1. Greening Health Care Josh Farley CDAE

2. Outline of Presentation Biophilia Toxic health care Market logic Requirements for efficient markets Green investments and health

3. 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?

4. Greening Hospitals High energy consumption Hazardous chemicals – Phthalates, PVCs, dioxins Reliance on disposables Toxic waste streams – What level of waste emissions is sustainable?

5. 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?

6. Pharma and Ecosystem Services

7. 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

8. What is the Goal of a Private Sector Health System? Maximize profits? – Goal of private sector firms – Costs belong in the numerator

9. Total Health Care Expenditures per Capita

10. Doctor Consultations per Capita

13. What is the Goal of a Public Health System? Achieve best health care outcomes (e.g. average years of healthy life)

18. 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

19. Health Outcomes per Dollar Spent

20. 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?

21. 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

22. Half of Americans Live Where Population Is Too Low for Competition Source: NEJM 1993;328:148 A town’s only hospital will not compete with itself

23. ‘Competition’ Increases Costs

25. How do insurance companies maximize profits? Avoid insuring anyone who might get sick Deny care when someone does get sick

26. What are the most serious threats to human health today?

27. Humans, like all species, depend on a healthy and well-functioning ecosystem

28. Essential and Non-substitutable Services from Nature Food Water Disease regulation Disturbance regulation

30. Unsolvable problems?

31. 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 – R&D: 80% annual return on investment – Extension: 80% annual return on investment – Infrastructure – No price rationing of non-rival resources

34. 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