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Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who... more
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.1.Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.2.Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.3.Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.4.Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.5.Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.6.Transparency: Look for transparency and objectivity of analytical inputs.7.Benefits: Examine how projected benefits rel...
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Research Interests: Quality of life, Medicine, Decision Trees, Humans, Markov chains, and 13 moreTransplant Surgery, Medicare, Recurrence, Clinical Sciences, Middle Aged, Reimbursement, Time Factors, Cost Benefit Analysis, Statistical models, Sensitivity and Specificity, Diverticulitis, Cohort Studies, and Costs and Cost Analysis
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Research Interests: Environmental Science, Environmental policy, Petroleum, Coal, Air pollution, and 15 morePublic Health, Hazardous Waste, Medicine, Multidisciplinary, Environmental science and technology, Humans, Mercury, United States, Animals, Fishes, Power Plants, Pollutant, Cardiovascular Diseases, Hazardous Air Pollutants, and Air Pollutants
Population-based HIV testing surveys have become central to deriving estimates of national HIV prevalence in sub-Saharan Africa. However, limited participation in these surveys can lead to selection bias. We control for selection bias in... more
Population-based HIV testing surveys have become central to deriving estimates of national HIV prevalence in sub-Saharan Africa. However, limited participation in these surveys can lead to selection bias. We control for selection bias in national HIV prevalence estimates using a novel approach, which unlike conventional imputation can account for selection on unobserved factors. For 12 Demographic and Health Surveys conducted from 2001 to 2009 (N=138 300), we predict HIV status among those missing a valid HIV test with Heckman-type selection models, which allow for correlation between infection status and participation in survey HIV testing. We compare these estimates with conventional ones and introduce a simulation procedure that incorporates regression model parameter uncertainty into confidence intervals. Selection model point estimates of national HIV prevalence were greater than unadjusted estimates for 10 of 12 surveys for men and 11 of 12 surveys for women, and were also gre...
Research Interests: Demography, Medical Microbiology, Adolescent, Medicine, Humans, and 13 moreFemale, Sexually transmitted infections, Male, Young Adult, Clinical Sciences, Prevalence, Middle Aged, Adult, Public health systems and services research, Selection Bias, Confidence Interval, HIV infections, and Africa south of the sahara
Principled Standard Setting Requires Consideration of More Than Science (AEI-Brookings Joint Center for Regulatory Studies, Brief 00-02) Brief Amicus Curiae in Support of Respondents, Browner v. American Trucking Associations, Inc., No. 99-1257, (U.S. September 11, 2000)(with 20 Law Professors, E...more
Summary of Argument: Throughout this proceeding, EPA has identified no policy or normative criteria to justify its NAAQS standards, thus suggesting that science alone can be used to determine the appropriate air quality standard. Science... more
Summary of Argument: Throughout this proceeding, EPA has identified no policy or normative criteria to justify its NAAQS standards, thus suggesting that science alone can be used to determine the appropriate air quality standard. Science plays a critical, indeed essential, role in evaluating the risks of possible air quality standards being considered for adoption by EPA. However, science by itself
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Expert judgment (or expert elicitation) is a formal process for eliciting judgments from subject‐matter experts about the value of a decision‐relevant quantity. Judgments in the form of subjective probability distributions are obtained... more
Expert judgment (or expert elicitation) is a formal process for eliciting judgments from subject‐matter experts about the value of a decision‐relevant quantity. Judgments in the form of subjective probability distributions are obtained from several experts, raising the question how best to combine information from multiple experts. A number of algorithmic approaches have been proposed, of which the most commonly employed is the equal‐weight combination (the average of the experts’ distributions). We evaluate the properties of five combination methods (equal‐weight, best‐expert, performance, frequentist, and copula) using simulated expert‐judgment data for which we know the process generating the experts’ distributions. We examine cases in which two well‐calibrated experts are of equal or unequal quality and their judgments are independent, positively or negatively dependent. In this setting, the copula, frequentist, and best‐expert approaches perform better and the equal‐weight comb...
