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Chanel O, Cucchi I. Better accounting for long-term health effects in economic assessments: an illustration for air pollution in the Canton of Geneva. Public Health 2024; 233:31-37. [PMID: 38848618 DOI: 10.1016/j.puhe.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES We propose a general framework for estimating long-term health and economic effects that takes into account four time-related aspects. We apply it to a reduction in exposure to air pollution in the Canton of Geneva. STUDY DESIGN Methodological developments on the evaluation of long-term economic and health benefits, with an empirical illustration. METHODS We propose a unified framework-the comprehensive impact assessment (CIA)-to assess the long-term effects of morbidity and mortality in health and economic terms. This framework takes full account of four time-related issues: cessation lag, policy/technical implementation timeframe, discounting and time horizon. We compare its results with those obtained from standard quantitative health impact assessment (QHIA) in an empirical illustration involving air pollution reduction in the canton of Geneva. RESULTS We find that by neglecting time issues, the QHIA estimates greater health and economic benefits than the CIA. The overestimation is about 50% under reasonable assumptions and increases ceteris paribus with the magnitude of the cessation lag and the discount factor. It decreases both with the time horizon and with the implementation timeframe. CONCLUSION A proper evaluation of long-term health and economic effects is an important issue when they are to be used in cost-benefit analyses, particularly for mortality, which often represents the largest fraction. We recommend using the CIA to calculate more accurate values.
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Affiliation(s)
- O Chanel
- Aix-Marseille Univ, CNRS, AMSE, Marseille, France.
| | - I Cucchi
- Service de l'air, du bruit et des rayonnements non-ionisants, Département du Territoire, République et Canton de Genève, Genève, Switzerland
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Fan M, Jiang H, Zhou M. Beyond particulate matter: New evidence on the causal effects of air pollution on mortality. JOURNAL OF HEALTH ECONOMICS 2023; 91:102799. [PMID: 37634275 DOI: 10.1016/j.jhealeco.2023.102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/05/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
The increasing demand for electricity worldwide has caused a corresponding rise in the consumption of coal, leading to an increase in sulfur dioxide (SO2) pollution levels. Despite the severity of the issue, there is a lack of conclusive evidence establishing a causal link between SO2 pollution and health, particularly in developing countries. We leverage a large national environmental regulation policy, implemented in China to reduce SO2 emissions, to estimate the impacts of SO2 pollution on mortality. We find that 1-μg/m3 reduction in SO2 concentrations leads to 18 fewer cardiovascular deaths per 100,000 people aged 60 years and above (0.9% decrease) and 2 fewer deaths per 100,000 children under the age of 5 (1.5% decrease) annually. A back-of-the-envelope calculation suggests that the total health benefits of the environmental policy outweigh its economic costs. The results are consistent across various robustness checks.
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Affiliation(s)
- Maoyong Fan
- Department of Economics, Ball State University, USA.
| | - Hanchen Jiang
- Department of Economics, University of North Texas, USA.
| | - Maigeng Zhou
- Chinese Center for Disease Control and Prevention, China.
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Abe KC, Rodrigues MA, Miraglia SGEK. Health impact assessment of air pollution in Lisbon, Portugal. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2022; 72:1307-1315. [PMID: 36048722 DOI: 10.1080/10962247.2022.2118192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Lisbon has about 500,000 inhabitants and it's the capital and the main economic hub of Portugal. Studies have demonstrated that exposure to Particulate Matter with an aerodynamic diameter<2.5 μm (PM2.5) have strong association with health effects. Researchers continue to identify new harmful air pollutants effects in our health even in low levels. OBJECTIVES This study evaluates air pollution scenarios considering a Health Impact Assessment approach in Lisbon, Portugal. METHODS We have studied abatement scenarios of PM2.5 concentrations and the health effects in the period from 2015 to 2017 using the APHEKOM tool and the associated health costs were assessed by Value of Life Year. RESULTS The mean concentration of PM2.5 in Lisbon was 23 μg/m3 ± 10 μg/m3 (±Standard Deviation). If we consider that World Health Organization (WHO) standards of PM2.5 (10 μg/m3) were reached, Lisbon would avoid more than 423 premature deaths (equivalent to 9,172 life years' gain) and save more than US$45 million annually. If Lisbon city could even diminish the mean of PM2.5 by 5 μg/m3, nearly 165 deaths would be avoided, resulting in a gain of US$17 million annually. CONCLUSION According to our findings, if considered the worst pollution scenario, levels of PM2.5 could improve the life's quality and save a significant amount of economic resources.Implications: The manuscript addresses the health effects and costs of air pollution and constitutes an important target for improving public policies on air pollutants in Portugal. Although Portugal has low levels of air pollution, there are significant health and economic effects that, for the most part, are underreported. The health impact assessment approach associated with costs had not yet been addressed in Portugal, which makes this study more relevant in the analysis of policies aimed to drive stricter control on pollutants' emissions. Health costs are a fundamental element to support decision-making process and to orientate the trade-offs in investments for improving public policies so that to diminish health effects, which can impact the management of the local health services and the population's quality of life, especially after the pandemic period when resources are scarce.
