Saturday, July 29, 2006

Allergies and responsibility

Emily Brazelon in Slate misses the point a bit when she likens a case about cutting down a tree to general policies on childhood allergies. Here is the case:
Earlier this month, the city of Milford, Conn., agreed to cut down three 60-feet-high hickory trees because of a 3-year-old's nut allergy. The trees rise over the backyard and swimming pool of the child's grandmother, who helps take care of him. According to the New York Times, he once had to go to the hospital after touching a bowl of cashews. If the trees don't come out, he could die, his family told the town. Neighbors, however, are skeptical: They say the grandmother tried to have one of the trees removed before and is now using the allergy to her advantage.

Who is crazy here—the family that wants the trees felled or the residents who seem willing to put a child at risk? It's hard to tell. That's the dilemma of nut allergies. There are cases of real danger and real death. And then there's the huge circle of caution that often gets drawn around children when, rationally speaking, more modest precautions might do. If every school is already a nut-free zone, the felling of the Milford trees suggests that every block might become one, too. Is this a smart way to marshal our resources to avoid risk, even risk to children?

The issue here is not whether the town should require the trees to be cut down or not but, instead, who should bear the costs if, indeed, it is worthwhile for them to be cut down. Brazelon rightly points out that it is not certain if the risk to the child (or children) is worth the cost of getting rid of trees: not just the physical cost but cost in terms of land values.

Now if the town had no policy but the risk to the child was truely great, the grandmother could go to her neighbours and offer compensation for the loss of the trees. If her assessment of the value of that risk wasn't really high enough, then we can conclude that it probably isn't worth cutting down the trees. However, if the town mandated the trees be cut down regardless, no such assessment would be made. So we would never know.

A better policy would be to give the grandmother a right to ask for the trees to be cut down. This opens up the possibility of negotiation again and that the trees wont be cut down if the risks aren't too large. The difference between that and no requirement is simply who bears the costs of cutting down the trees should that be desired: the grandmother or the neighbours. So in terms of issues such as this, the key is to open up the possibility of fruitful negotiation rather than preclude it.

Now when it comes to policies of schools prohibiting certain types of food, it may seem that a similar issue arises. Here, we trade-off the risk to the child with parental convenience. Here is Brazelon's take on this one:

At the risk of sounding heartless and bratty, though, let me try to make the case for better-calibrated, more-moderated responses to nut allergies. Parents who ask for more accommodation than their kids really need do a disservice, I think, by making the rest of us unsure of when we need to strictly comply. It's a form of crying wolf. Or at least that's how it has felt to me on occasion. One summer, my older son Eli, then 4, got sent home from preschool with a stern note, because the granola bar I'd given him for a snack was made at a factory that processed other products that contain tree nuts. The next day I sent Eli with a plastic baggie full of cheese crackers made by Annie's, the organic pasta company. Their factory stamped out organic macaroni and crackers, I thought—no nuts.

But the father of the boy in the class with the nut allergy wasn't so sure. He asked me to take the crackers home. I'm sure this seemed like a minor concession to him. But to me, it seemed unfair and a little ridiculous. My son and his son didn't sit at the same snack table. They'd never shared food. His son's allergy had never been triggered by airborne particles, and it was no longer particularly serious. And if I couldn't give Eli his crackers, then he wouldn't have a snack. For the second day in a row. So, there was a cost, however small, for doing as asked.

I left the crackers with Eli. They provoked no allergic reaction in his preschool classmate. When I got home that night, I checked the Annie's box. There was the telltale warning: "Produced in a facility that also manufactures products containing peanuts and tree nuts." So, what's the moral of this story—that I'm inconsiderate, or a reasonable risk-taker?

Now in this situation, daily negotiations are not possible. The costs would be too high. Instead, the school needs to have a policy on the foods that can be brought in. When the school knows it has a child at risk, something it would have to manage, it sets the policy accordingly. Because children are hard to manage at a young age, it is not surprising that they might think to control the situation by restricting foodstuffs. Schools do this for so much food brought in from meats (that might get bacteria) to sweets (that might cause hyperactivity and create conflicts).

In this situation, the issue would become whether the child could go to school at all or not. And for many families they may not have the wealth to buy off the convenience costs to other parents. So, in contrast to the trees, there is little scope for an efficient deal to be struck especially on cracker level decisions.

In my mind, the way to think about schools is very simple: social risk pooling. Someone's child may have a nut allergy. Yours may have something else. For instance, they might be poorly behaved and extra teaching resources are required. For all of them, managing the issue may cause inconvenience or cost to others. But the attitude should be, if it were me with that child, would I expect the school to accomodate the issue. If the answer is 'yes' it should be supported.

[By the way, all this analysis borrows from Ronald Coase -- the negotiations part -- and John Rawls -- the put yourself in the place of others part].