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Predicting the human‐health effects of reducing atmospheric emissions of nitrogen oxide (NOx) emissions from power plants, motor vehicles, and other sources is complex because of nonlinearity in the relevant atmospheric processes. We... more
Predicting the human‐health effects of reducing atmospheric emissions of nitrogen oxide (NOx) emissions from power plants, motor vehicles, and other sources is complex because of nonlinearity in the relevant atmospheric processes. We estimate the health impacts of changes in fine particulate matter (PM2.5) and ozone concentrations that result from control of NOx emissions alone and in conjunction with other pollutants in and outside the mega‐city of Shanghai, China. The Community Multiscale Air Quality (CMAQ) Modeling System is applied to model the effects on atmospheric concentrations of emissions from different economic sectors and geographic locations. Health impacts are quantified by combining concentration‐response functions from the epidemiological literature with pollutant concentration and population distributions. We find that the health benefits per ton of emission reduction are more sensitive to the location (i.e., inside vs. outside of Shanghai) than to the sectors that ...
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Public risk perceptions and demand for safer food are important factors shaping agricultural production practices in the United States. Despite documented food safety concerns, little attempt has been made to elicit consumers'... more
Public risk perceptions and demand for safer food are important factors shaping agricultural production practices in the United States. Despite documented food safety concerns, little attempt has been made to elicit consumers' subjective risk judgments for a range of food safety hazards or to identify factors most predictive of perceived food safety risks. In this study, over 700 conventional and organic fresh produce buyers in the Boston area were surveyed for their perceived food safety risks. Survey results showed that consumers perceived relatively high risks associated with the consumption and production of conventionally grown produce compared with other public health hazards. For example, conventional and organic food buyers estimated the median annual fatality rate due to pesticide residues on conventionally grown food to be about 50 per million and 200 per million, respectively, which is similar in magnitude to the annual mortality risk from motor vehicle accidents in t...
Research Interests: Business, Food Safety, Agricultural Policy, Environmental Health, Food, and 15 moreMedicine, Multidisciplinary, Food Microbiology, Organic Food, Humans, Food supply, Agricultural Production, Multiple Regression, Boston, Food Contamination, Health Food, Motor Vehicle Accident, Mortality Risk, Fresh Produce, and High risk
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This article provides a framework and offers strategies for theorizing and generalizing about risk assessment and regulation developed in the context of an on‐going comparative study of regulatory behavior. Construction of a universe of... more
This article provides a framework and offers strategies for theorizing and generalizing about risk assessment and regulation developed in the context of an on‐going comparative study of regulatory behavior. Construction of a universe of nearly 3,000 risks and study of a random sample of 100 of these risks allowed us to estimate relative U.S. and European regulatory precaution over a thirty‐five‐year period. Comparative nested analysis of cases selected from this universe of ecological, health, safety, and other risks or its eighteen categories or ninety‐two subcategories of risk sources or causes will allow theory‐testing and ‐building and many further descriptive and causal comparative generalizations.
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Research Interests: Engineering, Environmental Science, Air Quality, Air pollution, Public Health, and 15 moreMedicine, Multidisciplinary, Natural Gas, Humans, Cost Effectiveness Analysis, Fossil Fuels, Vehicle Emissions, Bus, Diesel Fuel, Theoretical Models, Compressed Natural Gas, Quality adjusted life years, Cost Benefit Analysis, Gasoline, and Air Pollutants
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Past opinion polls have shown that major nuclear accidents can have a serious impact on public attitudes. Drawing on a values-beliefs-norms (VBN) model of environmental commitment, the authors hypothesized that a major nuclear accident... more
Past opinion polls have shown that major nuclear accidents can have a serious impact on public attitudes. Drawing on a values-beliefs-norms (VBN) model of environmental commitment, the authors hypothesized that a major nuclear accident may also affect the most durable cognitive and cultural foundations that underpin public perceptions of nuclear power. For 32 Italian participants, the authors assessed perceptions of nuclear power and values 1 month before and after the Fukushima nuclear accident. Participants reported decreases in nuclear trust, environmental organization trust, and pronuclear attitudes; they reported a significant increase in environmental beliefs assessed by the new ecological paradigm and a marginally significant increase in altruism. Major nuclear accidents may have the potential to influence values and proenvironmental beliefs, probably for the reason that they are the basis of public attitudes toward nuclear power.
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This study investigates the economic valuation of air-pollution-related health risks in China by applying the contingent valuation method. An individual interview survey is conducted to elicit resident's willingness-to-pay (WTP) for... more
This study investigates the economic valuation of air-pollution-related health risks in China by applying the contingent valuation method. An individual interview survey is conducted to elicit resident's willingness-to-pay (WTP) for health risk reductions of asthma and mortality. Binary choice WTP question is used in the in-person interview. Using binary probit model, the estimated value of a statistical case of asthma is about US$2300, median VSL estimated is about US $24,000. The issues of private and public provision mechanisms of health risk reduction, and the scale effect of the WTP to the magnitude of risk are also discussed.