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Affiliation(s)
- Karina Camasmie Abe
- Universidade Federal de São Paulo, Instituto de Ciências Ambientais, Químicas e Farmacêuticas - ICAQF, Laboratório de Economia, Saúde e Poluição Ambiental, São Paulo, Brazil
| | - Matilde Alexandra Rodrigues
- Centro de Investigação em Saúde Ambiental - CISA e Centro de Investigação em Reabilitação, Escola Superior de Saúde do Instituto Politécnico do Porto, Porto, Portugal
| | - Simone Georges El Khouri Miraglia
- Universidade Federal de São Paulo, Instituto de Ciências Ambientais, Químicas e Farmacêuticas - ICAQF, Laboratório de Economia, Saúde e Poluição Ambiental, São Paulo, Brazil
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Adélaïde L, Chanel O, Pascal M. Health effects from heat waves in France: an economic evaluation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:119-131. [PMID: 34304326 PMCID: PMC8310615 DOI: 10.1007/s10198-021-01357-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/13/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019. METHODS Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs. RESULTS Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion). CONCLUSION The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.
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Affiliation(s)
- Lucie Adélaïde
- Santé publique France (SpF), 12, rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Olivier Chanel
- Aix-Marseille Univ, CNRS, AMSE, 5 boulevard Maurice Bourdet CS50498, 13205, Marseille Cedex 01, France.
| | - Mathilde Pascal
- Santé publique France (SpF), 12, rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
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Barco S, Woersching AL, Spyropoulos AC, Piovella F, Mahan CE. European Union-28: An annualised cost-of-illness model for venous thromboembolism. Thromb Haemost 2017; 115:800-8. [DOI: 10.1160/th15-08-0670] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
SummaryAnnual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5–2.2 billion, €1.0–1.5 billion, €0.5–1.1 billion and €0.2–0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8–3.3 billion, €1.2–2.4 billion, €0.6–1.8 billion and €0.2–0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0–8.5 billion, €2.2–6.2 billion, €1.1–4.6 billion and €0.5–1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5–13.2 billion, €1.0–9.7 billion, €0.5–7.3 billion and €0.2–6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28’s healthcare systems and that significant savings could be realised if better preventive measures are applied.
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Falcón-Rodríguez CI, Rosas-Pérez I, Segura-Medina P. Relación de los mecanismos inmunológicos del asma y la contaminación ambiental. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n2.59954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Se calcula que más de 300 millones de personas alrededor del mundo padecen asma y se estima que para el año 2025 esta cifra se incremente a 400 millones debido a los contaminantes criterio. Sin embargo, dadas sus limitaciones, los estudios epidemiológicos son controversiales sobre la contaminación y el desarrollo de asma.Objetivos. Describir las diferencias y similitudes de la respuesta inmunológica de pacientes asmáticos y los modelos animales de asma alérgica después de la exposición a contaminantes criterio y elementos biológicos, para así identificar los factores inmunológicos relacionados con el desarrollo de asma.Materiales y método. Se realizó una búsqueda sistemática en las bases de datos sobre asma y los diferentes contaminantes criterio.Resultados. La respuesta Th2 es activada por la inhalación de ozono, dióxido de nitrógeno, azufre y la exposición aguda a material particulado, mientras que el contacto con ciertos tipos de pólenes y glucanos y la exposición crónica de partículas incrementa la respuesta Th1, la cual inhibe a la respuesta Th2 produciendo un “efecto protector”.Conclusiones. La respuesta Th1 podría causar baja o nula asociación entre la exposición a contaminación y el desarrollo de asma en las diferentes ciudades, adicionando de esta manera otra limitación a los estudios epidemiológicos.
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Air Quality Strategies on Public Health and Health Equity in Europe-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121196. [PMID: 27918457 PMCID: PMC5201337 DOI: 10.3390/ijerph13121196] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/02/2016] [Accepted: 11/25/2016] [Indexed: 12/04/2022]
Abstract
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review.
