(In Dutch) Monetariseren van gezondheidseffecten moet beter | Monetising the health effects should be better
Tijdschrift Milieu , Dec 2012
Monetariseren van gezondheidseffecten moet beter Kosten-baten analyses worden steeds vaker ingeze... more Monetariseren van gezondheidseffecten moet beter Kosten-baten analyses worden steeds vaker ingezet voor het bepalen van de invloed van milieufactoren op onze gezondheid. Toch staat de kennis daarover nog in de kinderschoenen. Er worden vooral secundaire gegevensbronnen ingezet en er zijn praktische en ethische bezwaren.
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and noise health risks within the framework of a large European project. We used contingent valuation as a
method to assess the willingness-to-pay (WTP) for both types of pollutants simultaneously. We asked respondents
how much they would be willing to pay annually to avoid certain health risks from specific pollutants.
Three sets of vignettes with different levels of information were provided prior to the WTP questions. These vignettes
described qualitative general health risks, a quantitative single health risk related to a pollutant, and a
quantitative scenario of combined health risks related to a pollutant. The mean WTP estimates to avoid roadtraffic
air pollution effects for the three vignettes were: €130 per person per year (pp/y) for general health
risks, €80 pp/y for a half year shorter in life expectancy, and €330 pp/y to a 50% decrease in road-traffic air pollution.
Their medians were €40 pp/y, €10 pp/y and €50 pp/y, respectively. The mean WTP estimates to avoid
road-traffic noise effects for the three vignettes were: €90 pp/y for general health risks, €100 pp/y for a 13% increase
in severe annoyance, and €320 pp/y for a combined-risk scenario related to an increase of a noise level
from 50 dB to 65 dB. Their medians were €20 pp/y, €20 pp/y and €50 pp/y, respectively. Risk perceptions and
attitudes aswell as environmental and pollutant concerns significantly affectedWTP estimates. The observed differences
in crude WTP estimates between countries changed considerably when perception-related variables
were included in theWTP regression models. For this reason, great care should be takenwhen performing benefit
transfer from studies in one country to another.
reflected in market prices for transportation. We set out to simultaneously assess the willingness-to-pay (WTP)
for traffic-related air pollution and noise effect on health, using a single measurement instrument and approach.
We investigated the proportion and determinants of “protest vote/PV responses (people who were against
valuing their health in terms of money)” and “don’t know”/DK answers, and explored the effect of DK on the
WTP distributions.
Methods: Within the framework of the EU-funded project INTARESE, we asked over 5,200 respondents in five
European countries to state their WTP to avoid health effects from road traffic-related air pollution and noise in
an open-ended web-based questionnaire. Determinants of PV and DK were studied by logistic regression using
variables concerning socio-demographics, income, health and environmental concern, and risk perception.
Results: About 10% of the respondents indicated a PV response and between 47-56% of respondents gave DK
responses. About one-third of PV respondents thought that costs should be included in transportation prices,
i.e. the polluter should pay. Logistic regression analyses showed associations of PV and DK with several factors.
In addition to social-demographic, economic and health factors known to affect WTP, environmental concern,
awareness of health effects, respondent’s ability to relax in polluted places, and their view on the government’s
role to reduce pollution and on policy to improve wellbeing, also affected the PV and DK response. An exploratory
weighting and imputation exercise did not show substantial effects of DK on the WTP distribution.
Conclusions: With a proportion of about 50%, DK answers may be a more relevant issue affecting WTP than PV’s. The
likelihood to give PV and DK response were influenced by socio-demographic, economic and health factors, as well as
environmental concerns and appreciation of environmental conditions and policies. In contested policy issues where
actual policy may be based on WTP studies, PV and DK answers may indeed affect the outcome of the WTP study.
PV and DK answers and their determinants therefore deserve further study in CV studies on environmental health effects.
International comparison in the effects between the default systems (opt-in vs. opt-out) on the availability of organ donors.