Health Effects In Population Research Articles

The public health and economic burden of long COVID in Australia, 2022-24: a modelling study.

To estimate the number of people in Australia with long COVID by age group, and the associated medium term productivity and economic losses. Modelling study: a susceptible-exposed-infected-recovered (SEIR) model to estimate the number of people with long COVID over time following single infections, and a labour supply model to estimate productivity losses as a proportion of gross domestic product (GDP). Australia, 2022-2024. Estimated number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during 2022-2023 (based on serosurvey data) who have longCOVID, 2022-2024, by age group; estimated GDP loss during 2022 caused by reduced labour supply attributable to long COVID. Our model projected that the number of people with long COVID following a single infection in 2022 would peak in September 2022, when 310 341-1 374 805 people (1.2-5.4% of Australians) would have symptoms of long COVID, declining to 172 530-872 799 people (0.7-3.4%) in December 2024, including 7902-30 002 children aged 0-4 years (0.6-2.2%). The estimated mean labour loss attributable to long COVID in 2022 was projected to be 102.4million (95% confidence interval [CI], 50.4-162.2 million) worked hours, equivalent to 0.48% (95% CI, 0.24-0.76%) of total worked hours in Australia during the 2020-21 financial year. The estimated mean GDP loss caused by the projected decline in labour supply and reduced use of other production factors was $9.6 billion (95% CI, $4.7-15.2 billion), or 0.5% of GDP. The estimated labour loss was greatest for people aged 30-39 years (27.5 million [95% CI, 16.0-41.0 million] hours; 26.9% of total labour loss) and people aged 40-49 years (24.5 million [95% CI, 12.1-38.7 million] hours; 23.9% of total labour loss). Widespread SARS-CoV-2 infections in Australia mean that even a small proportion of infected people developing long COVID-related illness and disability could have important population health and economic effects. A paradigm shift is needed, from a sole focus on the immediate effects of coronavirus disease 2019 (COVID-19) to preventing and treating COVID-19 and treating long COVID, with implications for vaccine and antiviral policy and other mitigation of COVID-19.

Glyphosate Internal Doses of Exposure and Health Effects in Populations from an Agricultural Area of the Province of Cordoba (Argentina)

Glyphosate Internal Doses of Exposure and Health Effects in Populations from an Agricultural Area of the Province of Cordoba (Argentina)

Early-Life Disease Exposure and Its Heterogeneous Effects on Mortality Throughout Life: Sweden, 1905–2016

Exposure to infectious diseases in early life has been linked to increased mortality risk in later life in high-disease settings, such as eighteenth- and nineteenth-century Europe. Less is known about the long-term effects of early-life disease exposure in milder disease environments. This study estimates heterogeneous effects from disease exposure in infancy on later-life mortality in twentieth-century Sweden, by socioeconomic status at birth and sex. Using historical population data for southern Sweden, we study 11,515 individuals who were born in 1905–1929 from age 1 until age 85. We measure exposure to disease using the local post–early neonatal mortality rate in the first 12 months after birth and apply flexible parametric survival models. For females, we find a negative effect on life expectancy (scarring) at ages 1–85 following high disease exposure in infancy, particularly for those born to unskilled workers. For males, we find no negative effect on later-life survival, likely because stronger mortality selection in infancy outweighs scarring. Thus, even as the incidence of infectious diseases declined at the start of the twentieth century, early-life disease exposure generated long-lasting negative but heterogeneous population health effects.