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Chanel O, Perez L, Künzli N, Medina S. The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:1101-1115. [PMID: 26649740 DOI: 10.1007/s10198-015-0748-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 11/11/2015] [Indexed: 05/20/2023]
Abstract
Public decision-makers commonly use health impact assessments (HIA) to quantify the impacts of various regulation policies. However, standard HIAs do not consider that chronic diseases (CDs) can be both caused and exacerbated by a common factor, and generally focus on exacerbations. As an illustration, exposure to near road traffic-related pollution (NRTP) may affect the onset of CDs, and general ambient or urban background air pollution (BP) may exacerbate these CDs. We propose a comprehensive HIA that explicitly accounts for both the acute effects and the long-term effects, making it possible to compute the overall burden of disease attributable to air pollution. A case study applies the two HIA methods to two CDs-asthma in children and coronary heart disease (CHD) in adults over 65-for ten European cities, totaling 1.89 million 0-17-year-old children and 1.85 million adults aged 65 and over. We compare the current health effects with those that might, hypothetically, be obtained if exposure to NRTP was equally low for those living close to busy roads as it is for those living farther away, and if annual mean concentrations of both PM10 and NO2-taken as markers of general urban air pollution-were no higher than 20 μg/m3. Returning an assessment of € 0.55 million (95 % CI 0-0.95), the HIA based on acute effects alone accounts for only about 6.2 % of the annual hospitalization burden computed with the comprehensive method [€ 8.81 million (95 % CI 3-14.4)], and for about 0.15 % of the overall economic burden of air pollution-related CDs [€ 370 million (95 % CI 106-592)]. Morbidity effects thus impact the health system more directly and strongly than previously believed. These findings may clarify the full extent of benefits from any public health or environmental policy involving CDs due to and exacerbated by a common factor.
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Affiliation(s)
- Olivier Chanel
- Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS, Greqam, 2 rue de la Charité, 13236, Marseille Cedex 02, France.
| | - Laura Perez
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sylvia Medina
- Département Santé Environnement, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415, Saint Maurice Cedex, France
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Abe KC, Miraglia SGEK. Health Impact Assessment of Air Pollution in São Paulo, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070694. [PMID: 27409629 PMCID: PMC4962235 DOI: 10.3390/ijerph13070694] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 12/04/2022]
Abstract
Epidemiological research suggests that air pollution may cause chronic diseases, as well as exacerbation of related pathologies such as cardiovascular and respiratory morbidity and mortality. This study evaluates air pollution scenarios considering a Health Impact Assessment approach in São Paulo, Brazil. We have analyzed abatement scenarios of Particulate Matter (PM) with an aerodynamic diameter <10 μm (PM10), <2.5 μm (PM2.5) and ozone concentrations and the health effects on respiratory and cardiovascular morbidity and mortality in the period from 2009 to 2011 through the APHEKOM tool, as well as the associated health costs. Considering World Health Organization (WHO) standards of PM2.5 (10 μg/m3), São Paulo would avoid more than 5012 premature deaths (equivalent to 266,486 life years’ gain) and save US$15.1 billion annually. If São Paulo could even diminish the mean of PM2.5 by 5 μg/m3, nearly 1724 deaths would be avoided, resulting in a gain of US$ 4.96 billion annually. Reduced levels of PM10, PM2.5 and ozone could save lives and an impressive amount of money in a country where economic resources are scarce. Moreover, the reduced levels of air pollution would also lower the demand for hospital care, since hospitalizations would diminish. In this sense, Brazil should urgently adopt WHO air pollution standards in order to improve the quality of life of its population.
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Affiliation(s)
- Karina Camasmie Abe
- Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Laboratório de Economia, Saúde e Poluição Ambiental, Universidade Federal de São Paulo-UNIFESP, Rua São Nicolau 210, Diadema, São Paulo CEP 09913-030, Brazil.
| | - Simone Georges El Khouri Miraglia
- Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Laboratório de Economia, Saúde e Poluição Ambiental, Universidade Federal de São Paulo-UNIFESP, Rua São Nicolau 210, Diadema, São Paulo CEP 09913-030, Brazil.
