Cost of Environmental-Related Health Effects A Plan for Continuing Study (1981) / Chapter Skim
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Chapter 6: Conclusions and Recommendations
Chapter 6: Conclusions and Recommendations
Pages 133-168
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From page 133... ...
Major deficiencies in data bases, methodologies, administrative procedures, and, most important, theoretical knowledge for relating environmental hazards to health problems and their associated health costs have precluded earlier straightforward assembly of the information needed. Therefore, the committee proposes a series of phased activities for the ongoing study, including case studies, methodological and operational research, and evaluative efforts, to develop the required data bases and strategies for analyzing them.
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From page 134... ...
In attempting to estimate the health costs mentioned in the law, the ongoing study can provide a focus for developing methodologies and data for assessing benefits of steps that could reduce environmental hazards.
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From page 135... ...
1. Integrating available data The ongoing study should help to generate, coordinate, and integrate environmental and health data for use in identifying relationships among health problems and their environmental causes, and to enable evaluation of the consequences in terms of health costs.
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From page 136... ...
4. Encouraging research Efforts to associate environmental factors with resulting health problems quantitatively, and to estimate all the associated health costs, are in early stages of development.
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From page 137... ...
The committee recognizes that "voluntary" and "involuntary" exposures span a continuum with no sharp distinction between the two.* Nevertheless, the committee recommends that the ongoing study initially focus primarily on the health effects and costs resulting from relatively involuntary exposures to physical and chemical agents deriving from human activity.
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From page 138... ...
To determine the reduction in health costs from incremental reductions in a particular environmental hazard, relevant entries from the four types of tables would be appropriately multiplied together and additional necessary computations performed. This scheme is idealized; much of the needed information is not available now.
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From page 139... ...
A Reviewing What Is Known The conceptual framework described earlier will be used to identify and assess information on the sources and amounts of pollutants, levels of human exposure to these environmental hazards, the health effects resulting from such exposures, and costs of the health effects of such pollutants.
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From page 140... ...
Until concrete cases have been developed, the appraisal of health costs will continue to be a theoretical exercise of little or no value for action. When many case studies are available, the resulting data on comparative health costs will help policymakers decide where the national effort can best be distributed.
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From page 141... ...
Cost estimates would be attempted in both case studies. The goal would be to choose cases where the etiologies are relatively well understood so that data gaps could be identified, methodologies tried, and cost estimates attempted.
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From page 143... ...
The reports also would discuss methodologies and make recommendations. The committee believes that these reports would be responsive to the congressional charge to "identify deficiencies and limitations in the data on the matters under consideration," "recommend actions which may be taken to eliminate these deficiencies and limitations," and "include recommendations for facilitating studies of the effects of hazardous substances on humans...." The law also requires that the reports list various regulatory and related activities that federal agencies-are taking to reduce the identified health costs.
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From page 144... ...
Administrative Arrangements for the Ongoing Study P.L. 95-623 (Section 7(e)
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From page 145... ...
This planning committee strongly favors an administrative arrangement that would fix responsibility and authority for the ongoing study in one clearly defined body, presumably DHHS. This TOM planning committee recommends that the law be amended so that the NAS could serve in its customary advisory role, and DHHS could have primary responsibility for carrying out the ongoing study.
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From page 146... ...
The NAS/IOM committee may from time to time issue formal recommendations for data collection, especially on matters of importance or on which it is difficult to reach consensus, and these recommendations would be subject to the usual review procedures of the NAS. The Secretary of HIS would engage various parts of the Department and would cooperate with other government agencies, especially those designated in Section 7 (e)
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From page 147... ...
This planning committee emphasizes that whatever administrative arrangement is chosen should provide for participation by various -147
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From page 148... ...
Major efforts should be taken to improve our ability to relate environmental hazards to health outcome. This recommendation underlies virtually all the remaining statements in this section.
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From page 149... ...
Integrating and Linking Data Systems Data integration among current large data collection activities should be carried out so that health outcome data can be related to environmental exposure data. However, all such efforts must be consistent with the need to protect confidential information and individual privacy, while providing data on possible differences in response to environmental factors because of individual susceptibility.
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From page 150... ...
