Sprawl and Health

Colman 2001 - "Cost of Obesity in British Columbia"

Colman, Ronald; Dodds, Colin; Wilson, Jeff
"Cost of Obesity in British Columbia"
January, 2001. GPI Atlantic
On the Web
Relevance: high

Direct costs for obesity-related diseases cost the British Columbia health care system at least CAN$217.3 million a year (2.6% of the health care budget) in 1997. This is a very conservative estimate, so a reasonably higher estimate is $380 million, or 4.5% of the provincial health budget. Note that obesity is defined as BMI>27 for the conservative estimate and BMI>25 for the high estimate.

Using the assumption that the direct health care costs are only 45.7% of the total economic burden of illness, obesity could cost a total of $475.5 million to $831.5 million each year. At the time of writing, $830 million was 0.9% of BC's GDP.

Method: The author uses Birmingham's method of population attributable fractions applied to the BC population and 1997 medical costs.

Washington Dept. of Ecology 2004 - "The Economic Benefits of Clean Air

Washington Dept. of Ecology
"The Economic Benefits of Clean Air"
Created Sept 2002, updated June 2004
Publication number 02-02-011
On the Web
Relevance: medium

The Washington State Department of Ecology says that

• “Washington citizens save over $2 billion per year in health costs because the air is cleaner now than it was in 1990.”
• “Washington businesses save at least $17 million per year because cleaner air means fewer lost workdays or lost productivity due to illness caused by air pollution, according to EPA.”
• “Based on EPA estimates of cancer risks and measured pollution levels in Washington, [levels] of 11 high risk Hazardous Air Pollutants (HAPs) […] may result in as many as 30 cancer cased per year in Washington that would not otherwise have occurred. The cost of medical treatment alone for these is about $3,000,000.” 

It also estimates that if central Puget Sound and Clark county returned to ozone non-attainment, it would cost businesses $253 million for required cleaner gasoline and additional pollution controls.  In central Puget Sound it would also cost consumers about $10 million a year (1 penny per gallon) for required cleaner gasoline. In addition, we would lose local control over clean air strategies.

(Note that these estimates cover all air pollution, including industrial emissions and agricultural burning.)

BC Lung Assoc 2005 - "Health and Air Quality 2005 - Phase 2: Valuation of Health Impacts from Air Quality in the Lower Fraser Valley Airshed"

RWDI AIR Inc (for British Columbia Lung Association)
"Health and Air Quality 2005 - Phase 2: Valuation of Health Impacts from Air Quality in the Lower Fraser Valley Airshed"
July 15, 2005
On the Web
Relevance: high

This study estimates that a 10% reduction in fine particulate matter and ozone pollution in the Lower Fraser Valley (LFV) could produce $195+/- $122 million annually in 2010 (2003$ discounted) in health benefits. (I think these are not only direct health costs, but also use some other valuation method.)

• The study uses a linear model and assumes no thresholds, so the estimates are scalable to 1%, 20%, etc. The authors say that a 1% improvement would save $29 million (undiscounted) in 2010.
• They also note that the benefits from a given improvement in PM2.5 are about 10 times greater than the benefits from a similar improvement in ozone.

Davies 2005 - "Economic Costs of Diseases and Disabilities Attributable to Environmental Contaminants in Washington State"

Davies, Kate; Hauge, Dietrich.
"Economic Costs of Diseases and Disabilities Attributable to Environmental Contaminants in Washington State"
Collaborative for Health and Environment-Washington Research and Information Working Group
July 2005
On the Web
Relevance: low

The authors estimated the health costs attributable to environmental contaminants in Washington (for selected diseases) by applying national and other state studies to Washington's population. They use national estimates of the Environmentally Attributable Fraction Range (EAFR) of diseases due to contaminants, disease and population rates for Washington, and disease cost estimates. They conclude that the total cost is $1.8 billion (2004$) for children and $2.7 billion for adults and children.

Unfortunately, this study does not really estimate the costs for Washington, but rather Washington's likely share of national costs because the study uses national attribution rates rather than WA specific ones.  For example, it may be that a higher or lower fraction of asthma in WA is due to environmental contaminants.

Kawachi 1997 - "Social capital, income inequality, and mortality"

Kawachi, Kennedy, Lochner, Prothrow-Stith
"Social capital, income inequality, and mortality"
American Journal of Public Health
September 1997; v87, n9, pp 1491
On the Web
Relevance: High

This is perhaps the single most compelling study that social capital--in the broad sense of civic engagement--affects health. The authors use the General Social Survey's result to perform "ecologic" analyses of 39 states' levels of social capital and income inequality compared to mortality. Still, there are some important short-comings.

