Foreword The science is clear:breathing polluted air increases the risk of debilitating and deadly diseases such as lung cancer,stroke,heart disease,and chronic bronchitis.Air pollution is now the world's fourth-leading fatal health risk,causing one in ten deaths in 2013. At the same time,air pollution from industries,construction sites,agricultural practices,vehi- cles,and the combustion of dirty energy sources continues to grow.About 87 percent of the world's population now live in countries in which ambient pollution levels exceed air quality guidelines set by the World Health Organization.In low-and middle-income countries,the danger is even more pronounced:90 percent of the population in these countries was exposed to dangerous levels of ambient air pollution in 2013. To reduce the number of people gradually being contaminated by the air they breathe,pollu- tion control would need to be at the top of the agenda for most governments.However,in most countries,such expenditure competes with other budgetary priorities and policy objec- tives.Demonstrating the economic burden of pollution can help tilt the balance of decisions in favor of investments in clean air. This study is the result of a collaboration between the World Bank and the Institute for Health Metrics and Evaluation(IHME)at the University of Washington,Seattle.It represents an effort to merge cutting edge science and rigorous economic analysis for the good of public health. The study has found that premature deaths due to air pollution in 2013 cost the global econ- omy about $225 billion in lost labor income,or about $5.11 trillion in welfare losses world- wide.That is about the size of the gross domestic product of India,Canada,and Mexico combined-and a sobering wake-up call. However impressive and abstract these large numbers are,it is our hope that the cost of pre- mature deaths for countries'economies will leave the pages of this study and inform public debate and policy decisions at the national level.In country after country,the cost of pollution in human lives and on the quality of life is too high.We must work together to reduce it. Laura Tuck Vice President,Sustainable Development,World Bank Ta Keith Hansen, Vice President,Human Development,World Bank 以火？法t Christopher Murray Director,Institute for Health Metrics and Evaluation,University of Washington The Cost of Air Pollution:Strengthening the Economic Case for Action vi
The Cost of Air Pollution: Strengthening the Economic Case for Action vii Foreword The science is clear: breathing polluted air increases the risk of debilitating and deadly diseases such as lung cancer, stroke, heart disease, and chronic bronchitis. Air pollution is now the world’s fourth-leading fatal health risk, causing one in ten deaths in 2013. At the same time, air pollution from industries, construction sites, agricultural practices, vehicles, and the combustion of dirty energy sources continues to grow. About 87 percent of the world’s population now live in countries in which ambient pollution levels exceed air quality guidelines set by the World Health Organization. In low- and middle-income countries, the danger is even more pronounced: 90 percent of the population in these countries was exposed to dangerous levels of ambient air pollution in 2013. To reduce the number of people gradually being contaminated by the air they breathe, pollution control would need to be at the top of the agenda for most governments. However, in most countries, such expenditure competes with other budgetary priorities and policy objectives. Demonstrating the economic burden of pollution can help tilt the balance of decisions in favor of investments in clean air. This study is the result of a collaboration between the World Bank and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. It represents an effort to merge cutting edge science and rigorous economic analysis for the good of public health. The study has found that premature deaths due to air pollution in 2013 cost the global economy about $225 billion in lost labor income, or about $5.11 trillion in welfare losses worldwide. That is about the size of the gross domestic product of India, Canada, and Mexico combinedand a sobering wake-up call. However impressive and abstract these large numbers are, it is our hope that the cost of premature deaths for countries’ economies will leave the pages of this study and inform public debate and policy decisions at the national level. In country after country, the cost of pollution in human lives and on the quality of life is too high. We must work together to reduce it. Laura Tuck Vice President, Sustainable Development, World Bank, Keith Hansen, Vice President, Human Development, World Bank Christopher Murray Director, Institute for Health Metrics and Evaluation, University of Washington 1700234_Cost of Pollution.indd 7 9/1/16 4:24 PM
