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The Pareto Principal and Social Burden

Many of us have heard of some form of the 80:20, or Pareto Principal. For example 80% of a country’s wealth lies in 20% of the population; or 80% of a business’ profits are generated by 20% of its customers. In a fascinating paper, published in the December 2016 issue of Nature Human Behavior, our Science Advisory Board member Terrie Moffitt and her research team (led by Dr. Avshalom Caspi) show that this Pareto Principal can be applied in ways we never imagined. Focusing on costly health-care, criminal justice, and social welfare burdens the Moffitt researchers identified that a relatively small fraction of a population (~20%) contributed the majority of economic burdens (~80%).
Following a population of 1000 adults since their birth (all born between 1972-1973), the Moffit researchers found that a small, 22%, of the cohort was responsible for 81% of crimes, 78% of prescriptions, 77% of their children’s fatherless years, 66% of the welfare benefit payments, 57% of nights spent in a hospital bed, 54% of cigarettes smoked, 40% of kg of obese weight, and 36% of all injury insurance claims. These finding are quite profound.
We typically assume that interventions must be applied to an entire population to reduce costly lifetime problem behaviors. These interventions are difficult to develop and, ironically, costly when applied on an entire population basis. Here we have evidence that it is not the entire population we need to focus on, but in fact, focusing on a small minority will have a huge impact. This allows for more practical development and affordable application of interventions – thus reducing future moral and economic burden.
But the question is, “can these minority individuals be identified prior to their costly problem behaviors?” The Moffitt group was surprisingly able to answer this question, “yes!” Each individual in the study had undergone a 3 year old pediatric exam which included a neurological evaluation and assessments of verbal comprehension, language development, motor skills, and social behavior. This yielded a summary index that we are so pleased they call a ‘brain health’ index. The researchers found a correlation between the brain health index results and adult problem behaviors.
We see great hope in these findings. Being able to identify individuals at risk for adult problem behaviors, in particular violent and criminal behaviors, provides the opportunity to intervene at an early age and to change the course of lives. There is clearly more to be done – this is the first step to myriad possibilities. We need to understand what interventions are effective, what are the underlying causes of the problem behaviors, the interplay between genetics and environment, and notably, eliminating the barriers to people advocating for their own and their loved ones’ brain health. The Moffitt research is one example of the type of visionary science The Avielle Foundation is supporting and Terrie’s lab was the recipient of the 2016 Avielle Foundation Luminary Award. Please help us to support more research and to build bridges between the neurosciences and behavioral sciences. This is how we can imagine preventing violence and building compassion.

A. Caspi, R. M. Houts, D. W. Belsky, H. Harrington, S. Hogan, S. Ramrakha, R. Poulton, and T. E. Moffitt. Childhood forecasting of a small segment of the population with large economic burden.Nature Human Behaviour 1:0005, 2016.  http://www.nature.com/articles/s41562-016-0005

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