PM2.5 and its components and respiratory disease healthcare encounters – Unanticipated increased exposure-response relationships in recent years after environmental policies

Prior studies reported excess rates (ERs) of cardiorespiratory events associated with short-term increases in PM2.5 concentrations, despite implementation of pollution-control policies. In 2017, Federal Tier 3 light-duty vehicle regulations began, and to-date there have been no assessments of population health effects of the policy. Using the NYS Statewide Planning and Research Cooperative System (SPARCS) database, we obtained hospitalizations and ED visits with a principal diagnosis of asthma or chronic obstructive pulmonary disease (COPD) for residents living within 15 miles of six urban PM2.5 monitoring sites in NYS (2014–2019). We used a time-stratified case-crossover design and conditional logistic regression (adjusting for ambient temperature, relative humidity, and weekday) to estimate associations between PM2.5, POC (primary organic carbon), SOC (secondary organic carbon), and rates of respiratory disease hospitalizations and emergency department (ED) visits from 2014 to 2019. We evaluated demographic disparities in these relative rates and compared changes in ERs before (2014–2016) and after Tier 3 implementation (2017–2019). Each interquartile range increase in PM2.5 was associated with increased ERs of asthma or COPD hospitalizations and ED visits in the previous 7 days (ERs ranged from 1.1%–3.1%). Interquartile range increases in POC were associated with increased rates of asthma ED visits (lag days 0–6: ER = 2.1%, 95% CI = 0.7%, 3.6%). Unexpectedly, the ERs of asthma admission and ED visits associated with PM2.5, POC, and SOC were higher during 2017–2019 (after Tier 3) than 2014–2016 (before Tier-3). Chronic obstructive pulmonary disease analyses showed similar patterns. Excess Rates were higher in children (<18 years; asthma) and seniors (≥65 years; COPD), and Black, Hispanic, and NYC residents. In summary, unanticipated increases in asthma and COPD ERs after Tier-3 implementation were observed, and demographic disparities in asthma/COPD and PM2.5, POC, and SOC associations were also observed. Future work should confirm findings and investigate triggering of respiratory events by source-specific PM.

Sex ratio at birth across 100 years in Sweden and risk of cardiovascular disease and all-cause mortality – a national register study

The human sex ratio at birth (SRB) undergoes temporary changes around a mean proportion of 0.51 male births. SRB has been well studied for historical, geographical, and secular trends, but until now not linked to health outcomes in the total population, e.g. for cardiovascular disease (CVD) or mortality during follow-up of birth cohorts. We used linkage analysis based on national registers in Sweden that cover all births from 1900 to 2016. SRB at birth was calculated by every 10-year birth cohort in all survivors living in 1997 for a follow-up analysis of risk of CVD and mortality with data from national registers. When the highest quartile of SRB was used as reference, a slightly increased risk of fatal CVD (HR 1.03 (95% confidence intervals, CI): 1.02–1.04), non-fatal CVD (HR 1.01; 95%CI: 1.01–1.02) and mortality (HR 1.02; 95%CI, 1.01–1.03) was found after full adjustments in men belonging to the lowest SRB quartile. A similar pattern was also found for fatal CHD in women. in the lowest SBR quartile compared to the highest, HR 1.03 (95%CI: 1.02–1.05). In conclusion, in birth cohorts with a relatively lower than expected number of males born, long-term adverse health effects were observed with slightly increased cardiovascular risk and total mortality at the population level. This could indicate that men belonging to so-called “culled cohorts” in a developed country during the 20th century are characterized by a slightly increased risk that could reflect negative early life influences and environmental exposures in pregnant women resulting in selective loss of male embryos or fetuses. In a public health perspective SRB could be of some importance to monitor as an aspect of birth statistics linked to relatively minor population health effects.

Economic Disparities in Utilization and Outcomes of Structural Heart Disease Interventions in the United States

