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Air Pollution and Asthma
Methods to Estimate the Health Burden of Pollution
Sylvia Brandt
February 26, 2014
Center for Public Policy and Administration Department of Resource Economics
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Adapted from Kunzli, et al. Epidemiology. 2008; 19(2): 179-85 5
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NRP-cause asthma Other-cause asthma
Routine care Controller medication
Comorbidities episodes
Days with symptoms
NONE
Other-cause exacerbations
Bronchitis episodes
Hospital admissions & ER visits
Doctor visits
School absences
NONE
Regional pollution-caused exacerbations
Bronchitis episodes
Hospital admissions & ER visits
Doctor visits
School absences
Bronchitis episodes
Hospital admissions & ER visits
Doctor visits
School absences
Asthma-specific Outcomes
The Case of LAC � 2.5 million children (0-17)
� 12.57% prevalence in kids
� Pollution-attributable outcomes � 8% of asthma cases (27,100 cases) � 20% of hospitalizations � 11% ER visits � 12% MD visits � 31% of school-absences � 57% bronchitis
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Categories of Costs � Direct costs
� Associated price tag (explicit price) � Cost of inhalers � MD visits, ER visits
� Indirect costs � Opportunity costs (implicit price)
� Missed work, missed school � Reduced productivity
� Quality of life impacts � Willingness to pay to reduce asthma symptoms
Costs to Family � Typical cost of bronchitis
� Direct and indirect = $915 to $949
� Quality of life impacts = $595
� Typical cost of asthma case � Direct and indirect = $1,000 to $1,339
� Quality of life impacts = $1,614
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Aggregate costs of TRP asthma in LAC
� Pollution-attributable exacerbations
� $123 million
� Routine care for pollution-attributable cases
� $79 million
� In Riverside the indirect and direct costs are 6% of county’s 2010 budget for health and welfare
� In Long Beach the indirect and direct costs are 21% of city’s expenditures of Department of Health and Human Services.
Opportunity costs � In Los Angeles, if direct costs of pollution-
attributable asthma outcomes paid for though Medicaid were eliminated, we could provide
� Medi-Cal to additional 33,700 children a year OR
� two-doses of varicella vaccinations to an additional 135,218 children each year OR
� full-time pre-school for an additional 2,358 children
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Bottom-line � Childhood asthma has large impacts
on society.
� It represents a large intergenerational transfer of welfare.
� There is only economy and environment NOT economy versus environment.
Agenda for Action � National level
� Push for tighter limits on PM and ozone � Advocate for Title III
� Immediate-run initiatives � Enforcing bans on idling � Retrofitting of existing school buses and replacing older ones
� Medium-run changes � Buffers between roadways and homes & schools � Filtration systems in schools
� Longer-run � Regional planning --- locating schools, playgrounds � Replacing auto fleet with electric vehicles
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Maybe one day we can have traffic jams with purely cute
consequences ….
