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Issues in the economic evaluation of the health impacts of climate change

This search focuses on the economic evaluation of the health impacts of climate change. It explores the health consequences, population affected, prevention and management strategies, and the costs involved. Topics include adaptation costs, mortality, morbidity, quality of life, and uncertainty. The search also highlights the importance of considering multiple stakeholders, timeframes, and credible evidence.

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Issues in the economic evaluation of the health impacts of climate change

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  1. Issues in the economic evaluation of the health impacts of climate change SEARCHWashington, DCDecember 15, 2009 Alain Fontaine

  2. Decisions • Once we know: • What the health consequences will or may be • How many people will be affected, who, where and when • What can be done to prevent (need to understand causes) / manage these consequences • The key questions are: • Is it worth doing something about it? • Can we afford to do it? (and to do what?)(Can we afford not to do it?)

  3. Basic principles for economic evaluations (1) • Specify perspective(s): for whom (and for what decision) is the analysis performed? • Different costs (resources) and effects included • Distribution issues : equity / sustainability • Specify relevant time frame: • Timing of interventions / effects • Delayed / lasting effects

  4. Basic principles for economic evaluations (2) • Identify / quantify health effects: • What / How much ? • How much attributable to environmental changes (to causes that we may do something about) ? • Identify / quantify relevant intervention costs: • Investments (non specific) • Recurring costs / resources used

  5. Basic principles for economic evaluations (3) • Assign economic value: • Resources : direct / indirect / opportunity • Effects : indirect / intangible • Consider time preferences: • Present value of future events / resources • Present value for future generations? • Address uncertainty: • Scenarios • Modeling • Sensitivity analysis

  6. Adaptation costs(Ebi, 2007; Ebi, 2008 ; Kovats, 2008) • Under 3 climate change scenarios (emissions reductions) • Estimate additional incidence, mortality and burden of disease for diarrhoeal diseases, malnutrition and malaria. • Apply costs of individual prevention / treatment • Under a series of assumptions, projected excess costs in 2030 range from: • 3.3 to 10.7 billions US$ if emissions reductions lead to stabilization at 550 ppm CO2 equivalent by 2170 • 5.9 to 18 billions US$ if unmitigated emissions trends. • (Conservative) estimate of financial needs

  7. Heat Wave in France (1)(August 2003) • 15 000 excess deaths (82% ≥ 75 years old)

  8. Heat Wave in France (2)(August 2003)

  9. Examples (1) (Taylor et al., 2006)

  10. Examples (2) (Amalric et coll., 2007)

  11. Examples (3) (Amalric et coll., 2007)

  12. Two questions • How much are we willing / able to allocate to avoid undesired consequences? • Value of consequences • Value of resources required • How much will we need to manage undesired consequences? • Investments • Resources to be consumed

  13. Measuring / Valuing health outcomes • Mortality • Morbidity • Quality of life • Preferences • Health states • Demographic / social groups • DFLE • HLY • QUALYs • DALYs • Willingness to pay • …

  14. A complex system (Dahlgren and Whitehead, 1993)

  15. With multiple interactions… (Evans and Stoddard, 1990)

  16. Uncertainty • Develop scenarios • Modeling • Sensitivity analysis • Explicit assumptions / discussion of limits

  17. Precautionary principle (Constitution de la République Française) « Lorsque la réalisation d'un dommage, bien qu'incertaine en l'état des connaissances scientifiques, pourrait affecter de manière grave et irréversible l'environnement, les autorités publiques veillent, par application du principe de précaution et dans leurs domaines d'attributions, à la mise en œuvre de procédures d'évaluation des risques et à l'adoption de mesures provisoires et proportionnées afin de parer à la réalisation du dommage. » Can be overstated … (Conseil d’État, 1998): • « … il ne lui suffit pas de conformer sa conduite à la prise en compte des risques connus. Il doit en outre apporter la preuve, compte tenu de l’état actuel de la science, de l’absence de risque. »

  18. Time and people Stakeholders Time Over the next 2 years Over the next 5-10 years 20 years from now 50 years from now … • Policy makers • Distribution of the resources / efforts required • Distribution of health consequences

  19. Credible / Timely / Responsive Evidence

  20. Getting it together …

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