Direction générale de la Santé MASPRAS / AF Issues in the economic evaluation of the health impacts of climate change SEARCH Washington, DC December 15, 2009 Alain Fontaine

Direction générale de la Santé MASPRAS / AF Decisions Once we know: –What the health consequences will or may be –How many people will be affected, who, where and when –What can be done to prevent (need to understand causes) / manage these consequences The key questions are: –Is it worth doing something about it? –Can we afford to do it? (and to do what?) (Can we afford not to do it?)

Direction générale de la Santé MASPRAS / AF Basic principles for economic evaluations (1) Specify perspective(s): for whom (and for what decision) is the analysis performed? –Different costs (resources) and effects included –Distribution issues : equity / sustainability Specify relevant time frame: –Timing of interventions / effects –Delayed / lasting effects

Direction générale de la Santé MASPRAS / AF Basic principles for economic evaluations (2) Identify / quantify health effects: –What / How much ? –How much attributable to environmental changes (to causes that we may do something about) ? Identify / quantify relevant intervention costs: –Investments (non specific) –Recurring costs / resources used

Direction générale de la Santé MASPRAS / AF Basic principles for economic evaluations (3) Assign economic value: –Resources : direct / indirect / opportunity –Effects : indirect / intangible Consider time preferences: –Present value of future events / resources –Present value for future generations? Address uncertainty: –Scenarios –Modeling –Sensitivity analysis

Direction générale de la Santé MASPRAS / AF Adaptation costs (Ebi, 2007; Ebi, 2008 ; Kovats, 2008 ) 1.Under 3 climate change scenarios (emissions reductions) 2.Estimate additional incidence, mortality and burden of disease for diarrhoeal diseases, malnutrition and malaria. 3.Apply costs of individual prevention / treatment 4.Under a series of assumptions, projected excess costs in 2030 range from: – 3.3 to 10.7 billions US$ if emissions reductions lead to stabilization at 550 ppm CO2 equivalent by 2170 –5.9 to 18 billions US$ if unmitigated emissions trends.  (Conservative) estimate of financial needs

Direction générale de la Santé MASPRAS / AF Heat Wave in France (1) (August 2003) excess deaths (82% ≥ 75 years old)

Direction générale de la Santé MASPRAS / AF Heat Wave in France (2) (August 2003)

Direction générale de la Santé MASPRAS / AF Examples (1) (Taylor et al., 2006)

Direction générale de la Santé MASPRAS / AF Examples (2) (Amalric et coll., 2007)

Direction générale de la Santé MASPRAS / AF Examples (3) (Amalric et coll., 2007)

Direction générale de la Santé MASPRAS / AF Two questions How much are we willing / able to allocate to avoid undesired consequences? –Value of consequences –Value of resources required How much will we need to manage undesired consequences? –Investments –Resources to be consumed

Direction générale de la Santé MASPRAS / AF Measuring / Valuing health outcomes Mortality Morbidity Quality of life Preferences –Health states –Demographic / social groups DFLE HLY QUALYs DALYs Willingness to pay …

Direction générale de la Santé MASPRAS / AF A complex system (Dahlgren and Whitehead, 1993)

Direction générale de la Santé MASPRAS / AF With multiple interactions … (Evans and Stoddard, 1990)

Direction générale de la Santé MASPRAS / AF Uncertainty Develop scenarios Modeling Sensitivity analysis Explicit assumptions / discussion of limits

Direction générale de la Santé MASPRAS / AF Precautionary principle (Constitution de la République Française) « Lorsque la réalisation d'un dommage, bien qu'incertaine en l'état des connaissances scientifiques, pourrait affecter de manière grave et irréversible l'environnement, les autorités publiques veillent, par application du principe de précaution et dans leurs domaines d'attributions, à la mise en œuvre de procédures d'évaluation des risques et à l'adoption de mesures provisoires et proportionnées afin de parer à la réalisation du dommage. » Can be overstated … (Conseil d’État, 1998) : « … il ne lui suffit pas de conformer sa conduite à la prise en compte des risques connus. Il doit en outre apporter la preuve, compte tenu de l’état actuel de la science, de l’absence de risque. »

Direction générale de la Santé MASPRAS / AF Time and people Stakeholders Policy makers Distribution of the resources / efforts required Distribution of health consequences Time Over the next 2 years Over the next 5-10 years 20 years from now 50 years from now …

Direction générale de la Santé MASPRAS / AF Credible / Timely / Responsive Evidence

Direction générale de la Santé MASPRAS / AF Getting it together …