Health effects costs of particulate air pollution

Value Assessment of Health Losses Caused by PM2.5 in Changsha City, China

With the advancement of urbanization, the harm caused to human health by PM2.5 pollution has been receiving increasing attention worldwide. In order to increase public awareness and understanding of the damage caused by PM2.5 in the air and gain the attention of relevant management departments, Changsha City is used as the research object, and the environmental quality data and public health data of Changsha City from 2013 to 2017 are used. All-cause death, respiratory death, cardiovascular death, chronic bronchitis, and asthma were selected as the endpoints of PM2.5 pollution health effects, according to an exposure-response coefficient, Poisson regression model, and health-impact-assessment-related methods (the Human Capital Approach, the Willingness to Pay Approach, and the Cost of Illness Approach), assessing the health loss and economic loss associated with PM2.5. The results show that the pollution of PM2.5 in Changsha City is serious, which has resulted in extensive health hazards and economic losses to local residents. From 2013 to 2017, when annual average PM2.5 concentrations fell to 10 μg/m3, the total annual losses from the five health-effect endpoints were $2788.41 million, $2123.18 million, $1657.29 million, $1402.90 million, and $1419.92 million, respectively. The proportion of Gross Domestic Product (GDP) in the current year was 2.69%, 1.87%, 1.34%, 1.04% and 0.93%, respectively. Furthermore, when the concentration of PM2.5 in Changsha City drops to the safety threshold of 10 μg/m3, the number of affected populations and health economic losses can far exceed the situation when it falls to 35 μg/m3, as stipulated by the national secondary standard. From 2013 to 2017, the total loss under the former situation was 1.48 times, 1.54 times, 1.86 times, 2.25 times, and 2.33 times that of the latter, respectively. Among them, all-cause death and cardiovascular death are the main sources of health loss. Taking 2017 as an example, when the annual average concentration dropped to 10 μg/m3, the health loss caused by deaths from all-cause death and cardiovascular disease was 49.16% of the total loss and 35.73%, respectively. Additionally, deaths as a result of respiratory disease, asthma, and chronic bronchitis contributed to 7.31%, 7.29%, and 0.51% of the total loss, respectively. The research results can provide a reference for the formulation of air pollution control policies based on health effects, which is of great significance for controlling air pollution and protecting people's health.

Health damage assessment of particulate matter pollution in Jing-Jin-Ji region of China

Jing-Jin-Ji is the largest and most dynamic economic region in northern China, and its air pollution has attracted much public attention. Scientific evaluation of health losses caused by air pollution can provide decision-making basis for formulation and improvement of pollution reduction policies in the Jing-Jin-Ji region. This paper estimated the adverse effects of particulate matter pollution on health in the Jing-Jin-Ji region in 2016 by using logarithmic linear exposure-response function, and monetized the health effects by adjusting human capital method and disease cost method. The results show non-ignorable health hazards and economic impacts caused by atmospheric particulate pollution. The economic losses relevant to health hazards by PM2.5 in the Jing-Jin-Ji region are 122.40 billion yuan, and those relevant to PM10 are 118.34 billion yuan, accounting for 1.62% and 1.56% of the region's GDP, respectively. Similar evaluations previously conducted in other countries yielded figures within the same order of magnitude. Considering the difference in economic losses per unit among disease types, the economic losses caused by air pollution in the Jing-Jin-Ji region mainly come from premature deaths. Infants and elderly people are the main victims of particulate matter. Affected by population, pollutant concentration, industrial structure, and other factors, the economic losses of particulate matter pollution in Beijing, Tianjin, Shijiazhuang, Tangshan, and Baoding are large. In order to reduce health hazards and economic impacts caused by particulate matter pollution, this paper put forward to guide the urban population diversion, reduce the outgoing frequency of susceptible groups such as infants and the elderly in haze weather, adopt high-efficiency particulate matter air purifier indoors, and develop public transportation to reduce motor vehicle exhaust emissions. In Tianjin and Hebei, promoting cleaner production in industries such as steel and cement and reducing coal use in the power industry are also suggested.