Acknowledgments This is a joint report of the World Bank and the Institute for Health Metrics and Evaluation (IHME)at the University of Washington,Seattle.The core team,led by Urvashi Narain (World Bank),comprised Christopher Sall(World Bank),Michael Brauer(The University of British Columbia),Aaron Cohen(Health Effects Institute),Kara Estep(IHME),Mohammad Forou- zanfar (IHME),Zhiyun Jiang(World Bank),and Kevin O'Rourke (IHME).Contributions were also received from Lelia Croitoru(World Bank),Andreas Kopp(World Bank),and Maria Sarraf(World Bank). The team thanks Paula Caballero (World Bank),Valerie Hickey (World Bank)and Carter Brandon(World Bank)for their overall support and guidance.The report benefited greatly from discussions with Maureen Cropper(University of Maryland),Alan Krupnick(Resources for the Future (RFF)and peer reviewer),Jostein Nygard(World Bank)and Yewande Awe (World Bank).Constructive comments were received from the following peer reviewers for the study:Anjali Acharya(World Bank),Alan Krupnick,Montserrat Meiro-Lorenzo(World Bank),and Michael Toman (World Bank).The team would also like to acknowledge numer- ous other colleagues for their suggestions,including Sameer Akbar(World Bank),Michael Brody (World Bank),Gary Kleiman (World Bank),Kseniya Lvovsky (World Bank),Anna Malinovskaya(RFF),Klas Sanders(World Bank),and Elena Strukova(World Bank) The authors would also like to thank Flore Martinant de Preneuf(World Bank),Adam Broadfoot (World Bank),and Diana Manevskaya(World Bank)for production management.The manu- script was edited by Sabra Ledent.Any remaining errors or omissions are the authors'own. Last but not least,the team gratefully acknowledges the support of the University of British Colombia and the Health Effects institute,and the financial support provided for the report by the Pollution Management and Environmental Health Program of the World Bank. viⅷi The Cost of Air Pollution:Strengthening the Economic Case for Action
viii The Cost of Air Pollution: Strengthening the Economic Case for Action Acknowledgments This is a joint report of the World Bank and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. The core team, led by Urvashi Narain (World Bank), comprised Christopher Sall (World Bank), Michael Brauer (The University of British Columbia), Aaron Cohen (Health Effects Institute), Kara Estep (IHME), Mohammad Forouzanfar (IHME), Zhiyun Jiang (World Bank), and Kevin O’Rourke (IHME). Contributions were also received from Lelia Croitoru (World Bank), Andreas Kopp (World Bank), and Maria Sarraf (World Bank). The team thanks Paula Caballero (World Bank), Valerie Hickey (World Bank) and Carter Brandon (World Bank) for their overall support and guidance. The report benefited greatly from discussions with Maureen Cropper (University of Maryland), Alan Krupnick (Resources for the Future (RFF) and peer reviewer), Jostein Nygard (World Bank) and Yewande Awe (World Bank). Constructive comments were received from the following peer reviewers for the study: Anjali Acharya (World Bank), Alan Krupnick, Montserrat Meiro-Lorenzo (World Bank), and Michael Toman (World Bank). The team would also like to acknowledge numerous other colleagues for their suggestions, including Sameer Akbar (World Bank), Michael Brody (World Bank), Gary Kleiman (World Bank), Kseniya Lvovsky (World Bank), Anna Malinovskaya (RFF), Klas Sanders (World Bank), and Elena Strukova (World Bank). The authors would also like to thank Flore Martinant de Preneuf (World Bank), Adam Broadfoot (World Bank), and Diana Manevskaya (World Bank) for production management. The manuscript was edited by Sabra Ledent. Any remaining errors or omissions are the authors’ own. Last but not least, the team gratefully acknowledges the support of the University of British Colombia and the Health Effects institute, and the financial support provided for the report by the Pollution Management and Environmental Health Program of the World Bank. 1700234_Cost of Pollution.indd 8 9/7/16 9:20 AM
Abbreviations AAP ambient air pollution ALRI acute lower respiratory infection ANS adjusted net savings AOD aerosol optical depth APM ambient PM2s ASDR age-standardized death rate COPD chronic obstructive pulmonary disease DALYs disability-adjusted life years EPA Environmental Protection Agency(U.S.) GBD Global Burden of disease GDP gross domestic product GPR Gaussian process regression HAP household air pollution IARC International Agency for Research on Cancer IER integrated exposure-response IHD ischemic heart disease IHME Institute for Health Metrics and Evaluation ILO International Labour Organization LFPR labor force participation rate LRI lower respiratory infection OECD Organisation for Economic Co-operation and Development OMB Office of Management and Budget(U.S.) PAF population attributable fraction PAH polycyclic aromatic hydrocarbon PM particulate matter PMEH Pollution Management and Environmental Health(World Bank) PPP purchasing power parity RR relative risk RFF Resources for the Future SAR Special Administrative Region TM5-FASST FAst Scenario Screening Tool VI uncertainty interval VSL value of statistical life VSLY value per statistical life year WHO World Health Organization WTP willingness to pay YLDs years lived with disability YLLs years of life lost All dollar amounts are U.S.dollars unless otherwise indicated. The Cost of Air Pollution:Strengthening the Economic Case for Action ix
