Does Willingness to Pay Differ for Mental and Physical Health?

OBJECTIVES: The urban environment can have a significant impact on mental and physical health. Health impact appraisal of new developments should address these issues. However, transferable economic valuation evidence for urban planners in the United Kingdom is thin, especially around mental health, making it harder to estimate the cost-efficiency of public health interventions to address these conditions. A further complication is that mental health may be perceived differently from physical health. This study examines willingness to pay (WTP) to avoid depression and lower back pain. METHODS: WTP estimates were obtained by applying contingent valuation tasks in an online survey with a representative sample in the United Kingdom (N = 1553). Interval regression models were used to estimate the effects of disease severity, payment frequency, and respondent characteristics on WTP. RESULTS: Respondents' WTP to avoid both conditions was relatively high (around 5%-6% of stated income to return to current health state). Depression was rated as being twice as burdensome on quality of life than pain, and bids to avoid depression were 20% to 30% more than pain. Analysis of motivation responses suggests mental health treatment is perceived as less easy to access and less effective than the equivalent for pain, and respondents expect a larger burden on their family and relationships as they try to manage their condition themselves. CONCLUSIONS: Results suggest that depression bids may be affected by uncertainty around access to effective treatment in the healthcare system. This has implications for how mental illness may be prioritized in resource allocation toward public health interventions.

Overcoming Systemic Barriers Preventing Healthy Urban Development in the UK: Main Findings from Interviewing Senior Decision-Makers During a 3-Year Planetary Health Pilot.

This paper sets out the main findings from two rounds of interviews with senior representatives from the UK's urban development industry: the third and final phase of a 3-year pilot, Moving Health Upstream in Urban Development' (UPSTREAM). The project had two primary aims: firstly, to attempt to value economically the health cost-benefits associated with the quality of urban environments and, secondly, to interview those in control of urban development in the UK in order to reveal the potential barriers to, and opportunities for, the creation of healthy urban environments, including their views on the use of economic valuation of (planetary) health outcomes. Much is known about the 'downstream' impact of urban environments on human and planetary health and about how to design and plan healthy towns and cities ('midstream'), but we understand relatively little about how health can be factored in at key governance tipping points further 'upstream', particularly within dominant private sector areas of control (e.g. land, finance, delivery) at sub-national level. Our findings suggest that both public and private sector appeared well aware of the major health challenges posed by poor-quality urban environments. Yet they also recognized that health is not factored adequately into the urban planning process, and there was considerable support for greater use of non-market economic valuation to help improve decision-making. There was no silver bullet however: 110 barriers and 76 opportunities were identified across a highly complex range of systems, actors and processes, including many possible points of targeted intervention for economic valuation. Eight main themes were identified as key areas for discussion and future focus. This findings paper is the second of two on this phase of the project: the first sets out the rationale, approach and methodological lessons learned.

Physical and economic consequences of climate change in Europe.

Quantitative estimates of the economic damages of climate change usually are based on aggregate relationships linking average temperature change to loss in gross domestic product (GDP). However, there is a clear need for further detail in the regional and sectoral dimensions of impact assessments to design and prioritize adaptation strategies. New developments in regional climate modeling and physical-impact modeling in Europe allow a better exploration of those dimensions. This article quantifies the potential consequences of climate change in Europe in four market impact categories (agriculture, river floods, coastal areas, and tourism) and one nonmarket impact (human health). The methodology integrates a set of coherent, high-resolution climate change projections and physical models into an economic modeling framework. We find that if the climate of the 2080s were to occur today, the annual loss in household welfare in the European Union (EU) resulting from the four market impacts would range between 0.2-1%. If the welfare loss is assumed to be constant over time, climate change may halve the EU's annual welfare growth. Scenarios with warmer temperatures and a higher rise in sea level result in more severe economic damage. However, the results show that there are large variations across European regions. Southern Europe, the British Isles, and Central Europe North appear most sensitive to climate change. Northern Europe, on the other hand, is the only region with net economic benefits, driven mainly by the positive effects on agriculture. Coastal systems, agriculture, and river flooding are the most important of the four market impacts assessed.

Developing and testing an environmental economics approach to the valuation and application of urban health externalities.

