Online Journal of Health and Allied Sciences

Peer Reviewed, Open Access, Free Online Journal

Published Quarterly : Mangalore, South India : ISSN 0972-5997 This work is licensed under a
Volume 11, Issue 2; Apr-Jun 2012 Creative Commons Attribution-
No Derivative Works 2.5 India License

Review:
Role of Game Theory in Public Health
Author
Malhotra VM,
HQ 1 Armoured Division, C/O 56 Army Post Office, India
Address for Correspondence
Dr. VM Malhotra,
HQ 1 Armoured Division,
C/O 56 Army Post Office, India.
E-mail: varun_1955@yahoo.com
Citation
Malhotra VM. Role of Game theory in Public Health. Online J Health Allied Scs. 2012;11(2):2. Available at URL:
http://www.ojhas.org/issue42/2012-2-1.htm
Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
http://openmed.nic.in/view/subjects/ojhas.html
Submitted: May 10, 2012; Accepted: Jul 11, 2012; Published: Jul 25, 2012
Abstract: Game theory, a branch of applied mathematics has prisoners in separate cells and makes the following offer to each
been utilized by researchers in various fields including health to prisoner: if you will confess (strategy) to the robbery,
arrive at practical solutions to contemporary challenges. The implicating your partner, and he does not, then you will go free
article aims to introduce the subject to medical fraternity in India (pay-off) and he will get ten years. If you both confess, you will
and recommends that the theory should be included in the each get 5 years. If neither of you confess, then you will each get
syllabus of post graduate students of community medicine so two years for the auto theft. Here, punishments can be converted
that future generations of public health experts are aware of the into payoffs for each prisoner as 3 (free), 2 (2 years
theory and its potential use to find tangible solutions to public imprisonment), 1 (5 years imprisonment), and 0(10 years
health issues. imprisonment). The game can be represented as follows, where
Key Words: Game theory; Public Health. numerals written first in each cell reflects the payoffs to prisoner
A, while payoffs to prisoner B are mentioned subsequently.
Introduction:
Table 1: Prisoners Dilemma
Game theory is a branch of applied mathematics that provides
Prisoner B
tools for analyzing situations in which parties make decisions
that are interdependent. This interdependence causes each player Confess Refuses to confess
to consider the other players possible decisions, in formulating Confess 1,1 3,0
Prisoner A
his own. A game describes the optimal decisions of the players, Refuses to confess 0,3 2,2
who may have similar, opposed, or mixed interests, and the
Assuming that both prisoners are rational, each player will
outcomes that may result from these decisions.(1) Game theory
evaluate strategies available to him by comparing his payoffs,
has also been defined as a study of mathematical models of
for each possible action by his partner (now opponent). It is
conflict and cooperation between intelligent and rational
obvious that for player A the pay-offs are better if he confesses,
decision makers.(2) Although practical use of Game theory can
irrespective of whatsoever strategy his opponent chooses.
be found throughout history, the credit of its invention goes to
Obviously, he would confess. Prisoner B, meanwhile, evaluates
John von Neumann and Oskar Morgenstern(1944). Eight game-
his actions by comparing his payoffs and comes to exactly the
theorists have won the Nobel Prize in Economics, and John
same conclusion. In the PD, therefore, confessing dominates
Maynard Smith was awarded the Crafoord Prize for his
(called dominant strategy) the refusing for both players. Thus,
application of game theory to biology.(3)
both players will confess, and go to prison for 5 years, neither
Essential ingredients of a game the best nor the second best payoff for either of them.(4)
Players are the decision makers in the game; a player can Game theory has been extensively used in economics, business
be an individual, group, institution or population. and management. Political scientists, psychologists, biologists,
Strategies are the courses of action open to the players in a sport coaches, military strategists and software programmers
game. have made use of the theory to come to conclusions that are
more beneficial in the real world. In medical sciences, the theory
Payoffs are the final returns to players, which are usually has been applied in almost all specialties including
stated in terms that are objectively understood by each
pharmacology (5), physiology (6) pathology (7), sports medicine
player of the game.
(8), psychiatry (9), medical logistics (10), clinical medicine (11)
Prisoners dilemma: An Illustrative Game and clinical decision-making.(12,13)
One of the most popular games is prisoner's dilemma. The police Game theory and Public Health
have arrested two robbers (players) whom they know have
The application of game theory in public health is most relevant
committed an armed robbery together. Unfortunately, the police
when the actions of individuals or groups affect the health of
lack enough admissible evidence to get a conviction. They
others. On some occasions, individual or group strategies for
however do have evidence to send each prisoner away for two
betterment lead to inferior outcomes for the greater population.
years for theft of the getaway vehicle. The inspector locks the

1
Using game theory to model public health problems is not
different from using it to model any other type of problem or
decision-making scenario.
The Swamp: Extension of Prisoners dilemma
Consider a situation in which a swamp is located between two
villages, Rampur and Sitapur. The mosquito breeding in the
swamp is responsible for considerable morbidity due to malaria
and other mosquito borne diseases. The problem can be
remedied permanently by environmental measures ie filling the
swamp. However, people of neither village are willing to act first
because no incentives exist to take on the hard labour of leveling
the swamp.
Table 2: The Swamp - Extension of Prisoners dilemma
Village Sitapur
Contribute Not contribute
Contribute 1,1 0,2
Village Rampur
Not contribute 2,0 0,0
Similar to the game of Prisoners dilemma, the dominant
strategy in this situation for villagers of both Sitapur and Rampur
is not to act. The swamp survives; the worst outcome from
public health point of view. Environmentalists can relate this
game to innumerable real life situations. For example, is the
attitudes of individuals, societies and even Nations towards the
problem of global warming not akin to behaviour of Sita and
Rampurians?
Rubella Vaccination: Anotherillustration of use of Game theory
in Public Health is arriving at policy decision regarding Rubella
vaccine. Rubella is a highly contagious childhood disease that
causes relatively mild symptoms. However, the infection causes
severe congenital defects, known as congenital rubella syndrome
(CRS), if transmitted from a mother to fetus. Consequently,
women have higher incentive to vaccinate against rubella than
men do. While the vaccination protects the vaccinated, but also
increases the average age of infection, which in case of rubella
would increase the risk of CRS among unvaccinated females. To
evaluate the interplay among these factors, the Game theorists
developed an epidemiological model of rubella transmission and
vaccination, and found that high levels of vaccination for both
genders are most effective in maximizing average utility across
the population by decreasing the risk of CRS. The results
suggested that the rubella vaccination by males on voluntary
basis would be far lower than the population optimum, if rubella
vaccine were offered separately, instead of combined with
measles and mumps vaccination as the MMR vaccine.(14)
Other areas of public health where game theory has been applied
to obtain tangible solution to public health issues include role of
social distancing in control of an epidemic (15), sustaining
effective coalitions between public and private health care
facilities (16), medical ethics (17), organ donation (18), bio-
terrorism (19), medical-resource development (20), and
improving acceptability of primary health care.(21) In general,
Game theory provides a strong modeling device for public health
professionals and illustrates the need of public intervention when
the incentives of individuals impede progress for the group.
Conclusion
Community medicine specialists in India are generally unaware
of Game theory and its potential use in public health and
biomedical research. It is recommended that the subject of Game
theory be introduced to post-graduate students of Community
Medicine. It would empower the new generations of public
health experts with this tool that has the potentials to suggest
logical solutions to public health issues. We, the community
health educationists should realize that our pay-offs are better if
the game is played early.
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