A review on health cost accounting of air pollution in China

Over the last three decades, rapid industrialization in China has generated an unprecedentedly high level of air pollution and associated health problems. Given that China accounts for one-fifth of the world population and suffers from severe air pollution, a comprehensive review of the indicators accounting for the health costs in relation to air pollution will benefit evidence-based and health-related environmental policy-making. This paper reviews the conventional static and the new dynamic approach adopted for air pollution-related health cost accounting in China and analyzes the difference between the two in estimating GDP loss. The advantages of adopting the dynamic approach for health cost accounting in China, with conditions guaranteeing its optimal performance are highlighted. Guidelines on how one can identify an appropriate approach for health cost accounting in China are put forward. Further, we outline and compare the globally-applicable and China-specific indicators adopted by different accounting methodologies, with their pros and cons being discussed. A comprehensive account of the available databases and methodologies for health cost accounting in China are outlined. Future directions to guide health cost accounting in China are provided. Our work provides valuable insights into future health cost accounting research in China. Our study has strengthen the view that the dynamic approach is comparatively more preferred than the static approach for health cost accounting in China, if more data is available to train the dynamic models and improve the robustness of the parameters employed. In addition, future dynamic model should address the socio-economic impacts, including benefits or losses of air pollution polices, to provide a more robust policy picture. Our work has laid the key principles and guidelines for selecting proper econometric approaches and parameters. We have also identified a proper estimation method for the Value of Life in China, and proposed the integration of engineering approaches, such as the use of deep learning and big data analysis for health cost accounting at the fine-grained level (city-district or sub-regional level). Our work has also identified the gap for more accurate health cost accounting at the fine-grained level in China, which will subsequently affect the quality of health-related air pollution policy decision-making at such levels, and the health-related quality of life of the citizens in China.

Economic evaluation of the air pollution effect on public health in China's 74 cities

Air deterioration caused by pollution has harmed public health. The existing studies on the economic loss caused by a variety of air pollutants in multiple cities are lacking. To understand the effect of different pollutants on public health and to provide the basis of the environmental governance for governments, based on the dose-response relation and the willingness to pay, this paper used the latest available data of the inhalable particulate matter (PM10) and sulphur dioxide (SO2) from January 2015 to June 2015 in 74 cities by establishing the lowest and the highest limit scenarios. The results show that (1) in the lowest and highest limit scenario, the health-related economic loss caused by PM10 and SO2 represented 1.63 and 2.32 % of the GDP, respectively; (2) For a single city, in the lowest and the highest limit scenarios, the highest economic loss of the public health effect caused by PM10 and SO2 was observed in Chongqing; the highest economic loss of the public health effect per capita occurred in Hebei Baoding. The highest proportion of the health-related economic loss accounting for GDP was found in Hebei Xingtai. The main reason is that the terrain conditions are not conducive to the spread of air pollutants in Chongqing, Baoding and Xingtai, and the three cities are typical heavy industrial cities that are based on coal resources. Therefore, this paper proposes to improve the energy structure, use the advanced production process, reasonably control the urban population growth, and adopt the emissions trading system in order to reduce the economic loss caused by the effects of air pollution on public health.

A method to assess the potential effects of air pollution mitigation on healthcare costs

Objective. The aim of this study was to develop a method to assess the potential effects of air pollution mitigation on healthcare costs and to apply this method to assess the potential savings related to a reduction in fine particle matter in Denmark. Methods. The effects of air pollution on health were used to identify “exposed” individuals (i.e., cases). Coronary heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer were considered to be associated with air pollution. We used propensity score matching, two-part estimation, and Lin's method to estimate healthcare costs. Subsequently, we multiplied the number of saved cases due to mitigation with the healthcare costs to arrive to an expression for healthcare cost savings. Results. The potential cost saving in the healthcare system arising from a modelled reduction in air pollution was estimated at €0.1–2.6 million per 100,000 inhabitants for the four diseases. Conclusion. We have illustrated an application of a method to assess the potential changes in healthcare costs due to a reduction in air pollution. The method relies on a large volume of administrative data and combines a number of established methods for epidemiological analysis.