Background: Poor quality urban environments have substantial impacts on public and planetary health. These costs to society are not readily quantifiable and remain largely external to mainstream measures of progress. Methods for accounting for these externalities exist, but their effective application is in development. Yet there is an increasing urgency and demand given the profound threats to quality of life both now and in the future. Methods: We combine data from a series of systematic reviews of the quantitative evidence linking characteristics of the urban environment with health consequences and the economic valuation of these health impacts from a societal perspective within a spreadsheet-based tool. The tool-named HAUS-allows the user to estimate the health impacts of changes in urban environments. The economic valuation of these impacts in turn facilitates the use of such data in broader economic appraisal of urban development projects and policies. Findings: Using the Impact-Pathway approach, observations of a variety of health impacts associated with 28 characteristics of the urban environment are applied to forecast changes in cases of specific health impacts that result from changes in urban contexts. Unit values for the societal cost of 78 health outcomes are estimated and incorporated in the HAUS model in order to allow the quantification of the potential effect size of a given change in the urban environment. Headline results are presented for a real-world application in which urban development scenarios that have varying quantities of green space are evaluated. The potential uses of the tool are validated via formal semi-structured interviews with 15 senior decision-makers from the public and private sectors. Interpretation: Responses suggest that there is significant demand for this kind of evidence, that it is valued despite the inherent uncertainties, and has a very wide range of potential applications. Analysis of the results suggest expert interpretation and contextual understanding is critical for the value of evidence to be realized. More development and testing is needed to understand how and where it may be possible to apply effectively in real world practice.

Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD): Protocol of a five-year prevention research consortium.

Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact.

Pandemics, vulnerability, and prevention: time to fundamentally reassess how we value and communicate risk?: CITIES, HEALTH and COVID-19: Initial reflections and future challenges.

For over a decade, pandemics have been on the UK National Risk Register as both the likeliest and most severe of threats. Non-infectious 'lifestyle' diseases were already crippling our healthcare services and our economy. COVID-19 has exposed two critical vulnerabilities: firstly, the UK's failure to adequately assess and communicate the severity of non-communicable disease; secondly, the health inequalities across our society, due not least to the poor quality of our urban environments. This suggests a potentially disastrous lack of preventative action and risk management more generally, notably with regards to the existential risks from the climate and ecological crises.

Moving Health Upstream in Urban Development: Reflections on the Operationalization of a Transdisciplinary Case Study.

This paper describes the development, conceptualization, and implementation of a transdisciplinary research pilot, the aim of which is to understand how human and planetary health could become a priority for those who control the urban development process. Key challenges include a significant dislocation between academia and the real world, alongside systemic failures in valuation and assessment mechanisms. The National Institutes of Health four-phase model of transdisciplinary team-based research is drawn on and adapted to reflect on what has worked well and what has not operationally. Results underscore the need for experienced academics open to new collaborations and ways of working; clarity of leadership without compromising exploration; clarification of the poorly understood "impacts interface" and navigation toward effective real world impact; acknowledgement of the additional time and resource required for transdisciplinary research and "nonacademic" researchers. Having practitioner-researchers as part of the research leadership team requires rigourous reflective practice and effective management, but it can also ensure breadth in transdisciplinary outlook as well as constant course correction toward real-world impact. It is important for the research community to understand better the opportunities and limitations provided by knowledge intermediaries in terms of function, specialism, and experience.

BRAFO tiered approach for Benefit-Risk Assessment of Foods.

BRAFO stands for Benefit-Risk Analysis for Foods. This European Commission funded project aims at developing a framework that allows quantitative comparison of human health risks and benefits of foods and food compounds based on a common scale of measurement. A methodology group brought together methodologies from several disciplines relevant to the evaluation of risks and benefits in food. This group reviewed and assembled the methodologies available. They produced this guidance document that describes a tiered ('stepwise') approach for performing a risk and benefit assessment of foods. This process starts with pre-assessment and problem formulation to set the scope of the assessment. This includes defining two scenarios, the reference and an alternative that are compared in the assessment. The approach consists of four tiers. In many cases, a lower tier assessment in which risks and benefits are qualitatively evaluated may be sufficient to show a clear difference between the health impacts of the two scenarios. In other cases, increasingly sophisticated methods to integrate risks and benefits quantitatively are used at higher tiers to assess the net health impact.