PoPulationand Public HealtH etHics

policy
Core issue
Case study authors identify the central issue in choosing among the identified
policy options as one of justice in the allocation of resources. The view of justice
as “requir[ing] a decision-maker to weigh the competing interests of communities
with known and unknown water system risks against each other, while
also considering the financial implications of each option” is too narrowly focused
and may mis-specify the level of analysis required. The dice are loaded
as it were, in favour of accepting the proposition that “with limited funding,
communities would have to be prioritized” for post-survey responses. But why
must such communities compete against one another for available resources,
rather than with others among the myriad expenditure objectives of the GoC?
In the context of resource-allocation decisions with life-or-death consequences,
it is useful to consider the view of resource scarcities provided in Calabresi and
Bobbitt’s remarkable book Tragic Choices. Such scarcities are seldom natural
or absolute, in the sense exemplified by shortages of compatible donor organs
for transplantation or (in a hypothetical example) of a geologically rare
mineral that cannot be synthesized and has no substitute in the manufacture
of a life-saving medical device. Far more common are situations in which
“scarcity is not the result of any absolute lack of a resource but rather of the
decision by society that it is not prepared to forgo other goods and benefits
in a number sufficient to remove the scarcity.” 4 Arguably, the core issue here
is the (continuing) refusal of the GoC, and perhaps the society whose values
it can be said to represent, to remove the scarcity in question.
Assertions of resource scarcity must be assessed in the context of estimates
provided by the survey authors 5 of the costs of meeting official “protocols
for safe water and wastewater.” The adequacy of these protocols cannot be
explored here, but they provide a useful starting point for estimating costs.
The survey authors estimated the one-time costs of meeting these protocols
as $1.212 billion, including capital costs, non-construction costs, and repairs to
existing facilities; they estimated annual operating costs as $18.7 million. 5(p.30)
A much higher cost was attached to meeting future servicing needs over
the next 10 years: $4.7 billion, plus $419 million per year for operating and
maintenance. 5(p.34) Considerable imprecision is involved in all such estimates,
but they provide at least an order-of-magnitude indication of the amounts
involved, which must be compared with total federal program spending
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