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The COVID-19 pandemic has forced a trade-off between limiting its health impact and maintaining economic activity. Welfare economics offers tools to conceptualize this trade-off. We review four such tools: value of statistical life (VSL),... more
The COVID-19 pandemic has forced a trade-off between limiting its health impact and maintaining economic activity. Welfare economics offers tools to conceptualize this trade-off. We review four such tools: value of statistical life (VSL), value of statistical life years (VSLYs), quality-adjusted life-years (QALYs), and social welfare analysis. We find the last tool to be superior. We discuss how to choose policies that affect people’s wellbeing differentially. We argue for evaluating policies using a social welfare function, which should especially consider increasing the wellbeing of the less well off. We propose a model to illustrate how this framework can evaluate two policy types in response to the pandemic: eradication of the virus, and more lenient control of the spread. The evaluations depend on empirical facts but also on key value judgments about the relative importance of health and concern for the worse off. The purpose of this brief is not to make precise recommendations...
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We estimate willingness to pay for small reductions in the risk of suffering a range of morbid health conditions using a stated-preference survey fielded to an internet panel that is representative of the US population. The adverse health... more
We estimate willingness to pay for small reductions in the risk of suffering a range of morbid health conditions using a stated-preference survey fielded to an internet panel that is representative of the US population. The adverse health conditions are described using a generic health utility system (EQ-5D). Estimated WTP is significantly associated with the reduction in probability of illness and with the severity and duration of the health condition. The variation of WTP with severity and duration is much smaller than proportionate, which implies that WTP to reduce risk is not equal to the expected loss in quality adjusted life years (QALYs) multiplied by a constant monetary value per QALY. WTP to reduce risk to another person in the household is significantly larger than to oneself, approximately 70 percent larger for an adult and 190 percent larger for a child.
Research Interests: Economics, Medicine, WTP, Morbidity, Stated Preference, and 3 moreWillingness to Pay, Preference, and QALY
Mortality effects of exposure to air pollution and other environmental hazards are often described by the estimated number of “premature” or “attributable” deaths and the economic value of a reduction in exposure as the product of an... more
Mortality effects of exposure to air pollution and other environmental hazards are often described by the estimated number of “premature” or “attributable” deaths and the economic value of a reduction in exposure as the product of an estimate of “statistical lives saved” and a “value per statistical life.” These terms can be misleading because the number of deaths advanced by exposure cannot be determined from mortality data alone, whether from epidemiology or randomized trials (it is not statistically identified). The fraction of deaths “attributed” to exposure is conventionally derived as the hazard fraction (R – 1)/R, where R is the relative risk of mortality between high and low exposure levels. The fraction of deaths advanced by exposure (the “etiologic” fraction) can be substantially larger or smaller: it can be as large as one and as small as 1/e (≈0.37) times the hazard fraction (if the association is causal and zero otherwise). Recent literature reveals misunderstanding abo...
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Investing in global health and development requires making difficult choices about what policies to pursue and what level of resources to devote to different initiatives. Methods of economic evaluation are well established and widely used... more
Investing in global health and development requires making difficult choices about what policies to pursue and what level of resources to devote to different initiatives. Methods of economic evaluation are well established and widely used to quantify and compare the impacts of alternative investments. However, if not well conducted and clearly reported, these evaluations can lead to erroneous conclusions. Differences in analytic methods and assumptions can obscure important differences in impacts. To increase the comparability of these evaluations, improve their quality, and expand their use, this special issue includes a series of papers developed to support reference case guidance for benefit-cost analysis. In this introductory article, we discuss the background and context for this work, summarize the process we are following, describe the overall framework, and introduce the articles that follow.
