Suppose you’re planning a trip to Southeast Asia. You know there are health risks – malaria, dengue fever, hepatitis, intestinal disorders and all those other side stories of adventure travel.
You’re not worried. You’ve been to your doctor, loaded up on drugs and vaccinations, bought mosquito-proof clothing, and informed yourself on how to avoid known hazards. You feel armored and ready to go.
Then comes news: an avian flu outbreak in your destination country. More than 100 people are sick, and the number is growing. Mortality rates are more than 50 percent. There’s no vaccine. Travelers are canceling.
What do you do?
Adventure travelers face questions like this all the time. Going to remote places and doing things that they’d rather not admit to their insurance companies, they know they are taking more risk than travelers who stick to the mainstream.
Yet for everyone there is a point where risk outweighs reward. The tough thing is deciding where that point lies. It’s a moving target, hard to define but important nonetheless.
“Understanding and using the concept of risk is a core skill in travel medicine,” says Dr. Harvey Fineberg, president of the Institute of Medicine of the National Academies and past president of the Society for Medical Decision Making. Speaking at a recent conference for doctors who specialize in travel medicine, he addressed one of the toughest parts of the question: how the perception of risk relates to decisions about travel.
Perception of risk is not a simple matter, and avian flu is a good example. Highly publicized, it has become a source of serious anxiety among travelers. But consider, says Fine-
berg, that people canceling trips because of flu had been willing to accept the far more serious risk of traveling in motor vehicles.
Vehicle accidents are the main cause of death among Americans abroad. Vietnam in particular has a per-mile highway fatality rate 10,000 times greater than that of the United States.
This illustrates the difference between a knowable, familiar hazard and an unknown, uncontrollable, perhaps increasing hazard. Fineberg says avian flu has a high degree of what he calls dreadfulness, which tends to exaggerate anxiety.
As with other exaggerated fears – shark attacks, for example, which cause anxiety but almost never happen – the risk might be negligible but the resulting anxiety is real, and something travelers need to cope with. Fineberg offers some ways to do that.
You know more than you think. Fineberg suggests, “Ask yourself two questions: What do I know about this or things like this; or, what can I readily learn? Second, what do I know … that could modify the baseline estimate upward or downward?” The result is better than claiming total ignorance.
Don’t count on it. Once we’ve made an estimate, we tend to put too much faith in it. As Fineberg puts it, we tend to underestimate “the range of uncertainty about an estimate.” This can lead to overconfidence and statements such as, “This street is safe before midnight.”
Consider the variables. Fineberg distinguishes population risk from individual risk, which is quite variable. For example, risk increases with time spent in a hazardous place. The same is true for the frequency of visits.
Many hazards are mitigated by behavior. Sexually transmitted diseases are obviously of no concern to a celibate traveler. Likewise, a person who follows the advice of experts while trekking in the high mountains of Nepal – that is, to go slow and give the body time to adjust – is less likely to suffer from altitude sickness.
Be wary of statistics. Statistics can be meaningless in a practical sense. A risk to one person in a million is small except for that one person, for whom the risk was 100 percent. On the other hand, if numbers show that 25 percent of visitors to a particular region get bitten by at least one malaria-infected mosquito, travelers would find it a highly useful statistic.
Also consider how the risk is framed. If the news reports that 500 people died in train derailments in China last month, it might sound serious. The same report could say that more than a billion people did not die in Chinese train derailments last month, and we might wonder why they even bothered to report such a fact.
In the end, many of us rely on general feelings of security, modified by desire. That is, we do what we want to do.
I have a friend – a journalist and veteran traveler to dicey parts of the world – who says: “I’ll accept greater risk to do something I really care about. It feels sort of like intuition. I look at all the information I can get, but if I don’t want to go, then maybe I shouldn’t.”
The details
Medicine for Adventure Travel Conference, matjacksonhole.com.
“Risk: A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You,” by David Ropeik (Mariner Books).
