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

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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 e􀀀ective 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 froma 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.
Original languageEnglish
Number of pages15
JournalFrontiers in Public Health
Publication statusPublished - 17 Feb 2023

Bibliographical note

This work was supported by the Wellcome Trust through
the Wellcome Trust Sustaining Health Award (Award number:
106857/Z/15/Z) and by the UK Prevention Research Partnership
(UKPRP) through the Medical Research Council project: Tackling
Root Causes Upstream of Unhealthy Urban Development (TRUUD)
(Grant Ref: MR/S037586/1).
Data availability statement:
The original contributions presented in the study are included in
the article/Supplementary material, further inquiries can be directed
to the corresponding author.


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