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While much is known about dyslexia in school-age children and adolescents, less is known about its effects on quality of life in adults. Using data from the Connecticut Longitudinal Study, we provide the first estimates of the monetary... more
While much is known about dyslexia in school-age children and adolescents, less is known about its effects on quality of life in adults. Using data from the Connecticut Longitudinal Study, we provide the first estimates of the monetary value of improving reading, speaking, and cognitive skills to dyslexic and nondyslexic adults. Using a stated-preference survey, we find that dyslexic and nondyslexic individuals value improvements in their skills in reading speed, reading aloud, pronunciation, memory, and information retrieval at about the same rate. Because dyslexics have lower self-reported levels on these skills, their total willingness to pay to achieve a high level of skill is substantially greater than for nondyslexics. However, dyslexic individuals’ willingness to pay (averaging $3000 for an improvement in all skills simultaneously) is small compared with the difference in earnings between dyslexic and nondyslexic adults. We estimate that dyslexic individuals earn 15% less per...
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Extrapolation of estimates of the value per statistical life (VSL) from high- to low- or middle-income populations requires attention to the possible effects of differences in income, current mortality risk, health, life expectancy, and... more
Extrapolation of estimates of the value per statistical life (VSL) from high- to low- or middle-income populations requires attention to the possible effects of differences in income, current mortality risk, health, life expectancy, and many other factors. The standard theoretical model of VSL implies that VSL increases with income and decreases with current mortality risk. The effect of mortality risk is likely to be negligible while the effect of income is large and poorly quantified. Effects of differences in life expectancy and health are theoretically ambiguous. Effects of other factors, including differences in health care, formal and informal support networks, and cultural or religious factors that affect preferences for spending on oneself or others may be important but are unknown. Practical issues include choice of the most appropriate measure of income and possible differences in the patterns of age dependence between populations.
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In "Global health 2035: a world converging within a generation," The Lancet Commission on Investing in Health (CIH) adds the value of increased life expectancy to the value of growth in gross domestic product (GDP) when... more
In "Global health 2035: a world converging within a generation," The Lancet Commission on Investing in Health (CIH) adds the value of increased life expectancy to the value of growth in gross domestic product (GDP) when assessing national well-being. To value changes in life expectancy, the CIH relies on several strong assumptions to bridge gaps in the empirical research. It finds that the value of a life year (VLY) averages 2.3 times GDP per capita for low- and middle-income countries (LMICs) assuming the changes in life expectancy they experienced from 2000 to 2011 are permanent. The CIH VLY estimate is based on a specific shift in population life expectancy and includes a 50 percent reduction for children ages 0 through 4. We investigate the sensitivity of this estimate to the underlying assumptions, including the effects of income, age, and life expectancy, and the sequencing of the calculations. We find that reasonable alternative assumptions regarding the effects of ...
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Researchers and policymakers have long been interested in developing simple decision rules to aid in determining whether an intervention is, or is not, cost-effective. In global health, interventions that impose costs per... more
Researchers and policymakers have long been interested in developing simple decision rules to aid in determining whether an intervention is, or is not, cost-effective. In global health, interventions that impose costs per disability-adjusted life year averted less than three and one times gross domestic product per capita are often considered cost-effective and very cost-effective, respectively. This article explores the conceptual foundation and derivation of these thresholds. Its goal is to promote understanding of how these thresholds were derived and their implications, as well as to suggest options for improvement. These thresholds are intended to reflect the monetary value of the benefits to affected individuals, based on their preferences for spending on health vs spending on other goods and services. However, the current values were not rigorously derived, which means that their application may lead to inappropriate conclusions regarding which interventions should be adopted...
Research Interests: Economics, Public Economics, Global Health, Developing Countries, Medicine, and 11 moreHumans, Developing Country, Psychological Intervention, Health Policy and Planning, Health Expenditures, Quality adjusted life years, Public Administration and Policy, Public health systems and services research, Cost Benefit Analysis, Per Capita Income, and Gross Domestic Product
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The choice of the rate at which one should discount the long-term benefits of mitigating climate change is highly controversial. Both the level and the slope of the term structure of discount rates have been discussed intensively in... more
The choice of the rate at which one should discount the long-term benefits of mitigating climate change is highly controversial. Both the level and the slope of the term structure of discount rates have been discussed intensively in relation to the determination of the social cost of carbon. Although some of the parameters of the problem are ethical and outside the scope of economic analysis, we claim that there are converging and convincing arguments in favor of using an annual real risk-free discount rate going from approximately 4% to approximately 1% for maturities going from zero to infinity. Investing in climate mitigation yields highly uncertain future benefits. Such uncertainty should also be taken into account in the selection of the discount rate, although the appropriate approach is highly controversial.