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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 ….