The authors claim that "income inequality leads to increased mortality via disinvestment in social capital" though it is not clear to me that they actually demonstrate this. Instead, they demonstrate that income inequality is correlated to social capital and also show a correlation between social capital and mortality. (It's relatively well-documented that income inequality is associated with higher mortality).

Kawachi 1999 - "Social capital and community effects on population and individual health"

Kawachi
"Social capital and community effects on population and individual health"
Annals of New York Academy of Sciences
1999; v896; pp 120-130
On the Web
Relevance: High

This paper references what is probably the single most convincing piece of evidence we have for believing that social capital affects health--Kawachi et al's 1997 analysis of the GSS survey for 39 states, conducted between 1986 and 1990. In two reported analyses, he finds a close state-by-state correlation between social capital and health. In particular, trust was important: "the level of trust explained 58% of the variance in total mortality across states, including statistically significant associations with most major causes of death including heart disease, malignant neoplasms, stroke, homicide, and infant mortality."

Hirdes 1992 - "The importance of social relationships, socioeconomic status and health practices with respect to mortality among healthy Ontario males"

Hirdes, Forbes
"The importance of social relationships, socioeconomic status and health practices with respect to mortality among healthy Ontario males"
Journal of Clinical Epidemiology
February 1992; v45, n2; pp 175-182
On the Web
Relevance: Medium

The authors examined 2000 men in Ontario and found that social relationships had "a strong association with mortality." Unfortunately, their social relationships index was comprised of marital status, number of children, family contact, and participation in voluntary associations -- only the last of these is conceivably affected by sprawl. Also, the strong association of social capital to mortality is in the comparison between the highest scoring 10% in social capital and the lowest scoring 10%. It's not clear whether sprawl is affect social capital in these extremes or in the middle 80% (where, in turn, the effects on mortality are less pronounced).

Interestingly, the effect of income was greater than the effect of social capital (adjusted relative risk of 0.41 versus 0.30). The effect of income is even greater because the risk factors for income include the top 20% versus the bottom 20% (not just top and bottom deciles, as for social capital).

Veenstra 2002 - "Social capital and health (plus wealth, income inequality, and regional health governance)"

Veenstra
"Social capital and health (plus wealth, income inequality and regional health governance)"
Social Science and Medicine
March 2002; v54, n6; pp 849-868
On the Web
Relevance: Medium-high

Describes a study of 30 health districts in Saskatchewan, comparing population health with social capital, income inequality, wealth, and governance. Social capital meant associational and civic participation. Two findings stand out:

• The author found no evidence of a relationship between social capital and good governance in the health districts.
• Low social capital was correlated to high mortality; high income inequality was also correlated to high mortality. The author writes, "the two may be co-mingled somehow when it comes to population health, although they were not significantly related to one another."

Veenstra's findings are promising because his use of social capital--associational and civic participation--is the same kind that may be affected by sprawl. And while the effects of social capital on mortality are "co-mingled" with income inequality, there is a relationship.

WA Dept. of Health 2004 - "The Economic Cost of Physical Inactivity Among Washington State Adults"

Chenoweth & Associates, Inc.
"The Economic Cost of Physical Inactivity Among Washington State Adults"
Washington State Department of Health
February 2004
On the Web (pdf)
Relevance: high

Chenoweth and Associates estimate the direct costs of physical inactivity in Washington to be $4.8 billion in 2002:

• $197.8 million for direct medical care
• $9.2 million for worker's compensation
• $4600 million for lost productivity

They also calculate the indirect costs at $593 million for medical care and $36.8 million for worker's compensation, bringing the total cost (direct + indirect) to $5.46 billion. Per Washington resident, this total cost of physical inactivity was $899 in 2002; per Washington adult, the cost was $1,232.

B.C Health Planning 2004 - "The Cost of Physical Inactivity in British Columbia"

Colman, Ronald; Walker, Sally
"The Cost of Physical Inactivity in British Columbia"
B.C. Ministry of Health Planning
November 2004
On the Web (pdf)
Relevance: high

The authors use data from the Canadian Community Health Survey, the Economic Burden of Illness in Canada, and the literature to calculate the cost of physical inactivity in BC.  They estimate that physical inactivity costs the British Columbian health care system $211 million (2001CAN$) (1.8% of provincial health spendig) a year in direct costs.  They also estimate that indirect costs of productivity losses add up to $362 million a year due to premature death and disability, leading to a total cost of $573 million.  5% (1400) of all premature deaths are due to physical inactivity. This results in more than 4,380 potential years of life lost annually.