BackgroundDisparities in access to care cause negative health consequences for underserved populations. Economic disparities in structural heart disease (SHD) interventions are not well characterized. ObjectivesThe objective of this study was to evaluate economic disparities in the utilization and outcomes of SHD interventions in the United States. MethodsWe queried the National Inpatient Sample (2016-2020) to examine economic disparities in the utilization, in-hospital outcomes, length of stay, and cost of SHD interventions among patients ≥65 years of age. Outcomes were determined using logistic regression models. ResultsA total of 401,005 weighted hospitalizations for transcatheter aortic valve replacement, left atrial appendage occlusion, transcatheter mitral valve repair, and transcatheter mitral valve replacement were included. Utilization rates (number of procedures performed per 100,000 hospitalizations) were higher in patients with high income compared with medium and low income for transcatheter aortic valve replacement (559 vs 456 vs 338), left atrial appendage occlusion (148 vs 136 vs 99), transcatheter mitral valve repair (65 vs 54 vs 41), and transcatheter mitral valve replacement (7.7 vs 6.7 vs 1.2) (all P < 0.01). Low- and medium-income patients had distinctive demographic and clinical risk profiles compared with high-income patients. There were no significant differences in the adjusted in-hospital mortality, key complications, or length of stay between high-, medium-, and low-income patients following any of the 4 SHD interventions. High-income patients incurred a modestly higher cost with any of the 4 SHD interventions compared with medium- and low-income patients. ConclusionsEconomic disparities exist in the utilization of SHD interventions in the United States. Nonetheless, adjusted in-hospital outcomes were comparable among high-, medium-, and low-income patients. Multifaceted implementation strategies are needed to attenuate these utilization disparities.

Child exposure to N-(1,3-dimethylbutyl)-N′-phenyl-p-phenylenediamine (6PPD) and its derived quinone (6PPDQ) in e-waste areas: Urinary concentrations, sources, and health effect assessment

N-(1,3-dimethylbutyl)-N′-phenyl-p-phenylenediamine quinone (6PPDQ) and its parent 6PPD are ubiquitous in the environment and may induce multi-endpoint toxicity. Electronic waste (e-waste) dismantling is an under-recognized source of 6PPD and 6PPDQ emissions, and there is a lack of epidemiological investigations into their presence and health effects in local populations. This study aimed to determine the urinary concentrations of 6PPD and 6PPDQ in children aged 2–7 years from e-waste dismantling areas and evaluate their potential risk to physical growth. We found that children from the e-waste area had significantly elevated urinary concentrations of 6PPD and 6PPDQ (median: 0.073 and 2.34 ng/mL) compared to those in the reference area (0.020 and 0.24 ng/mL, respectively). The estimated urinary excretions of 6PPDQ in the e-waste exposure group were considerably higher than that in the reference group (p < 0.001). Furthermore, a borderline significant association of co-exposure to high levels of 6PPD and 6PPDQ with lower BMI z-score (OR = 1.99, 95 % Cl: 1.04, 3.82) was observed in the crude model and the model adjusted for age and gender. In conclusion, our study first reported the urinary 6PPD and 6PPDQ concentrations in children from e-waste dismantling areas. The result indicated that e-waste recycling activities contribute to significantly elevated body burdens of 6PPD and 6PPDQ in children, which may be a potential risk factor for physical growth. Further epidemiological and toxicological studies are needed to investigate the exposure and health risks, especially in vulnerable populations.

Distilling the Fundamentals of Evidence-Based Public Health Policy.

Public health policy interventions are associated with many important public health achievements. To provide public health practitioners and decision makers with practical approaches for examining and employing evidence-based public health (EBPH) policy interventions, we describe the characteristics and benefits that distinguish EBPH policy interventions from programmatic interventions. These characteristics include focusing on health at a population level, focusing on upstream drivers of health, and involving less individual action than programmatic interventions. The benefits of EBPH policy interventions include more sustained effects on health than many programs and an enhanced ability to address health inequities. Early childhood education and universal preschool provide a case example that illustrates the distinction between EBPH policy and programmatic interventions. This review serves as the foundation for 3 concepts that support the effective use of public health policy interventions: applying core component thinking to understand the population health effects of EBPH policy interventions; understanding the influence of existing policies, policy supports, and the context in which a particular policy is implemented on the effectiveness of that policy; and employing a systems thinking approach to identify leverage points where policy implementation can have a meaningful effect.

