Cost of Environmental-Related Health Effects A Plan for Continuing Study (1981) / Chapter Skim
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Chapter 1: Introduction
Chapter 1: Introduction
Pages 15-36
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From page 15... ...
a 1 bene f i ts.6-8 In an effort to improve estimations of benefits, Congress enacted Public Law 95-623, the Health Services Research, Health Statistics, and Health Care Technology Act of 1978.9 Section 7 calls for an "ongoing" study designed to improve the information on and methodologies for estimating costs of illness caused by harmful environmental exposures and for estimating benefits of improvements in the environment. The benefits of concern are improved health and decreased costs of illness.
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Major goals of the planning study were to o describe the basic information requirements necessary for - the ongoing study and for the biennial reports o provide a framework for the ongoing study and an assessment of the feasibility of meeting the various requirements of the law o recommend administrative arrangements for carrying out the ongoing study -16
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Historical Background: Estimating Benefits of Environmental Regulations A brief review of the recent history of environmental regulation indicates the need for benefit estimates.ll The decades of the 1950s, 1960s, and especially the 1970s were periods of major federal legislative activity to control potential environmental hazards, particularly pollutants.6 Appendix B briefly describes major federal environmental statutes. In the periods preceding enactment of virtually all of these laws, data were gathered to define the magnitude of the environmental problem and, in many cases, its qualitative association with health.
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The data collection systems that evolved from the various pieces of legislation met at least partially the needs for which they were intended, but they were not set up to relate health effects to environmental measures.14 Beneficial health effects were assumed, but not measured.l5 Also, there was no particular attempt made to evaluate costs of these regulations, or to develop cost/benefit estimates. For example, the OSHA Act specifically excludes cost as a reason for obtaining a variance from some provisions of the law.16 Now, however, increased concern with costs of illness and costs of environmental regulations has led Congress to seek evidence for health benefits of these regulatiOns.17,18 Although the legislation calling for this planning study refers to reducing health costs, the aim also can be considered in terms of health bene fi ts that would result from reducing environmental hazards.
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quantify (i) the present and projected future health costs of the diseases and effects identified under subparagraph (B)
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Sources and Dispersion of Substances Boxes 1 and 2 in the figure represent information related to the sources of a substance and the amounts of it or its derivatives entering the various parts of the environment. Much of this information comes from environmental monitoring activities carried out in response to regulatory requirements.24 Monitoring information is useful for determining pathways of exposure and for taking steps to decrease exposures arising from human activities.*
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Health problems Cancer Cardiovascular problems Respiratory problems Heritable defects Other 5. ESTIMATING COSTS OF ILLNESS Medical costs Physicians Hospitalization Drugs Lost productivity Lost workdays Bed days Home expenses Pain and suffering Years of life lost Other
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Difficulties in determining these costs are caused by the extensive variety of costs that the law wants evaluated and by the requirement that future health costs, as well as present ones, be quantified. Furthermore, the reduction in health costs that would result from incremental reductions in pollutants and other hazards must be ascertained.
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approach developed by Cooper and Rice,34 cost of illness studies estimate direct and indirect health costs. Direct costs are medical care expenses, such as those for hospitalization and physi clans .35 ~ 35 Total direct medical care costs are fairly readily estimated and allocated among the various health services and supplies.
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Y ~ ~n~ mm ~ ¢: _ u, ~ 0 ~o ~ ~ e4 ~ ~ ~ ~ u~ O Iq 0 1 1 ~ ~ - o 4~ ~ o .
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95-623. Early Phases of the Ongoing Study Because the ongoing study cannot cover all environmental hazards, health effects, and costs in each biennial report, this planning study suggests criteria for choosing topics that might receive the greatest attention, although the ongoing study will have to set more explicit priorities.
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The committee suggests that initial emphasis be given to adverse health consequences of involuntary exposures resulting from man-made changes in the physical and chemical composition of the environment, including some effects of noise and radiation. Consideration of life-style factors, such as diet, exercise, smoking, and alcohol consumption, would largely be deferred, as would the social environment, accidents, most aspects of infectious diseases, and side effects of therapeutic actions.
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Although exposure to alcohol and cigarette smoke is partially voluntary, there are many cases of involuntary exposure. For instance, exposure of the fetus is involuntary, and smoking and alcohol consumption each adversely affect fetal growth and development.2,43~45 Synergistic effects between smoking and exposure to other environmental hazards magnify harmful effects.46~47 Furthermore, recent studies indicate that measurable physiologic changes occur in non-smokers in an environment with smokers.48~51 The committee would not propose to deal with all cigarette and alcohol problems, but only with those aspects that relate to involuntary exposure and to potentiating effects of other conditions.
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In a related matter, effects of medical radiation would not receive early consideration, in contrast to effects of other human activities, such as use of nuclear power, that may increase background radiation. However, total radiation exposure is relevant for assessing health consequences.
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9. Health Care Services Research, Health Statistics, and Health Care Technology Act of 1978.
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Report by the Committee on Interstate and Foreign Commerce, to accompany HR 12584, the Health Services Pesearch, Health Statistics, and Health Care Technology Act. Report No.
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26. Council on Environmental Quality, Toxic Substances Strategy Committee.
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Paper prepared for the Public Health Service Task Force on Cost of Illness Studies. Unpublished.
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Monthly Vital Statistics Report, Advance Report Volume 29, No. 6, Supplement 2.
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Allele increasing susceptibility to human breast cancer may be linked to the glutamate-pyruvate transaminase locus. Science 208 406-408, 1980.
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