Societal costs of air pollution-related health hazards: A review of methods and results

This paper aims to provide a critical and systematic review of the societal costs of air pollution-related ill health (CAP), to explore methodological issues that may be important when assessing or comparing CAP across countries and to suggest ways in which future CAP studies can be made more useful for policy analysis. The methodology includes a systematic search based on the major electronic databases and the websites of a number of major international organizations. Studies are categorized by origin - OECD countries or non-OECD countries - and by publication status. Seventeen studies are included, eight from OECD countries and nine from non-OECD countries. A number of studies based on the ExternE methodology and the USA studies conducted by the Institute of Transportation are also summarized and discussed separately. The present review shows that considerable societal costs are attributable to air pollution-related health hazards. Nevertheless, given the variations in the methodologies used to calculate the estimated costs (e.g. cost estimation methods and cost components included), and inter-country differences in demographic composition and health care systems, it is difficult to compare CAP estimates across studies and countries. To increase awareness concerning the air pollution-related burden of disease, and to build links to health policy analyses, future research efforts should be directed towards theoretically sound and comprehensive CAP estimates with use of rich data. In particular, a more explicit approach should be followed to deal with uncertainties in the estimations. Along with monetary estimates, future research should also report all physical impacts and source-specific cost estimates, and should attempt to estimate 'avoidable cost' using alternative counterfactual scenarios.

Cost-of-illness studies : a review of current methods

The number of cost-of-illness (COI) studies has expanded considerably over time. One outcome of this growth is that the reported COI estimates are inconsistent across studies, thereby raising concerns over the validity of the estimates and methods. Several factors have been identified in the literature as reasons for the observed variation in COI estimates. To date, the variation in the methods used to calculate costs has not been examined in great detail even though the variations in methods are a major driver of variation in COI estimates. The objective of this review was to document the variation in the methodologies employed in COI studies and to highlight the benefits and limitations of these methods. The review of COI studies was implemented following a four-step procedure: (i) a structured literature search of MEDLINE, JSTOR and EconLit; (ii) a review of abstracts using pre-defined inclusion and exclusion criteria; (iii) a full-text review using pre-defined inclusion and exclusion criteria; and (iv) classification of articles according to the methods used to calculate costs. This review identified four COI estimation methods (Sum_All Medical, Sum_Diagnosis Specific, Matched Control and Regression) that were used in categorising articles. Also, six components of direct medical costs and five components of indirect/non-medical costs were identified and used in categorising articles.365 full-length articles were reflected in the current review following the structured literature search. The top five cost components were emergency room/inpatient hospital costs, outpatient physician costs, drug costs, productivity losses and laboratory costs. The dominant method, Sum_Diagnosis Specific, was a total costing approach that restricted the summation of medical expenditures to those related to a diagnosis of the disease of interest. There was considerable variation in the methods used within disease subcategories. In several disease subcategories (e.g. asthma, dementia, diabetes mellitus), all four estimation methods were represented, and in other cases (e.g. HIV/AIDS, obesity, stroke, urinary incontinence, schizophrenia), three of the four estimation methods were represented. There was also evidence to suggest that the strengths and weaknesses of each method were considered when applying a method to a specific illness. Comparisons and assessments of COI estimates should consider the method used to estimate costs both as an important source of variation in the reported COI estimates and as a marker of the reliability of the COI estimate.

A case study of spatial variation and enrichment of selected elements in ambient particulate matter around a large coal-fired power station in central India

The dominant use of coal in power sectors has been associated with adverse environmental impacts. Ambient air monitoring for the two size fractions of particulate matter, respirable suspended particulate matter (RSPM) and non-respirable suspended particulate matter (NRSPM) in the downwind and upwind directions of a large coal-fired power station in central India, was carried out. Collected samples of ambient particulate matter were analysed atomic absorption spectrophotometrically for 15 elements. Spatial variability in elemental composition of RSPM and NRSPM and the degree of enrichment of these toxic metals in RSPM were investigated. A significant spatial variability for the elements in RSPM and NRSPM and higher degrees of enrichment of the elements were observed.