An approach to assess the consequence of a hypothetical radionuclide release in Singapore - a densely populated urban setting

This study is to demonstrate an approach to investigate the consequence of a hypothetical radionuclide release scenario in Singapore, a typical urban setting with high population density. To this end, we made use of MACCS 4.1, a Gaussian-based atmospheric dispersion model to compute the peak dose and the population health effects. We developed the meteorological and site files from data provided by local government agencies. Our investigation showed that the chosen scenario poses very little to negligible risk to the health of local population as the peak dose received across the country is below the radiation safety level recommended by ICRP.

Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties.

Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.

Research on the spatial and temporal patterns of ozone concentration and population health effects in the Central Plains Urban Agglomeration from 2017 to 2020.

Fine particulate matter (PM2.5) and near-surface ozone (O3) are the main atmospheric pollutants in China. Long-term exposure to high ozone concentrations adversely affects human health. It is of great significance to systematically analyze the spatiotemporal evolution mechanism and health effects of ozone pollution. Based on the ozone data of 91 monitoring stations in the Central Plains Urban Agglomeration from 2017 to 2020, the research used Kriging method and spatial autocorrelation analysis to investigate the spatiotemporal variations of ozone concentration. Additionally, the study assessed the health effects of ozone on the population using the population exposure risk model and exposure-response relationship model. The results indicated that: (1) The number of premature deaths caused by ozone pollution in the warm season were 37,053 at 95% confidence interval (95% CI: 28,190-45,930) in 2017, 37,685 (95% CI: 28,669-46,713) in 2018, and 37,655 (95% CI: 28,647-46,676) in 2019. (2) The ozone concentration of the Central Plains urban agglomeration showed a decreasing trend throughout the year and during the warm season from 2017 to 2020, there are two peaks monthly, one is June, and the other is September. (3) In the warm season, the high-risk areas of population exposure to ozone in the Central Plains Urban Agglomeration were mainly concentrated in urban areas. In general, the population exposure risk of the south is lower than that of the north. The number of premature deaths attributed to ozone concentration during the warm season has decreased, but some southern cities such as Xinyang and Zhumadian have also seen an increase in premature deaths. China has achieved significant results in air pollution control, but in areas with high ozone concentrations and high population density, the health burden caused by air pollution remains heavy, and stricter air pollution control policies need to be implemented.

Association Between Household Online Grocery Delivery Service Use and Food and Drink Purchase Behavior in England: Cross-Sectional Analysis.

Online grocery delivery services (OGDSs) are a popular way of acquiring food. However, it is unclear whether OGDS use is associated with the healthiness of purchases and whether there are sociodemographic differences in OGDS use. If so, the increased prevalence of OGDS use may have implications for population diet, and differential OGDS use could contribute to diet inequalities. This study aimed to examine whether OGDS use varies by sociodemographic characteristics and is associated with the amount and types of groceries purchased. Item-level take-home food and drink purchase data (n=3,233,920 items) from households in London and the North of England were available from the 2019 UK Kantar fast-moving consumer goods panel (N=1911). Purchases were categorized as being bought online or in-store. We used logistic regression to estimate the likelihood of an above-median frequency of OGDS use by sociodemographic characteristics. We used Poisson regression to estimate the differences in energy and nutrients purchased by households that had above- and below-median OGDS use and the proportion of energy purchased from products high in fat, salt, and sugar (HFSS) online versus in-store among households that used both shopping methods (n=665). In total, 668 (35%) households used OGDSs at least once in 2019. Of the households that used OGDSs, the median use was 5 occasions in 2019. Households were more likely to have above-median use in London versus in the North of England (odds ratio 1.29, 95% CI 1.01-1.65) and if they had a higher annual household income (odds ratio 1.56, 95% CI 1.02-2.38 for ≥£50,000 [US $64,000] vs <£20,000 [$25,600]). Households with above-median OGDS use had a higher weekly mean purchase of energy by 1461 (95% CI 1448-1474) kcal per person compared with households with below-median OGDS use. For households that used a combination of in-store and online shopping, HFSS products made up a lower proportion (-10.1%, 95% CI -12% to -8.1%) of energy purchased online compared to in-store. Differences in grocery purchases between households with above- and below-median OGDS use could have positive or negative consequences. The extra energy purchased among households with above-median OGDS use could lead to overconsumption or food waste, which has negative consequences for population and environmental health. Alternatively, this extra energy may be replacing out-of-home purchasing, which tends to be less healthy, and may be beneficial for the population diet. Households made fewer HFSS purchases when shopping online compared to in-store, which may be due to differences in the shopping environment or experience, such as fewer promotions and advertisements when shopping online or not having to transport and carry purchases home. As higher-income households used OGDS more frequently, the implications of this sociodemographic pattern on dietary inequalities must be explored.

