Greening Health Care
Josh Farley
CDAE
Outline of Presentation
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Biophilia
Toxic health care
Market logic
Requirements for efficient markets
Green investments and health
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 Patil2
Int J Environ Res Public Health. 2009 September; 6(9): 2332–2343.
Biophilia: Does Visual Contact with Nature Impact on Health and Well-Being?
Greening Hospitals
• High energy consumption
• Hazardous chemicals
– Phthalates, PVCs, dioxins
• Reliance on disposables
• Toxic waste streams
– What level of waste emissions is sustainable?
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?
Pharma and Ecosystem Services
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
What is the Goal of a Private
Sector Health System?
• Maximize profits?
– Goal of private sector firms
– Costs belong in the numerator
Total Health Care Expenditures per
Capita
Doctor Consultations per Capita
Doctor Consultations per capita
14
12
10
8
6
4
2
0
What is the Goal of a Public Health
System?
• Achieve best health care outcomes (e.g.
average years of healthy life)
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
Health Outcomes per Dollar Spent
0.1
Years of life per dollar per capita
0.09
0.08
0.07
0.06
0.05
0.04
0.03
0.02
0.01
0
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?
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
Half of Americans Live Where
Population Is Too Low for Competition
A town’s only hospital will not compete with itself
Source: NEJM 1993;328:148
‘Competition’ Increases Costs
How do insurance companies
maximize profits?
• Avoid insuring anyone who might get sick
• Deny care when someone does get sick
What are the most serious threats to
human health today?
• Humans, like all species, depend on a healthy
and well-functioning ecosystem
Essential and Non-substitutable
Services from Nature
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Food
Water
Disease regulation
Disturbance
regulation
Unsolvable problems?
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
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R&D: 80% annual return on investment
Extension: 80% annual return on investment
Infrastructure
No price rationing of non-rival resources
US Life Expectancy
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
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