Association between traffic volume and health care use for asthma among residents at a U.S.-Canadian border crossing point

Little information is available about health impacts of the North American Free Trade Agreement (NAFTA) traffic-related pollution on residents near the major traffic corridors along the U.S.-Canadian border. Here we report on a 10 year (1991-2000) retrospective study of commercial traffic volumes across the Peace Bridge and health care use for asthma in a residential community, which serves as a conduit for traffic crossing between Fort Erie, Ontario, Canada, and Buffalo, New York. We hypothesized that commercial traffic pollution was impacting on residents in close proximity to the trade corridor. Commercial traffic volumes, hospital discharges for asthma, and outpatient visits to area hospitals and clinics were analyzed before and after implementation of NAFTA. Results showed a positive association between increased commercial traffic volume and increased health care use for asthma. Zip codes 14201 and 14213, which surround the Peace Bridge Plaza Complex (PBC), had the highest prevalence rates and health care use rates for asthma. Statistical analysis showed the findings to be significant (p < 0.05) in that residential proximity to the PBC was associated with greater hospital discharge rates for asthma. The findings were strongest (p < 0.000) in the zip codes where the PBC was located (14213) and the major highway I-190 passed through (14201). A yearly excess of 230.2 adult asthma hospital discharges was associated with an increase in traffic volume during the period from 1991 to 1996 in the study area. This is in contrast to an overall decrease in the national rate of hospitalizations for asthma by 7.5% in the same period. The results suggest that NAFTA-related commercial traffic has a negative health impact on asthmatics living in close proximity to the trade corridor. Health and social costs due to traffic pollution need to be included in cost estimates of transport decisions related to the NAFTA corridors. Similar health effects due to NAFTA traffic need to be studied at other U.S.-Canada border crossing points.

Assessing the benefit and cost for a voluntary indoor air quality certification scheme in Hong Kong

A voluntary indoor air quality certification scheme has been proposed in Hong Kong for assessing and evaluating the indoor air quality level in a variety of public places like offices, restaurants and pubs. The scheme intends to promote the public well being, however, its technical and financial practicality has led to serious discussions among the government officials, practitioners and premises owners. Accordingly, this study intends to develop a protocol for examining its financial viability by linking the appropriate dose-response and economic data with the results from indoor micro-environment models. The financial viability of the scheme is evaluated by examining the cost and benefit associated with compliance on the different prescribed indoor particulate (PM10) levels. According to our analysis, the indoor action level of 180 microg/m3 as 8-h mean (with the objective of protecting the health of general public) does not require office owners to improve beyond the base setting. Nevertheless, owners should consider altering the base settings in their air conditioning systems so as to secure more benefit on every dollar they spent. On the contrary, the 20 microg/m3 level as 8-h mean (with the objective of providing comfort) is not considered to be financially viable for office owners as they will incur financial loss on compliance. Subsequent sensitivity analysis indicates that the total net benefit derived have a great dependency on the value-of-life estimates used. If conservative health estimates are adopted, the optimum level determined to be beneficial to both owners and the society will be 55 microg/m3, which can be obtained by operating the air conditioning system with a ventilation rate of 10 l/s, primary filters of 80-85% efficiency and secondary filters efficiency of 60-65% arrestance. This information should be extremely valuable for government officials and policy makers in assessing the financial viability of the voluntary indoor assessment scheme.

Single pollutant versus surrogate measure approaches: do single pollutant risk assessments underestimate the impact of air pollution on lung cancer risk?

Cancer risk as a result of air pollution may be quantified by different approaches. We compared the sum of unit risk based effects of single pollutants with an epidemiology-based method by using PM(10) as a surrogate of the total air pollution. The excess rate for lung cancer cases attributable to an increase of 10 microg/m3 in average PM(10) exposure was estimated from available cohort studies. Applying the epidemiology-based risk method to the air pollution situation in the Basel area (Switzerland) resulted in 13.3 (95% CI = 6.9-19.8) excess lung cancer cases per 100,000 person years. This estimate was considerably higher than the unit risk-based estimate yielding 1.1 (range, 0.45-2.8) cancer cases per 100,000 person years. We discuss these discrepancies in light of inherent differences between approaches in toxicology and epidemiology.