Transcript Costs of Chronic Disease

Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
MEASURING PROGRESS AS
IF CHILDREN MATTERED:
Beyond GDP to New Measures of Wellbeing and
Progress
Child Honoring: Pittsburgh, 30 March, 2007
What kind of world are we
leaving our children...?
... In experience and
language of ordinary people
More possessions, longer lives, BUT
• Higher stress rates, obesity, childhood
asthma, environmental illness
• Insecurity - safety, livelihood
• Greater inequality; child poverty
• Decline of volunteerism
• Natural resource depletion, species loss
• Global warming
The Big Myth: “The more the
economy grows, the better off we are”
 Resource depletion as economic gain = a
poorer world for our children
 More consumption, energy use, greenhouse
gas emissions, make economy grow, but are
we better off
 Crime, sickness, pollution, make economy
grow —just because money is being spent.
Current measures of progress
send the wrong messages
 GDP can grow even as poverty and inequality
increase.
 More work hours make economy grow; free
time has no value – affects health (stress)
 GDP ignores work that contributes directly to
community health (volunteers, work in
home)
Why We Need New
Indicators - Policy Reasons:
 “Economic growth = better off” sends
misleading signals to policy-makers and
local communities
 Vital social, environmental assets ignored
 Preventive initiatives to conserve and use
resources sustainably, to reduce poverty,
sickness and greenhouse gas emissions,
are blunted and inadequately funded
Indicators are Powerful
What we measure:
 reflects what we value as a society;
 determines what makes it onto the
policy agenda;
 influences behaviour
A good set of indicators
can help communities:
 foster common vision and purpose –
the world we leave our children;
 identify strengths and weaknesses;
 change public behaviour;
 hold leaders accountable at election
time
 initiate actions to promote wellbeing
GPI Atlantic was founded to
address that need
• Non-profit, fully independent research
group founded April, 1997
• Located Halifax, Nova Scotia, Canada.
Web site: www.gpiatlantic.org
• -> New Canadian Index of Wellbeing
• Working with Bhutan, New Zealand
Measuring Wellbeing. In the GPI:
 Health, free time, unpaid work (voluntary and
household), and education have value
 Sickness, crime, disasters, pollution are costs
 Natural resources (eg forests) are capital assets
 Reductions in greenhouse gas, crime, poverty,
ecological footprint are progress
 Growing equity signals progress
Cf closed economy model…..
Natural
environment
Society
Economy
Values, elements of wellbeing
• Health
• Security
• Knowledge
• Community
• Freedom
• Ecological integrity
• Equity
“Generating Wealth”
• GDP = input. What are the outcomes
we want? – E.g. Adequate living
standards, decent jobs vs jobless growth
• GPI not opposed to growth but asks
what is growing (Kuznets). Socially and
environmentally responsible dev’t. E.g.
Denmark, fair trade coffee, Dow – GHGs
• See “Good News for a Change”; 2005
conference (e.g. Ray Anderson)
Outcome domains in the new
Canadian Index of Wellbeing
• Standard of living
• Time use (and balance)
• Healthy populace
• Educated populace
• Community vitality
• Ecosystem services
• Governance
Towards Full Cost Accounting
Basic Principles and challenges:
• Expanded definition of capital: Natural,
human, social, cultural, produced capital,
but no common metric for measurement
• External -> internal benefits and costs
• Price non-market benefits and costs
• Fixed -> variable costs
Strengths: Enhances market efficiency,
reduces needs for govt. regulation, provides
more accurate, comprehensive information
Nova Scotia Genuine Progress Index:
20 Components
Natural Capital:
• Soils and Agriculture
• Forests
• Marine Environment/Fisheries
• Water Resources / Water Quality
• Energy
Nova Scotia Genuine Progress Index: Twenty-two Components
Environment:
• Greenhouse Gas Emissions
• Sustainable Transportation
• Ecological Footprint Analysis
• Air Quality
• Solid Waste
Nova Scotia Genuine Progress Index: Twenty-two Components
Time Use:
• Value of Civic and Voluntary Work
• Value of Unpaid Housework & Childcare
• Work Time and Underemployment
• Value of Leisure Time
(Penelope Leach’s questions on balance)
Nova Scotia Genuine Progress Index: Twenty-two Components
Social Capital/Socioeconomic
• Health
• Educational Attainment
• Income Distribution
• Debts and Assets
• Economic Security
• Costs of Crime
Examples of GPI Results:
e.g. Valuing Voluntary Work
• Canadians contribute 3.4 billion hours of
voluntary work per year; equivalent of 1.8
million FTE jobs (economic add-on)
• Services worth $53.2 billion / year, invisible in
our conventional measures of progress
• 1990s: voluntary work down 12.3% - time stress
• Canadians lose $6 billion in volunteer services
Valuing a Healthy Population
GPI Population Health Reports include:
• Cost of Chronic Illness in Canada (focus on
preventable portion)
• Women’s Health in Atlantic Canada
• Income, Health and Disease in Canada; Equity
and Disease in Atlantic Canada
• Costs of Tobacco, Obesity, Physical Inactivity
• Cost of HIV/AIDS in Canada
• Economic Impact of Smoke-Free Workplaces
• Value of Care-giving
Costs of Chronic Disease: NS
->New Dept Health Promotion
• 60% medical costs = $1.2 billion / year
• 76% disability costs = $900 million
• 78% premature death costs = $900
million
• 70% total burden of illness = $3 billion
= 13% GDP
Cost of Chronic Illness in
Nova Scotia 1998 (2001$ million)
Circulatory
Cancer
Respiratory
Musculoskeletal
Endocrine
Nervous system
Mental
TOTAL:
Hosp.