The Cost of Air Pollution: Strengthening the Economic Case for Action ix Abbreviations AAP ambient air pollution ALRI acute lower respiratory infection ANS adjusted net savings AOD aerosol optical depth APM ambient PM2.5 ASDR age-standardized death rate COPD chronic obstructive pulmonary disease DALYs disability-adjusted life years EPA Environmental Protection Agency (U.S.) GBD Global Burden of Disease GDP gross domestic product GPR Gaussian process regression HAP household air pollution IARC International Agency for Research on Cancer IER integrated exposure-response IHD ischemic heart disease IHME Institute for Health Metrics and Evaluation ILO International Labour Organization LFPR labor force participation rate LRI lower respiratory infection OECD Organisation for Economic Co-operation and Development OMB Office of Management and Budget (U.S.) PAF population attributable fraction PAH polycyclic aromatic hydrocarbon PM particulate matter PMEH Pollution Management and Environmental Health (World Bank) PPP purchasing power parity RR relative risk RFF Resources for the Future SAR Special Administrative Region TM5-FASST FAst Scenario Screening Tool UI uncertainty interval VSL value of statistical life VSLY value per statistical life year WHO World Health Organization WTP willingness to pay YLDs years lived with disability YLLs years of life lost All dollar amounts are U.S. dollars unless otherwise indicated. 1700234_Cost of Pollution.indd 9 8/29/16 1:55 PM
Executive Summary Introduction Air pollution is recognized today as a major health risk.Exposure to air pollution,both ambi- ent and household,increases a person's risk of contracting a disease such as lung cancer,stroke, heart disease,and chronic bronchitis.According to the latest available estimates,in 2013, 5.5 million premature deaths worldwide,or 1 in every 10 total deaths,were attributable to air pollution.Air pollution has posed a significant health risk since the early 1990s,the earliest period for which global estimates of exposure and health effects are available.In 1990,as in 2013,air pollution was the fourth leading fatal health risk worldwide,resulting in 4.8 million premature deaths. Air pollution is especially severe in some of the world's fastest-growing urban regions,where greater economic activity is contributing to higher levels of pollution and to greater exposure. But air pollution is also a problem outside cities.Billions of people around the world continue to depend on burning solid fuels such as wood,charcoal,coal,and dung in their homes for cooking and heating.Consequently,the health risk posed by air pollution is the greatest in developing countries.In 2013 about 93 percent of deaths and nonfatal illnesses attributed to air pollution worldwide occurred in these countries,where 90 percent of the population was exposed to dan- gerous levels of air pollution.Children under age 5 in lower-income countries are more than 60 times as likely to die from exposure to air pollution as children in high-income countries. Air pollution is not just a health risk but also a drag on development.By causing illness and premature death,air pollution reduces the quality of life.By causing a loss of productive labor, it also reduces incomes in these countries.Air pollution can have a lasting effect on productiv- ity in other ways as well-for example,by stunting plant growth and reducing the productivity of agriculture,and by making cities less attractive to talented workers,thereby reducing cities' competitiveness. Motivation for This Study This study sets out to calculate the economic costs of premature mortality from air pollution to strengthen the business case for governments to act ambitiously in reducing pollution.The costs of pollution to society are many,but a full accounting is beyond the scope of this report. Instead,it will focus on what many studies have shown to be the largest and most damaging cost of pollution:premature mortality. The number of deaths each year attributable to air pollution makes a compelling case for reducing pollution.Valuing the costs of premature deaths associated with pollution helps to further highlight the severity of the problem.Governments face a wide array of competing development challenges,and monetizing the costs of pollution can help them decide how to allocate scarce resources to better the lives of their citizens.Monetary values can also help The Cost of Air Pollution:Strengthening the Economic Case for Action
