships with their children.

 

Gigerenzer suggests that the survey results represent a direct parental response to initially receiving a false positive test when their child was a newborn infant. He argues that parents received the biochemical test results without being informed about the chance of false positives and without understanding the prevalence of false positives due to a general lack of risk literacy.  Parents initially reacted strongly to the bad news of the test, and somewhere in their mind, even after the test was proven to be a false positive, they never adjusted their thoughts and evaluations of the children, and the false positive test in some ways became a self-fulfilling prophecy.

 

In writing about Gigerenzer’s argument, it feels more far-fetched than it did in an initial reading, but I think his general argument that risk literacy and emotional stress are tied together is probably accurate. Regarding the parents in the study, he writes, “risk literacy could have moderated emotional reactions to stress that harmed these parents’ relation to their child.”¬†Gigerenzer suggests that parents had strong negative emotional reactions when their children received a false positive and that their initial reactions carried four years into the future. However, had the doctors better explained the chance of a false positive and better communicated next steps with parents, then the strong negative emotional reaction experienced by parents could have been avoided, and they would not have spent four years believing their child was in some ways more fragile or more needy than other children. I recognize that receiving a medical test with a diagnosis that no parent wants to hear is stressful, and I can see where better risk communication could reduce some of that stress, but I think there could have been other factors that the study picked up on. I think the results as Gigerenzer reported overhyped the connection between risk literacy and emotional stress.

 

Nevertheless, risk literacy is important for all of us living in a complex and interconnected world today. We are constantly presented with risks, and new risks can seemingly pop-up anywhere at any time. Being able to decipher and understand risk is important so that we can adjust and modulate our activities and behaviors as our environment and circumstances change. Doing so successfully should reduce our stress, while struggling to comprehend risk and adjust behaviors and beliefs is likely to increase emotional stress. When we don’t understand risks appropriately, we can become overly fearful, we can spend money on unnecessary insurance, and we can stress ourselves over incorrect information. Developing better charts, better communicative tools, and better information about risk will help individuals improve their risk literacy, and will hopefully reduce risk by allowing individuals to successfully adjust to the risks they face.