greening health care josh farley cdae. outline of presentation biophilia toxic health care market...
TRANSCRIPT
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Greening Health Care
Josh FarleyCDAE
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Outline of Presentation
• Biophilia• Toxic health care• Market logic• Requirements for efficient markets• Green investments and health
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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?
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Greening Hospitals
• High energy consumption• Hazardous chemicals– Phthalates, PVCs, dioxins
• Reliance on disposables• Toxic waste streams– What level of waste emissions is sustainable?
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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?
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Pharma and Ecosystem Services
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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
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What is the Goal of a Private Sector Health System?
• Maximize profits?– Goal of private sector firms– Costs belong in the numerator
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Total Health Care Expenditures per Capita
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Doctor Consultations per Capita
Chile
Mexico
Swed
en
United St
ates
Finlan
d
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
0
2
4
6
8
10
12
14
Doc
tor C
onsu
ltatio
ns p
er c
apita
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What is the Goal of a Public Health System?
• Achieve best health care outcomes (e.g. average years of healthy life)
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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
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Health Outcomes per Dollar Spent
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0.1
Year
s of
life
per
dol
lar p
er c
apita
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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?
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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
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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
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‘Competition’ Increases Costs
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How do insurance companies maximize profits?
• Avoid insuring anyone who might get sick• Deny care when someone does get sick
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What are the most serious threats to human health today?
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• Humans, like all species, depend on a healthy and well-functioning ecosystem
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Essential and Non-substitutable Services from Nature
• Food• Water• Disease regulation• Disturbance
regulation
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Unsolvable problems?
Marginal benefits of food systems
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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
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19701972
19741976
19781980
19821984
19861988
19901992
19941996
19982000
20022004
20062008
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
US Life Expectancy
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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