x The Cost of Air Pollution: Strengthening the Economic Case for Action Executive Summary Introduction Air pollution is recognized today as a major health risk. Exposure to air pollution, both ambient and household, increases a person’s risk of contracting a disease such as lung cancer, stroke, heart disease, and chronic bronchitis. According to the latest available estimates, in 2013, 5.5 million premature deaths worldwide, or 1 in every 10 total deaths, were attributable to air pollution. Air pollution has posed a significant health risk since the early 1990s, the earliest period for which global estimates of exposure and health effects are available. In 1990, as in 2013, air pollution was the fourth leading fatal health risk worldwide, resulting in 4.8 million premature deaths. Air pollution is especially severe in some of the world’s fastest-growing urban regions, where greater economic activity is contributing to higher levels of pollution and to greater exposure. But air pollution is also a problem outside cities. Billions of people around the world continue to depend on burning solid fuels such as wood, charcoal, coal, and dung in their homes for cooking and heating. Consequently, the health risk posed by air pollution is the greatest in developing countries. In 2013 about 93 percent of deaths and nonfatal illnesses attributed to air pollution worldwide occurred in these countries, where 90 percent of the population was exposed to dangerous levels of air pollution. Children under age 5 in lower-income countries are more than 60 times as likely to die from exposure to air pollution as children in high-income countries. Air pollution is not just a health risk but also a drag on development. By causing illness and premature death, air pollution reduces the quality of life. By causing a loss of productive labor, it also reduces incomes in these countries. Air pollution can have a lasting effect on productivity in other ways as well—for example, by stunting plant growth and reducing the productivity of agriculture, and by making cities less attractive to talented workers, thereby reducing cities’ competitiveness. Motivation for This Study This study sets out to calculate the economic costs of premature mortality from air pollution to strengthen the business case for governments to act ambitiously in reducing pollution. The costs of pollution to society are many, but a full accounting is beyond the scope of this report. Instead, it will focus on what many studies have shown to be the largest and most damaging cost of pollution: premature mortality. The number of deaths each year attributable to air pollution makes a compelling case for reducing pollution. Valuing the costs of premature deaths associated with pollution helps to further highlight the severity of the problem. Governments face a wide array of competing development challenges, and monetizing the costs of pollution can help them decide how to allocate scarce resources to better the lives of their citizens. Monetary values can also help 1700234_Cost of Pollution.indd 10 9/7/16 10:45 AM
them measure the benefits of policies to tackle pollution and,when compared with costs of implementation,to devise cost-effective air quality management plans. This study also presents the results of 2013 Global Burden of Disease Study(GBD 2013 Col- laborators 2015).The GBD measures illnesses and premature deaths from a multitude of causes and risk factors around the world,including air pollution.It offers the most extensive estimates of exposure and trends in air pollution levels and their associated burden of disease. The GBD effort dates to the early 1990s when the World Bank commissioned the original GBD study for feature in its World Development Report 1993:Investing in Health.Since 2010, the Institute for Health Metrics and Evaluation(IHME)at the University of Washington,Seat- tle,has steered the GBD study,with the latest set of estimates for 2013. Methodology The disease burden attributable to air pollution is estimated by first measuring the severity of air pollution and the extent to which people are exposed to it (Brauer et al.2016; Cohen et al.n.d.).The GBD evaluates exposure to outdoor (ambient)air pollution as well as indoor air pollution in households cooking with solid fuels.The GBD approach to estimating ambient air pollution aims to make the greatest use of information from different sources in the most reasonable way possible,combining data from ground monitoring with satellite observations and chemical transport models.Exposure to household air pollution is estimated from a combination of data on the proportion of households using solid fuels,estimates of indoor pollution concentrations associated with fuel use,and the ratio of