1. Health and Wellbeing Impacts of Green and Blue Infrastructure: Critical Issues for Application of Cost Benefit Analysis for Policy Appraisal Dr Tim Taylor Lecturer in Environmental and Public Health Economics

2. NEA and Health Valuation Source: Pretty et al. (2011) Health Values from Ecosystems. Chapter 23 of UKNEA.

3. NEA and Health Valuation Methods Values not presented in monetary form in health literature generally. Methods include: –Survey tools on self-esteem, mood state, mental well-being (e.g. General Health Questionnaire) –Physiological and questionnaire based methods for physical health – including BMI, blood pressure, cortisol –Questionnaires on connectedness to nature

4. QALY vs monetary valuation How best to represent health? Quality Adjusted Life Years (QALYs) – ranking based on surveys about different conditions Monetary valuation of value of life year lost, cost of illness, social value of a QALY etc. Different metrics may be appropriate for different audiences and for different policy contexts

5. Monetary Valuation methods Overview of monetary valuation methods Cost of illness Productivity measures Pain and suffering – e.g. contingent valuation, choice experiment, deliberative monetary valuation

6. Monetary Valuation methods

7. Critical Issues in Valuation Latency Timing of benefits => implicit discount rate Individual action required The need for the individual to exercise may affect the value Health is one of many benefits of green infrastructure => need to consider these as well

8. Choice Experiments in the Health setting Choice experiments far more used in environmental context E.g. have been used in valuing health benefits of improved environment in terms of air quality Few studies have used monetary methods to value mental health impacts – some have looked at major depression (e.g. Morey et al, 2006; Herbild et al, 2009).

9. Towards “Public” Values for Health Some argue existing methods do not properly account for public benefits of health e.g. Hausman (2010) argues: –Private evaluation of health states is not a good measure of public evaluation: Preferences vs value of health states e.g. drugs vs output in manic depression Judgments of value require information, experience and time Public value of health not aggregation of personal values e.g. coping with disability may lead to good QoL values –Here deliberative monetary valuation may fill a gap

10. Choice experiments in the Health setting Choice experiments and Deliberative Monetary Valuation : some thoughts Choice experiments may still offer useful insights into values: In the UK context, they may be seen to be more realistic decision making environment Experience of deliberative methods limited in UK compared to other contexts Values are derived from information provided and information held by individual “Joe Public” Combining QALY impacts with monetary values may give more information to the decision maker.

11. www.ecehh.org timothy.taylor@pcmd.ac.uk Thanks for listening