Long-term ambient air pollution exposure and prospective change in sedentary behaviour and physical activity in individuals at risk of type 2 diabetes in the UK.

Air pollution may be a risk factor for physical inactivity and sedentary behaviour (SED) through discouraging active lifestyles, impairing fitness and contributing to chronic diseases with potentially important consequences for population health. Using generalized estimating equations, we examined the associations between long-term particulate matter with diameter≤2.5μm (PM2.5), ≤10μm (PM10) and nitrogen dioxide (NO2) and annual change in accelerometer-measured SED, moderate-to-vigorous physical activity (MVPA) and steps in adults at risk of type 2 diabetes within the Walking Away from Type 2 Diabetes trial. We adjusted for important confounders including social deprivation and measures of the built environment. From 808 participants, 644 had complete data (1605 observations; 64.7% men; mean age 63.86years). PM2.5, NO2 and PM10 were not associated with change in MVPA/steps but were associated with change in SED, with a 1ugm-3 increase associated with 6.38 (95% confidence interval: 0.77, 12.00), 1.52 (0.49, 2.54) and 4.48 (0.63, 8.34) adjusted annual change in daily minutes, respectively. Long-term PM2.5, NO2 and PM10 exposures were associated with an annual increase in SED: ~11-22min/day per year across the sample range of exposure (three standard deviations). Future research should investigate whether interventions to reduce pollution may influence SED.

The enrolment gap and the COVID-19 pandemic: an exploration of routinely collected primary care enrolment data from 2016 to 2023 in Aotearoa New Zealand.

Introduction For many countries, primary health care (PHC) serves as the gateway for individuals to access healthcare services. It has been shown to not only improve health but also health equity. To maximise this benefit, a substantial proportion of the population needs to be connected with PHC. The aim here was to assess the degree and evolution of enrolment in light of the coronavirus disease 2019 (COVID-19) pandemic in Aotearoa New Zealand. Methods We examined data on the enrolment of people in PHC organisations between 2016 and 2023. This analysis included breakdowns by sex, age groups, ethnicity, and socioeconomic deprivation levels. Poisson regression models were used to explore whether enrolment changed because of the COVID-19 pandemic. Results In 2016, Māori, young people and the most deprived had lower enrolment rates relative to their peers. Although young people's enrolment rate increased over time, especially during the COVID-19 pandemic, the Māori enrolment rate declined, as did the rate for Pacific people, and those who were the most deprived. The groups who had increases in enrolment rates were those with the lowest levels of socioeconomic deprivation and those in the 'Other' ethnic category, predominantly made up of European New Zealanders. Conclusion Enrolment statistics reveal disparities across sociodemographic lines. The COVID-19 pandemic was associated with changed patterns of enrolment that appear to have consequences for population health.