personal to area exposure. The GBD then evaluates how personal exposure raises people's relative risk of contracting ill- nesses such as ischemic heart disease,stroke,chronic obstructive pulmonary disease,lung cancer,acute lower respiratory infections,and pneumonia.Elevated risk among the exposed population translates into a higher portion of deaths from these conditions each year,which are attributed to air pollution. Using the GBD estimates of premature mortality attributable to pollution,this study values the economic costs in dollar terms following two different approaches:(1)a welfare-based approach that monetizes the increased fatality risk from air pollution according to individuals' willingness to pay(WTP);and(2)an income-based approach that equates the financial cost of premature mortality with the present value of forgone lifetime earnings.Each of these approaches is given equal weight in this report,although they are tailored to different purposes. The welfare-based approach is intended to measure the economic costs of fatal health risks to the individuals that make up a society.By increasing people's risk of contracting a deadly ill- ness,air pollution represents a threat to the many things they value,including consumption, leisure,good health,and simply being alive.This value is reflected in the WTP,which captures the trade-offs that individuals are willing to make to reduce their chances of dying.The value of statistical life(VSL)represents the sum of many individuals'WTP for marginal changes in The Cost of Air Pollution:Strengthening the Economic Case for Action xi
The Cost of Air Pollution: Strengthening the Economic Case for Action xi them measure the benefits of policies to tackle pollution and, when compared with costs of implementation, to devise cost-effective air quality management plans. This study also presents the results of 2013 Global Burden of Disease Study (GBD 2013 Collaborators 2015). The GBD measures illnesses and premature deaths from a multitude of causes and risk factors around the world, including air pollution. It offers the most extensive estimates of exposure and trends in air pollution levels and their associated burden of disease. The GBD effort dates to the early 1990s when the World Bank commissioned the original GBD study for feature in its World Development Report 1993: Investing in Health. Since 2010, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, has steered the GBD study, with the latest set of estimates for 2013. Methodology The disease burden attributable to air pollution is estimated by first measuring the severity of air pollution and the extent to which people are exposed to it (Brauer et al. 2016; Cohen et al. n.d.). The GBD evaluates exposure to outdoor (ambient) air pollution as well as indoor air pollution in households cooking with solid fuels. The GBD approach to estimating ambient air pollution aims to make the greatest use of information from different sources in the most reasonable way possible, combining data from ground monitoring with satellite observations and chemical transport models. Exposure to household air pollution is estimated from a combination of data on the proportion of households using solid fuels, estimates of indoor pollution concentrations associated with fuel use, and the ratio of personal to area exposure. The GBD then evaluates how personal exposure raises people’s relative risk of contracting illnesses such as ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, acute lower respiratory infections, and pneumonia. Elevated risk among the exposed population translates into a higher portion of deaths from these conditions each year, which are attributed to air pollution. Using the GBD estimates of premature mortality attributable to pollution, this study values the economic costs in dollar terms following two different approaches: (1) a welfare-based approach that monetizes the increased fatality risk from air pollution according to individuals’ willingness to pay (WTP); and (2) an income-based approach that equates the financial cost of premature mortality with the present value of forgone lifetime earnings. Each of these approaches is given equal weight in this report, although they are tailored to different purposes. The welfare-based approach is intended to measure the economic costs of fatal health risks to the individuals that make up a society. By increasing people’s risk of contracting a deadly illness, air pollution represents a threat to the many things they value, including consumption, leisure, good health, and simply being alive. This value is reflected in the WTP, which captures the trade-offs that individuals are willing to make to reduce their chances of dying. The value of statistical life (VSL) represents the sum of many individuals’ WTP for marginal changes in 1700234_Cost of Pollution.indd 11 8/31/16 3:36 PM