Greening Health Care

Josh FarleyCDAE

Outline of Presentation

• Biophilia• Toxic health care• Market logic• Requirements for efficient markets• Green investments and health

Biophilia

• “Adding elements of Nature to living spaces can presumably induce positively valued changes in cognition and emotion, which again may impact on stress level, health and well-being.”

Bjørn Grinde1* and Grete Grindal Patil2Int J Environ Res Public Health. 2009 September; 6(9): 2332–2343.Biophilia: Does Visual Contact with Nature Impact on Health and Well-Being?

Greening Hospitals

• High energy consumption• Hazardous chemicals– Phthalates, PVCs, dioxins

• Reliance on disposables• Toxic waste streams– What level of waste emissions is sustainable?

Greening Pharmaceuticals

• 10 prescriptions per American per year on average, 17 gr of antibiotics, 3x rate of European countries

• Eighty percent of the U.S. streams / quarter of groundwater sampled contaminated with a variety of medications

• Feminine fish, hermaphroditic frogs• Antibiotic resistance/sewage plants• Waste water recycling• Impacts on humans?

Pharma and Ecosystem Services

Why so much pollution?

• Who owns the sky? Who owns the ocean? Who pays for toxic waste?

• The ‘tragedy of the commons’• Profit maximization: privatize benefits,

socialize costs

What is the Goal of a Private Sector Health System?

• Maximize profits?– Goal of private sector firms– Costs belong in the numerator

Total Health Care Expenditures per Capita

Doctor Consultations per Capita

Chile

Mexico

Swed

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United St

ates

Finlan

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Portuga

l

Denmark

Canad

a

Netherl

ands

United Kingd

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Luxe

mbourg

Turke

y

Australi

a

Icelan

d

Estonia

Slove

nia

Poland

Austria

France

German

y

Hungary

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ublic

Slova

k Rep

ublicKorea

Japan

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Doc

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onsu

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apita

What is the Goal of a Public Health System?

• Achieve best health care outcomes (e.g. average years of healthy life)

What is the Goal of a Public Health System?

• Achieve best health care outcomes (e.g. average years of healthy life) at lowest possible costs– Costs belong in the denominator

Health Outcomes per Dollar Spent

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What is the Goal of a Public Health System?

• Access to some form of health care• We have decided it is unethical to simply leave

the poor to die• What is the most cost effective way to provide

health care?

Prerequisites for efficient markets

• Large numbers of sellers and buyers– Price takers

• Perfect information• No entry or exit barriers• No externalities– E.g. contagious disease

Half of Americans Live Where Population Is Too Low for Competition

Source: NEJM 1993;328:148

A town’s only hospital will not compete with itself

‘Competition’ Increases Costs

How do insurance companies maximize profits?

• Avoid insuring anyone who might get sick• Deny care when someone does get sick

What are the most serious threats to human health today?

• Humans, like all species, depend on a healthy and well-functioning ecosystem

Essential and Non-substitutable Services from Nature

• Food• Water• Disease regulation• Disturbance

regulation

Unsolvable problems?

Marginal benefits of food systems

New Technologies

• Agroecology– Agroecology croplands that generate more services,

shifts ecological threshold to left– Agroforestry ecosystems that generate more food,

shifts economic threshold to right• Requires public good investments– R&D: 80% annual return on investment– Extension: 80% annual return on investment– Infrastructure– No price rationing of non-rival resources

19701972

19741976

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20062008

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US Life Expectancy

New Institutions

• Economic systems that explicitly account for and promote ecosystem services

• Requires collective, cooperative payments for public good benefits

• Requires penalties for destruction of public goods– Common property rights