Central America and the Dominican Republic at Crossroads: The Importance of Regional Cooperation and Health Economic Research to Address Current Health Challenges

ObjectivesWe discuss key health challenges currently faced by countries in the Central America and Dominican Republic region after the COVID-19 pandemic. We highlight the influence of socioeconomic determinants for the challenging public health dynamics observed and the crucial roles that regional cooperation and health economic research can have for tackling such challenges. MethodsWe present a descriptive overview of the current situation of public finances and its effect on government capacity to improve social expenditure. We also discuss the impact of the COVID-19 pandemic crisis on social dynamics and living conditions in the region. ResultsOur analysis suggests that the interplay between all these factors is likely to have important consequences for health systems and population health in the post-pandemic period. Previous examples of successful cross-country cooperation in the region indicate the great potential that these initiatives have for supporting health system resilience against current challenges. Technical cooperation must be informed by (currently unavailable) research evidence that can guide decision making, especially health economic research to support national health resource allocation policies. Areas identified as priorities for applied health economic research include both macro and microeconomic analyses. ConclusionsCentral America and the Dominican Republic face significant health challenges post-pandemic. Our article emphasizes the great potential that regional technical cooperation, informed by further health economic research, has to improve public policies and health governance in the region.

State and sex-specific trends in the annual incidence of child marriage in the United States since the year 2000

ObjectivesChild marriage, defined as marriage before 18 years of age, is a violation of human rights with harmful consequences for population health, educational attainment, and economic opportunities. Child marriage is legal across most of the United States but how often it happens is challenging to estimate. We measured state and sex-specific trends in the annual incidence of child marriage in 41 states and the District of Columbia. MethodsWe collected data from marriage certificates filed between 2000 and 2019. These certificates allowed us to identify marriages that occurred within each state and involved a spouse under the age of 18. We divided the number of 15–17-year-olds married in each year by the number of children in that age range living in the state in that year and graphed these annual rates to present trends over time. ResultsThe rate of child marriage declined substantially across the United States between 2000 and 2019. Over 75 % of all married children in each state were girls. Girls married men who were an average of 4 years older than they were, and the age gap was substantially larger when girls married than when boys married. ConclusionsChild marriage continues across most of the United States and reflects gender inequities in American society. The continued legality of marriage before the age of 18 is at odds with the country's commitment to eliminate child marriage by the year 2030 and violates the human rights of children, primarily girls, across the country.

The smoking and vaping model, A user-friendly model for examining the country-specific impact of nicotine VAPING product use: application to Germany

BackgroundSimulation models play an increasingly important role in tobacco control. Models examining the impact of nicotine vaping products (NVPs) and smoking tend to be highly specialized and inaccessible. We present the Smoking and Vaping Model (SAVM),a user-friendly cohort-based simulation model, adaptable to any country, that projects the public health impact of smokers switching to NVPs.MethodsSAVM compares two scenarios. The No-NVP scenario projects smoking rates in the absence of NVPs using population projections, deaths rates, life expectancy, and smoking prevalence. The NVP scenario models vaping prevalence and its impact on smoking once NVPs became popular. NVP use impact is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the No-NVP and NVP scenarios. We illustrate SAVM’s adaptation to the German adult ages 18+ population, the Germany-SAVM by adjusting the model using population, mortality, smoking and NVP use data.ResultsAssuming that the excess NVP mortality risk is 5% that of smoking, Germany-SAVM projected 4.7 million LYLs and almost 300,000 SVADs averted associated with NVP use from 2012 to 2060. Increasing the excess NVP mortality risk to 40% with other rates constant resulted in averted 2.8 million LYLs and 200,000 SVADs during the same period.ConclusionsSAVM enables non-modelers, policymakers, and other stakeholders to analyze the potential population health effects of NVP use and public health interventions.

Adverse effects of air pollution on human health predicted from tree-ring reductions – A conceptualization of a new ecosystem service

Air pollution adversely affects human health, while trees, conifers in particular, growing in areas affected by air pollution, immediately register pollution by developing rings with decreased width. Some diseases in human population, e.g. lung cancer, develop and are diagnosed with a certain delay in relation to the exposure to air pollution, thus, with a certain delay to ring reductions in trees. Therefore, reductions can be recognized as an early indicator that alerts about forthcoming outbreak of adverse health effects in human population. Based on this phenomenon we propose a new approach and a new methodology for assessing threats to human health and lives resulting from air pollution. In this paper we explain the application of new approach by presenting and describing it step by step. We state that data obtained through the new ecosystem service can be applied for early warning against adverse effects of air pollution on human health. This includes improved prediction of hospitalization patterns and financial costs for the healthcare system. The proposed methodology can be useful for decision makers e.g. local governments, state agencies, private enterprises and other stakeholders interested in controlling local emitters of air pollution and the harmfulness of pollution to human health and lives.

