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Greening Health Care Josh Farley CDAE

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Page 1: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Greening Health Care

Josh FarleyCDAE

Page 2: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Outline of Presentation

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

Page 3: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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?

Page 4: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Greening Hospitals

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

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

Page 5: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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?

Page 6: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Pharma and Ecosystem Services

Page 7: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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

Page 8: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

What is the Goal of a Private Sector Health System?

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

Page 9: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Total Health Care Expenditures per Capita

Page 10: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Doctor Consultations per Capita

Chile

Mexico

Swed

en

United St

ates

Finlan

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Portuga

l

Denmark

Canad

a

Netherl

ands

United Kingd

om

Luxe

mbourg

Turke

y

Australi

a

Icelan

d

Estonia

Slove

nia

Poland

Austria

France

German

y

Hungary

Czech Rep

ublic

Slova

k Rep

ublicKorea

Japan

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2

4

6

8

10

12

14

Doc

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apita

Page 11: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 12: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 13: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

What is the Goal of a Public Health System?

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

Page 14: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 15: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 16: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 17: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 18: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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

Page 19: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Health Outcomes per Dollar Spent

0

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0.03

0.04

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Year

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Page 20: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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?

Page 21: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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

Page 22: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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

Page 23: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

‘Competition’ Increases Costs

Page 24: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 25: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

How do insurance companies maximize profits?

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

Page 26: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

What are the most serious threats to human health today?

Page 27: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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

Page 28: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Essential and Non-substitutable Services from Nature

• Food• Water• Disease regulation• Disturbance

regulation

Page 29: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 30: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

Unsolvable problems?

Marginal benefits of food systems

Page 31: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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

Page 32: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments
Page 33: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

19701972

19741976

19781980

19821984

19861988

19901992

19941996

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20022004

20062008

0.0

10.0

20.0

30.0

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70.0

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US Life Expectancy

Page 34: Greening Health Care Josh Farley CDAE. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments

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