Health professionals, environmental professionals, economists, and others should contribute to and monitor the data collection and analyses. For example, if a system to monitor health effects of a particular occupational exposure is set up, the data collected should be sufficiently detailed to permit reliable cost estimates.
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From page 151... ...
Longitudinal studies, in which a population is followed through time, can record systematically changes in health status and environmental exposures. Careful evaluation of such groups, such as was done in Framingham to identify risk factors for cardiovascular disease, is useful for generating hypotheses that relate environmental factors to health outcome.
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From page 153... ...
Measuring Human Exposure Improved methods and measurements are necessary for determining human exposure to environmental hazards more accurately. Investigations should focus on determining ambient concentrations of various substances in locations where people spend time, and in determining individual exposures .
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From page 154... ...
Efforts to improve information on occupational exposures should be enhanced. A National Occupational Hazards Survey should be conducted at regular intervals and the results disseminated widely.
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From page 155... ...
ESTIMATING COSTS A major function of the ongoing study is to determine the costs of environment-related health effects, including the reduction in health costs that would result from stepwise reductions in pollutants and other hazards, and to suggest areas for future research in data sources and methodologies. This committee recognizes that costs may be expressed in terms other than dollars and that, ultimately, dollar estimates are derived from these other measures of the burden of illness.
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From page 156... ...
Health costs should be calculated by the use of both output-accounting and willingness-to-pay methods, to the extent feasible. In the first few biennial reports of the ongoing study, estimates of monetary losses due to morbidity and mortality associated with environmental factors should be presented using a range of fixed values drawn from existing studies for cost per death, cost per day of illness, and cost per year of life lost.
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From page 157... ...
Direct Costs Efforts should be undertaken to improve estimates of direct costs by incorporating additional data in the calculations. Additional data sources may improve direct cost estimates.
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From page 158... ...
In many respects, however, incidence-based costs are more logical and would give more appropriate information, as, for example, in estimating future health costs of environmental hazards and stepwise reductions in costs that could be achieved by stepwise reductions in hazards. Few incidence-based health cost studies exist, but a comparative analysis of prevalence- and incidence-based studies would provide evidence as to how closely prevalence costs approximate incidence costs in those instances that logically call for incidence costs.
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From page 159... ...
that would have been incurred if the person had not died. Net direct costs are the total direct costs minus the discounted value of the health costs that would have been incurred if the person had survived.
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From page 160... ...
As examples, NMCUES and NMCES are two surveys that will provide data, starting in 1981, on costs of disease and illness incurred by participants during one-year periods. Indirect Costs The development of indirect cost estimates poses problems that differ from those presented by direct costs.
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From page 161... ...
However, the calculation of indirect costs (and net direct costs) depends critically on the discount rate chosen.
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From page 162... ...
IS SUES RELATED TO COORDINATION AND PLANNING Efforts should be made to coordinate data resources among the many groups that have an interest in environment-related health effects and ensuing health costs, because such efforts will be mutua 1 ly bene f i c ia 1 . As an early activity of the ongoing study, mechanisms of communication should be established with the many groups that can either provide information re levant to the ongoing study, or use the data and reports provided by the study.
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From page 163... ...
Planning P.L. 95-623 calls for a broad study to determine the reductions in health costs that would result from incremental reductions in environmental hazards.
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From page 164... ...
Although some recommendations for improving analysis of existing data or for adding questions to existing surveys are not overly expensive, collecting new data and setting up new data systems require a long-term commitment of funds. In particular, longitudinal studies must be undertaken to study long-te`~ effects of environmental exposures, and such studies are expensive.
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From page 165... ...
The effects of genetic factors and other conditions that predispose individuals and groups to disease susceptibility need further exploration. Results of these studies could play a major role in strategies to prevent illness from exposure to environmental hazards.
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From page 166... ...
The ongoing study must incorporate sufficient flexibility to respond to changing needs and conditions. The ongoing study and biennial reports should serve a variety of purposes.
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From page 167... ...
Not only will information about relationships between environmental hazards and illness increase, but also analysts will be better able to assess the efficacy of actions designed to decrease harmful environmental health effects. By showing where efforts to modify the environment will yield the greatest health benefits, the ongoing study could provide a major impetus for preventing health problems.
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