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Zúñiga J, Tarajia M, Herrera V, Urriola W, Gómez B, Motta J. Assessment of the Possible Association of Air Pollutants PM10, O3, NO2 With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis. Medicine (Baltimore) 2016; 95:e2464. [PMID: 26765444 PMCID: PMC4718270 DOI: 10.1097/md.0000000000002464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In recent years, Panama has experienced a marked economic growth, and this, in turn, has been associated with rapid urban development and degradation of air quality. This study is the first evaluation done in Panama on the association between air pollution and mortality. Our objective was to assess the possible association between monthly levels of PM10, O3, and NO2, and cardiovascular, respiratory, and diabetes mortality, as well as the seasonal variation of mortality in Panama City, Panama.The study was conducted in Panama City, using air pollution data from January 2003 to December 2013. We utilized a Poisson regression model based on generalized linear models, to evaluate the association between PM10, NO2, and O3 exposure and mortality from diabetes, cardiovascular, and respiratory diseases. The sample size for PM10, NO2, and O2 was 132, 132, and 108 monthly averages, respectively.We found that levels of PM10, O3, and NO2 were associated with increases in cardiovascular, respiratory, and diabetes mortality. For PM10 levels ≥ 40 μg/m3, we found an increase in cardiovascular mortality of 9.7% (CI 5.8-13.6%), and an increase of 12.6% (CI 0.2-24.2%) in respiratory mortality. For O3 levels ≥ 20 μg/m3 we found an increase of 32.4% (IC 14.6-52.9) in respiratory mortality, after a 2-month lag period following exposure in the 65 to <74 year-old age group. For NO2 levels ≥20 μg/m3 we found an increase in respiratory mortality of 11.2% (IC 1.9-21.3), after a 2-month lag period following exposure among those aged between 65 and <74 years.There could be an association between the air pollution in Panama City and an increase in cardiovascular, respiratory, and diabetes mortality. This study confirms the urgent need to improve the measurement frequency of air pollutants in Panama.
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Affiliation(s)
- Julio Zúñiga
- From the Gorgas Memorial Institute for Health Studies (JZ, VH, BG, JM); Centro de Biología Molecular y Celular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (MT); Región de Panamá Oeste, Caja de Seguro Social, Panama City, Panama (MT); and Institute of Specialized Analysis of the University of Panama, Miraflores, Panama City, Panama (WU)
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Martenies SE, Wilkins D, Batterman SA. Health impact metrics for air pollution management strategies. ENVIRONMENT INTERNATIONAL 2015; 85:84-95. [PMID: 26372694 PMCID: PMC4648637 DOI: 10.1016/j.envint.2015.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/11/2015] [Accepted: 08/24/2015] [Indexed: 05/24/2023]
Abstract
Health impact assessments (HIAs) inform policy and decision making by providing information regarding future health concerns, and quantitative HIAs now are being used for local and urban-scale projects. HIA results can be expressed using a variety of metrics that differ in meaningful ways, and guidance is lacking with respect to best practices for the development and use of HIA metrics. This study reviews HIA metrics pertaining to air quality management and presents evaluative criteria for their selection and use. These are illustrated in a case study where PM2.5 concentrations are lowered from 10 to 8μg/m(3) in an urban area of 1.8 million people. Health impact functions are used to estimate the number of premature deaths, unscheduled hospitalizations and other morbidity outcomes. The most common metric in recent quantitative HIAs has been the number of cases of adverse outcomes avoided. Other metrics include time-based measures, e.g., disability-adjusted life years (DALYs), monetized impacts, functional-unit based measures, e.g., benefits per ton of emissions reduced, and other economic indicators, e.g., cost-benefit ratios. These metrics are evaluated by considering their comprehensiveness, the spatial and temporal resolution of the analysis, how equity considerations are facilitated, and the analysis and presentation of uncertainty. In the case study, the greatest number of avoided cases occurs for low severity morbidity outcomes, e.g., asthma exacerbations (n=28,000) and minor-restricted activity days (n=37,000); while DALYs and monetized impacts are driven by the severity, duration and value assigned to a relatively low number of premature deaths (n=190 to 230 per year). The selection of appropriate metrics depends on the problem context and boundaries, the severity of impacts, and community values regarding health. The number of avoided cases provides an estimate of the number of people affected, and monetized impacts facilitate additional economic analyses useful to policy analysis. DALYs are commonly used as an aggregate measure of health impacts and can be used to compare impacts across studies. Benefits per ton metrics may be appropriate when changes in emissions rates can be estimated. To address community concerns and HIA objectives, a combination of metrics is suggested.
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Affiliation(s)
- Sheena E Martenies
- Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Donele Wilkins
- Green Door Initiative, 5555 Conner Street Suite 1017A, Detroit, MI 48213, USA
| | - Stuart A Batterman
- Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
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