Nobel laureate William Nordhaus called climate change “the ultimate challenge facing economics”. Arguably, climate change also poses a serious challenge to health economists.climate change may have negative health effects across multiple dimensions, including:
- Increased Pollution Negatively Affects Respiratory Diseases
- Increased intensity of natural disasters (e.g., hurricanes, wildfires) increases death toll
- Some pathogens may spread more easily in hotter climates
- Access to clean drinking water may become problematic as freshwater sources dry up.
- Mental health problems may emerge as anxiety over climate change rises
Few people recognize the healthcare sector as one of the main causes and beneficiaries of increased air pollution. De Preux and Rizmie (2018) Write:
The healthcare sector is one of the largest polluters in the UK, accounting for 25% of total public sector CO2 emissions.Ironically, it is the healthcare industry
itself is mainly affected by the deterioration of the environment that affects the health of individuals and their needs for healthcare. As such, the healthcare sector is a direct beneficiary of its own steps towards sustainability and is increasingly seen as the sector that should lead the way for change.
This paper proposes a simple modification of the standard cost-benefit approach to incorporate the carbon footprint of the technology into the cost-benefit analysis. Methodologically, this is done by examining carbon emissions (tons of CO2 per year) multiplied by the carbon price of a ton of CO2.
How other studies have incorporated climate change into health technology assessment (HTA) papers identified in scoping review Polisena et al. (2018). a key paper, Marsh et al. (2017)describes more formally and graphically how carbon emissions can be easily incorporated into HTA (see figure below).
Marsh et al. (2016) Some options for integrating climate change into CEA were also proposed. These include:
- Cost-benefit analysis. The above approach is an example of a cost-benefit analysis. Under CBA, all results are converted to currency. Therefore, environmental considerations can be easily implemented in CBA if the carbon emissions and carbon costs are known. CBA does have some limitations, as one needs a reliable estimate of the monetary value of carbon; moreover, CBA is not widely accepted by HTA agencies.
- direct health effects. Increased CO2 emissions and pollution lead to worse health outcomes, and these health effects are then translated into health-related measures of quality of life. The authors note that this approach can be problematic to implement. “Extreme work has been done to categorize empirical research on health effects of environmental outcomes. …[but further] Work is needed to determine the feasibility of using these data to estimate marginal health gains associated with marginal environmental improvements using one technology over another. “
- Macda. Policymakers are likely to value health gains and improved environmental outcomes. One way to balance these competing goals is to undertake a multi-criteria decision analysis (MCDA) framework. MCDA actually includes a variety of specific methods, such as: analytic hierarchy process, network analysis, multi-attribute utility theory, multi-attribute value theory, outranking, social multi-criteria evaluation, similarity between preference ranking technology and ideal solution. Furthermore, the use of MCDA in formal HTA assessments is currently limited.
To give a specific example, mHealth technologies can have positive or negative impacts on the environment. DeGavre et al. (2022) Note that emissions can be reduced as mobile health (mHealth) can help reduce travel time. However, mHealth requires additional power consumption.Furthermore, embedding information and communication technology (ICT) in other materials, such as textiles, may “create
Difficulties with local waste management processes, often requiring specific recycling procedures”. Furthermore, mHealth manufacturing processes may be more or less energy-intensive compared to alternative treatments.
Of course, this is an area that needs more additional research.
