EHEN has prompted discussion among experts about several important topics, ranging from current systematic review (Bielefeld University, 2014) to risk communication (WHO Regional Office for Europe, 2013c) to health inequality (WHO
Regional Office for Europe, 2012) and deprivation indices (see Fig. 15). Research findings on these topics show the importance of well-balanced approaches to policy-making.
Fig. 15. Best use of economics in environmental health – key messages from EHEN
Source: Drawing by Andreas Gaertner, the Kommunikationslotsen Agency. WHO Regional Office for Europe (2013).
Some examples of health economics research findings are shown in Fig. 16, which is based on the work of the WHO Regional Director for Europe, Zsuzsanna Jakab and compiled from a group of international studies carried out in recent years. The figure shows the relationship between health outcomes listed on the left and their cost on the right.
Another example of health economics research findings resulted from an analysis of the effects of austerity measures in Thessaloniki, Greece, on exposure to particulate matter and the disproportionate vulnerability that resulted from these measures. As part of an austerity package, Greece increased taxes for light heating oil.
Citizens without the financial means to cope
with the increased cost turned to biomass as an alternative fuel source, which resulted in increased exposure to PM2.5 (Table 3).
This is associated with greater risk of adverse health outcomes, such as cardiac and respiratory morbidity and mortality.
Fig. 16. The economic case for health promotion and disease prevention
Cardiovascular disease €169 billion annually in the EU;
healthcare accounting for 62% of costs
Alcohol-related harm €125 billion annually in the EU, equivalent to 1.3% of GDP
Obesity-related illness
(including diabetes and CVD) Over 1% GDP in the US; between 1-3%
of health expenditure in most countries
Cancer 6.5% of all health care
expenditure in Europe
Road traffic injuries Up to 2% of GDP in middle- and high-income countries
CVD; cardiovascular disease; GDP: gross domestic product.
Source: adapted from Jakab (2014).
Table 3. Temporal comparison of energy use for heating in Thessaloniki, Greece
Year Heating oil (%)
Natural gas (%) Electricity (%)
Biomass
burning (%) PM2.5 (μg/)
2011 44.0 40.0 10.4 5.6 43.5
2012 20.0 40.0 19.4 20.7 62.5
Source: Sarigiannis, Karakitsios & Kermenidou (in press).
In light of the complex, multifactorial analysis required in such a situation, WHO is taking part in ongoing model development that takes into account environmental factors and also in projects that evaluate future impacts based on various potential policies. One of the key outcomes of this development was that investing in climate change mitigation resulted in significant co-benefits for health outcomes – for example reduction of noise and air pollution. This proved that these investments would also have high economic rates of return. For example, about €1.5 million (from total costs of €33 million per year caused by the adverse
effects on health of exposure to PM2.5) in the urban area of Kuopio, Finland, could be saved yearly as a result of health benefits achieved from decreased PM2.5 levels ( Asikainen et al., 2014).
Such analyses are vital to the evaluation of economic policies and their effects on environmental exposure. Conversely, economic evaluations of environmental policy can enhance understanding of the importance of preventative measures in ensuring health and economic development through evaluation of long-term costs.
In general, economic evidence can provide
strong arguments for governmental decision-making for possible and efficient policy interventions, such as: regulations, subsidies; laws; and investments in public health, environment and other sectors. One prominent example of this is the EC Clean Air Policy Package, which was adopted in December 2013. It was supported by evidence from cost–benefit analyses performed before and after adoption, demonstrating that the benefits of the proposed Policy Package would exceed costs by at least a factor of 12 (Holland, 2014).
The results of investments in primary prevention and environmental protection are often perceived as costly exercises.
However, policies set forth with the best of intentions can have unexpected consequences. In addition, there is often proof that prevention, early investments (for example, in mitigating climate change) and policy interventions can yield a high rate of return, directly and indirectly. This occurs not only by increasing health and well-being, but also by contributing to economic resilience. Consequently, economic growth can be promoted in a way that is both green and sustainable.
References
Asikainen A, Pärjälä E, Kettunen T, Savastola M, Niittynen M, Tuomisto J (2014). URGENCHE WP10: effects of CO2 emission reduction measures in City of Kuopio. Kuopio: City of Kuopio (http://www.kuopio.fi/c/document_library/get_file?uuid=990128c5-6c34-4320-b20e-cc1ff8f7d98f&groupId=12141, accessed 5 February 2015).
Bielefeld University (2014). Gesundheitsökonomie und Environmental Burden of Disease im Umwelt-Schutz (GeniUS) [website]. Bielefeld: Bielefeld University, School of Public Health, Department Environment and Health (http://www.uni-bielefeld.de/gesundhw/ag7/projekt/
genius.html, accessed 23 June 2014).
Holland M (2014). Cost–benefit analysis of final policy scenarios for the EU clean air package.
Faringdon: Ecometrics Research and Consulting.
Jakab Z (2014). Better Health for Europe [PowerPoint slides]. Presented at Interdepartmental Plan for Public Health of Catalonia (PINSAP) Strategy and Programme, 14 February 2014, Barcelona, Spain. Copenhagen: WHO Regional Office for Europe (http://www.euro.who.
int/en/about-us/regional-director/speeches-and-presentations-by-year/2014/presentation- better-health-for-europe-interdepartmental-plan-for-public-health-of-catalonia-pinsap-strategy-and-programme, accessed 14 August 2014).
Sarigiannis DA, Karakitsios SP, Kermenidou M (in press). Socioeconomic impact of the health burden from using biomass for space heating. Sci Total Environ.
WHO Regional Office for Europe (2010). Parma Declaration on Environment and Health.
Copenhagen: WHO Regional Office for Europe (http://www.euro.who.int/__data/assets/pdf_
file/0011/78608/E93618.pdf?ua=1, accessed 20 June 2014).
WHO Regional Office for Europe (2012). Environmental health inequalities in Europe: assessment report. Copenhagen: WHO Regional Office for Europe (http://www.euro.who.int/__data/
assets/pdf_file/0010/157969/e96194.pdf, accessed 20 June 2014).
WHO Regional Office for Europe (2013a). Health 2020: a European policy framework supporting action across government and society for health and well-being. Copenhagen: WHO Regional Office for Europe (http://www.euro.who.int/__data/assets/pdf_file/0006/199536/Health2020-Short.pdf?ua=1, accessed 20 June 2014).
WHO Regional Office for Europe (2013b). Environmental Health Economics Network. Inaugural Newsletter, October 2013. Copenhagen: WHO Regional Office for Europe (http://www.euro.
who.int/__data/assets/pdf_file/0017/231515/EHEN-Newsletter_9Oct2013-cleared-repost.
pdf?ua=1, accessed 20 June 2014).
WHO Regional Office for Europe (2013c). Health and environment: communicating the risks.
Copenhagen: WHO Regional Office for Europe (http://www.euro.who.int/en/publications/
abstracts/health-and-environment-communicating-the-risks, accessed 12 June 2014).
Summary
The EU has a significant funding programme for environment and health research. The projects funded by its Framework Programmes for Research and Technological Development, also
called Framework Programmes, have contributed to building a knowledge base, which is needed to make informed policy decisions in Europe and beyond.