Assessing the Fiscal Burden of Obesity in Canada by Applying a Public Economic Framework.

Rising obesity prevalence is a health priority for many governments because of its impact on population health and economic consequences. We sought to estimate the broader consequences of obesity in Canada by applying a government perspective framework that captures lost tax revenues and increased government spending on social benefit programs. An age-specific prevalence-based model was built to quantify the fiscal burden of disease for government attributed to people living with obesity. The model was populated with age-specific wages, employment activity and government benefits received to estimate taxes and transfer costs. A targeted literature search was conducted to identify modifiers of employment status, wages and disability status attributed to people with obesity, and applied to employment and epidemiological projections which enabled us to estimate government costs and tax losses. Government tax revenue and costs attributed to obesity were projected over a 10-year period and discounted at 3%. The fiscal burden of obesity in Canada is estimated at CAD$22,974 million (2021). This figure consists of obesity-attributed revenue losses of CAD$9404 million from direct taxes due to decreased employment activity and CAD$2374 million from indirect tax revenue losses due to reduced consumption taxes. Healthcare costs are estimated at CAD$7881 million annually and disability costs of CAD$3686 million annually. This fiscal burden of disease distributed amongst taxpayers in 2021 is estimated to be CAD$752 per capita. We estimate for every 1% reduction in obesity prevalence, CAD$229.7 million net fiscal gains can be achieved annually. Obesity is associated with substantial clinical and economic burden not only to the healthcare system but also to wider government budgets as demonstrated using fiscal analysis. Reductions in obesity prevalence are likely to have positive fiscal gains for government from reduced spending on public benefits and increased tax revenue attributed to employment changes.

Disease costs due to outdoor ambient particulate matter pollution in Germany, 2018

Abstract Introduction In addition to the population health effects of outdoor ambient particulate matter pollution (PM2.5), estimates of the costs related to these health impacts are increasingly requested to inform policy decision-making processes. Within the UKAGEP-project the burden of disease due to PM2.5 in Germany was monetized. Methods First, the disease burden attributable to PM2.5 in Germany for the year 2018 was estimated using the Environmental Burden of Disease approach. To estimate the monetary impact of PM2.5, two approaches were followed. We applied the Value of Statistical Life (VSL) approach, using a monetary value of about 6.3 (2.4-7.2) million € attached to each death case. Further, we used the Value Of a statistical Life Year (VOLY) approach, attaching a monetary value of 58,623 (36.646-146.582) € to the loss of a life year. Statistical uncertainties in both the disease burden results and the VSL and VOLY values were considered, presenting a lower and upper estimate of the overall disease costs. Results In 2018, the overall burden of disease attributable to PM2.5 was 209,702 (194,265-391,112) Disability-Adjusted Life Years. Using the VOLY-approach, this corresponds to disease costs of about 17 (7-57) billion €. In contrast, when using the VSL-approach, the estimated 15,652 (10,390-21,466) deaths attributable to PM2.5 in this year result in disease costs of about 98 (25-124) billion €. Conclusions In comparison with other cost assessments, connecting EBD estimates with the VSL- and VOLY-approach allows to include indirect and intangible costs and not to simply focus on the disease treatment costs. The VSL-approach leads to remarkably higher costs because it does not take into account the age at the time of death and thus attaches the same monetary value to each death case. We recommend to use the VOLY-approach because it considers the remaining life expectancy. Key messages • Air pollution causes considerable disease costs in Germany. • We recommend to use the VOLY-approach because it considers the remaining life expectancy.