Doctor
Drugs
Other
Total
Direct
Premat.
Death
DisTOTAL
ability
161.6
71.4
21.6
55.9
18.5
55.3
104.2
26.6
11.8
3.2
20.3
7.2
27.9
17.7
63.6
7.5
16.6
22.0
29.3
19.2
39.2
137.8
49.6
22.7
53.8
30.1
56.0
88.2
389.6
140.3
64.1
152.0
85.0
158.5
249.2
326.8
427.2
43.4
3.5
43.8
30.0
16.0
244.4
14.5
78.1
307.2
27.0
158.6
72.3
960.8
582.1
185.5
462.8
155.8
347.0
337.5
488.4
114.8
197.5
438.1
1,238.8
890.8
901.9
3,031.5
What Portion is
Preventable? Excess Risk
Factors Account for:
• 40% chronic disease
• 50% chronic disease mortality
• 25% medical care costs = $500 mill./yr
• 38% total burden of disease = $1.8 bill.
(includes direct and indirect costs)
Excess Risk Factors Account for
(% economic burden of disease)
• Tobacco:
10%
• Physical Inactivity:
7%
• Obesity:
5.5%
• High blood pressure:
5%
• Lack fruits/vegetables:
3%
• High blood cholesterol:
2.5%
• Alcohol:
2%
Costs of Key Risk Factors,
Nova Scotia (2001 $ millions)
Deaths
Direct
Indirect
Total
Tobacco
1,600
$188
$300
$488
Obesity
1,000
$120
$140
$260
700
$107
$247
$354
Physical
Inactivity
Cost-Effective
Interventions
- School-based smoking prevention =
At least 10:1
– WIC - 3:1
– Counselling pregnant women (LBW)
- 5:1
– Workplace: 2: 1 etc
Health Costs of Poverty
• Most reliable predictor of poor health,
premature death, disability: 4x more
likely report fair or poor health = costly
• e.g. (1) Increased hospitalization:
Men 15-39 = +46%; 40-64 = +57%
Women 15-39 = +62%; 40-64 = +92%
Heart Health Costs of
Poverty
• Higher risk smoking, obesity, physical
inactivity, cardiovascular risk = costly
• York U: 6,366 Canadian deaths; $4
billion health care costs / year are
attributable to poverty-related heart
disease
• NS could avoid 200 deaths, $124 million
per year if all Nova Scotians were as
heart healthy as higher income groups
Health Cost of Inequality
• British Medical Journal: “What matters
in determining mortality and health
is less the overall wealth of the
society and more how evenly wealth
is distributed. The more equally
wealth is distributed, the better the
health of that society.”
• e.g. Sweden, Japan vs USA
Costs of Socioeconomic
Inequality in Nova Scotia
• Use of physician services:
– No high school
= +49% than degree
– High school diploma = +12% more
– Lower income
= +43% than higher
– Lower middle income = +33% more
Excess Physician Use
(=small fraction total costs)
• Educational inequality = $42.2 million
= 17.4% of total
• Income inequality
= $27.5 million
= 11.3%
= costs avoided if all Nova Scotians were
as healthy as higher income / university
Valuing Equity:
GDP tells us how
much income, not how income shared
Disp. Income: Richest 20% : Poorest 20%
1990
1998
7.1
8.5
Canada
N.S.
6.2
8.5
Quebec
6.9
7.9
Ontario
7.1
8.3
Manitoba
6.7
7.6
Alberta
7.4
10.4
B.C.
