References

ReferencesHiligsmann, M., Gathon, H. J., Bruyere, O., Daubie, M., Parmentier, Y., Dercq, J. P. et al. (2011). Hospitalisation costs of hip fractures in Belgium. Osteoporosis International 22: 332-332.Nawrot, T., Plusquin, M., Hogervorst, J., Roels, H. A., Celis, H., Thijs, L. et al. (2006). Environmental exposure to cadmium and risk of cancer: a prospective population-based study. Lancet Oncology 7(2): 119-126.Staessen, J. A., Roels, H. A., Emelianov, D., Kuznetsova, T., Thijs, L., Vangronsveld, J. et al. (1999). Environmental exposure to cadmium, forearm bone density, and risk of fractures: prospective population study. Lancet 353(9159): 1140-1144.

3. Case study

• Campine region (brown area) in Belgium• Heavy metal pollution due to zinc smelters• No more Cd emissions since 1980s

Results from earlier epidemiologic research:• Higher Cd body burden in high exposure areas (HEA) • Increased relative risk (RR) of osteoporotic fractures (Staessen

et al., 1999) and lung cancer (Nawrot et al., 2006)

6. Conclusion

• More than €500,000 per year in medical costs due to pollution• Pollution flow has stopped since 1980s, 20-25 years ago pollution causes long lasting health and economic burden• Contribution of soil Cd to body burden is relatively small PA illnesses are expected to decrease in the future

Assumptions and restrictions• Conservative economic estimate• RR have remained constant over the years

Epidemiologic research• Objective: Identify impact of environmental

pollution on human health• Method: Cohort study (Staessen et al., 1999;

Nawrot et al., 2006)

Health risk assessment• Objective: Determine pollution-attributable (PA)

illnesses on the population level• Method: Exposure assessment

Health economic analysis• Objective: Assess economic burden as a result

of PA illnesses• Method: Cost of Illness (COI)

Economic impact assessment of environmental contamination: A damage function approach

Eloi Schreursa, Irina Cleemputb, Tim Nawrotc, Theo Thewysa

OF ENERGY, WATER AND ENVIRONMENT SYSTEMSeptember 22-27, 2013, Dubrovnik, Croatia

8th CONFERENCE ON SUSTAINABLE DEVELOPMENT UNESCO sponsored conference

a Centre for Environmental Sciences (CMK), Hasselt University, Agoralaan – Building D, 3590 Diepenbeek, BELGIUM; presenting authorb Faculty of Business Economics, Hasselt University, Agoralaan – Building D, 3590 Diepenbeek, BELGIUMc Faculty of Life Sciences, Hasselt University, Agoralaan – Building D, 3590 Diepenbeek, BELGIUM

1. Introduction

• Environmental pollution is a persistent and harmful problem• Exposure to heavy metals can have an impact on public health• Cadmium (Cd) has been associated with osteoporosis, cancer

and kidney damage

2. Methodology

Damage function approach

Health risk assessment• Relative risks• Incidence rates illnesses• Predicted soil Cd values as proxy for level of exposure• Population at each exposure level

PA illnesses = x Populationi x Incidence

Health economic analysis• Hip fracture costs from Hiligsmann et al. (2011)

• COI study of lung cancer• Case-control design (n1 = 359; n2 = 357)• Micro-level database of reimbursed medical costs• Adjusted for comorbidities of smoking

4. Data

Rese

arch

topi

c

5. Results

• Health risk assessment (only lung cancer presented here)

• Health economic analysis

PA cases per year

COI per case (in €)

PA health care cost per year (in €)

Lung cancer 11.62(1.45-17.69)

25,385.60 294,980.67(36,809.12-449,071.26)

Hip fracture men 5.07(0.73-7.91)

10,828 54,897.96(7904.44-85,649.48)

Hip fracture women

15.92(7.69-21.69)

10,389 165,392.88(79,891.41-225,337.41)

Soil Cd

level

RR lung cancer (95% CI)

Population (in 2010)

Incidence (per 100,000)

PA cases per year

1 1.00 102,979 73.3 /2 1.49 (1.04-2.14) 21,891 73.3 5.28 (0.62-8.55)3 1.88 (1.06-3.34) 10,384 73.3 3.57 (0.43-5.33)4 2.22 (1.08-4.58) 3207 73.3 1.29 (0.17-1.84)5 2.52 (1.10-5.85) 1038 73.3 0.46 (0.07-0.63)6 2.80 (1.11-7.15) 802 73.3 0.38 (0.06-0.51)7 3.06 (1.12-8.46) 424 73.3 0.21 (0.03-0.27)8 3.31 (1.12-9.80) 864 73.3 0.44 (0.07-0.57)

11.62 (1.45-17.69)