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Pages 1-14

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From page 1...
... However, the commi tree that is presenting thi s plan and related findings also cautions that the broad scope of the congressional charge far exceeds what is feasible in our present state of knowledge and that a more systematic effort that evolves over time is needed to derive consistent information on costs of environment-related health effects. Ways that environmental factors affect human health and well-being have attracted growing attention in recent years, with much illness and disease now believed to be associated with environmental factors.
From page 2...
... The Institute of Medicine undertook this planning study to faci litate the ongoing study' s proceeding in an orderly and use ful way. The planning study goals, as related to the organization of this report, were to 0 describe the basic information requirements necessary for the ongoing study and for the biennial reports [Chapters 2,3,4]
From page 3...
... The ongoing study should help generate, coordinate, and integrate environmental and health data for use in identi fair re 1 at i onshi ps among hea 1 th prob 1 ems and thei r environments 1 causes and to enable evaluation of the consequences in terms of health costs . Although this planning study primari ly emphasizes —3—
From page 4...
... Data integration and linkage among current large data collection activities should be encouraged, consistent with the protection of confidential information and individual privacy. o Developing health cost estimates The ongoing study should lead to improved data and methods for evaluating and expressing health costs in monetary terms, as well as in terms other than dollars, such as number of days ill.
From page 5...
... The approach should be to choose cases in which the etiologies are relatively well understood. These examples might serve: Health problems -- chronic respiratory disease, lung cancer, angiosarcoma, chronic disorders of the nervous system Pollutants -- asbestos, vinyl chloride, lead, nitrosoureas.
From page 6...
... The usefulness of the biennial reports will depend in part on how successfully the uncertainty is expressed.* As examples, public interest organizations, state and local officials, industry, labor, federal government officials, and researchers may use the data and reports for such specific purposes as setting policy, modifying work conditions, presenting a case in court, setting pollution emission standards, or planning a research pro ject .
From page 7...
... Whatever relationship is arranged, the TOM planning committee recommends an administrative arrangement that fixes responsibility and author) ty for the ongoing study in one clearly defined body.
From page 8...
... Improving Information for the Ongoing Study In addition to suggesting a framework and administrative arrangement for the ongoing study, this committee made recommendations to improve the data and methods needed to provide the estimates Congress requested. Recognizing that resources are scarce, the committee recommends that existing data systems be used to the fullest extent, and that they be modified or expanded where feasible to facilitate relating exposure to health outcome and associated health costs.
From page 9...
... Methods for more adequately assessing individual exposure should be explored. Although exposure episodes resulting from industrial accidents or chemicals leaking from toxic dumps should be prevented by all practicable means, these inadvertent events can sometimes provide useful information about health effects of environmental exposure.
From page 10...
... A li st of sentinel health events for occupational disease and illness should be developed to alert people to potentially preventable occupational health problems.
From page 11...
... Output accounting measures direct costs for medical expenses and indirect costs that correspond to lost output. Wi llingness-to-pay measures the resources individuals would forgo to reduce a risk of death or illness.
From page 12...
... The committee recommends steps to enhance the data available for estimating direct costs longitudinal survey of patients in a prospective study of costs by diagnosis should be begun. In addition to longi tudinal surveys, cross-sectional surveys of patients to determine utilization and costs of medical care should be considered as a source of information about direct costs and health effects.
From page 13...
... Net direct costs take into account future direct costs, appropriately discounted, that would have been incurred if the person had not died. Net direct costs of a disease or illness are the total direct costs minus the discounted value of the health costs for other health problems that would have been incurred if the person had survived.
From page 14...
... Recommendations for improving willingness-to-pay estimates of health costs associated with environmental hazards follow. Wage data used in willingness-to-pay estimates should be improved.


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