7.6
8.0
NBBC
Global, equity dimensions:
• 20% of world’s people in highest-income
countries account for 86% of consumption
spending. Poorest 20% account for 1.3%
• Richest 20% consume 45% of all meat and fish,
poorest 20% consume just 5%
• Richest 20% = 58% of total energy, poorest 20%
= <4%
• Richest 20% =84% of paper, poorest 20% = 1.1%
• Richest 20% =87% of world's vehicle fleet, the
poorest 20% = <1%
Translation to Behaviour:
e.g. Estimated Transportation Footprint,
NS 1985-2025
2.5
Hectares per capita
2
1.5
1
0.5
0
1985
1995
2005
2015
2025
Reduction in Commuting
Footprint
Change from:
1 person \ vehicle
to 2
1 person \ vehicle
to 4
driving alone to
taking bus
driving to cycling
1 day
a week
3 days
a week
All the
time
10%
30%
50%
15%
45%
75%
16%
47%
79%
18%
55%
92%
Valuing Natural Resource Health
For example, a healthy forest effectively:
• Prevents soil erosion/sediment control
• Protects watersheds
• Regulates climate regulation/sequesters carbon
• Provides habitat for wildlife / biodiversity
• Supports recreation, tourism, aesthetic quality
• Provides timber
Volume 2, Figure 18
Natural Age Limits
Maritime tree species
White Ash
American Beech
White Birch
Yellow Birch
East’n Hemlock
Red Maple
Sugar Maple
100-200
300-400
120-150
150-250
300-800
100-150
300-400
Red Oak
200-350
Red Pine
200-250
White Pine 200-450
Black Spruce 200-250
Red Spruce 250-400
White Spruce 150-200
Volume 1, Figure 4
Volume 1, Figure 5
Volume 1, Figure 6
Volume 1, Figure 3
Old Forests Store More Carbon
A study published in Science, reported that:
... replacing old-growth forest by young Kyoto stands
... will lead to massive carbon losses to the
atmosphere mainly by replacing a large pool with a
minute pool of regrowth and by reducing the flux into
a permanent pool of soil organic matter.
(Schulze et. al. 2000)
Nova Scotia forests have lost $1.3 billion in
carbon storage value since 1958
Changes in Atlantic Bird
Species Populations
40
35
34
Increasing Population
Decreasing Population
30
Number of Species
32
25
22
20
20
15
10
5
0
1966-79
1980-94
Recreational Brook Trout
Caught and Retained in Nova Scotia 1975-1995
3
2.6
Number (millions)
2.5
2
2
2
1.8
2
1.5
1.3
Kept
1
1.2
Caught
0.6
0.5
0
1970
1975
1980
1985
1990
1995
2000
Valuation of Non-Timber Forest
Ecosystem Goods and Services in NS
(Costanza, replacement values)
Ecosystem
Service
Climate regulation
Soil formation
Waste treatment
Biological control
Food production
Recreation
Cultural
Total (not
including raw
materials)
Monetary
Value
(1997$/ha/year )
Total Flow Value for NS
(1997$millions/year total
forest)
$126.20
$14.34
$124.77
$5.74
$71.71
$51.63
$2.87
$534.0
$60.7
$528.0
$24.3
$303.4
$218.5
$12.1
$397.25
$1,681.0
Volume 1, Figure 32
Retail Prices for Clear vs. Knotty
White Pine (Jan. 2001 prices)
CONCLUSION: Clearcut harvesting and
loss of natural age and species diversity
have resulted in loss of:
 valuable species
 wide diameter and clear lumber that fetch
premium market prices
 resilience and resistance to insect
infestation
 wildlife habitat, & decreasing populations
of birds
 forest recreation values - impact nature
tourism
 a decline in forested watershed
protection and a 50% drop in shadedependent brook trout
 soil degradation and the leaching of
nutrients that can affect future
timber productivity
 a substantial decline in carbon
storage capacity and an increase in
biomass carbon loss
• a decline in other essential forest
ecosystem services.
This represents a substantial
depreciation
of a valuable natural capital asset
The Good News: Volume 2:
Best Forestry Practices in N. S.
• Selection harvesting increases forest
value and provides more jobs
• Shift to value-added creates more jobs
• Restoration forestry is a good
investment
• What incentives can encourage
restoration
Goal: Changing Behaviour
E.g. % Waste Diversion in Nova Scotia
60
% Diversion
50
40
30
20
10
0
1989 1990 1991
1992
1993
1994
1995
1996 1997
1998
1999 2000
Can it be
done?...1900s/1980s...
GPI: Measuring what we
value to leave a better
world for our children
Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
www.gpiatlantic.org