Methodology and Process
Collaboration across disciplines, linking the silos of knowledge and evidence
MARCHES is an interdisciplinary research project consisting of a series of interrelated work packages with the aim of applying and further developing methodologies to assess the health costs of environmental stressors. Here follows a concise summary.
MARCHES brings scientific expertise from health science, environmental economics, atmospheric and hydrological modelling and social sciences together within a shared framework for collaboration.
MARCHES consists of a series of interrelated academic work packages (WPs):
- Exposure-response functions for the health impacts of air and drinking water pollution
- Economic valuation of new health endpoints of morbidity, disabilities and mortality
- Quality of life indicators
- Innovative methodologies for exposure assessment and unit prices
- Costs of inaction and action - case studies
The various work packages are directly related to the objectives of MARCHES. Besides the academic work packages, the project includes work packages on project management and communication.
Exposure-response functions for the health impacts of air and drinking water pollution (WP 2)
Lead: Dr. Jörg Schullehner and prof. Torben Sigsgaard, Dept. of Public Health, Aarhus University
MARCHES will establish and update exposure-response functions for air pollution and drinking water nitrate from systematic reviews. The project will focus on morbidity and mortality at exposure levels relevant to European conditions. MARCHES will use published systematic reviews with meta-analyses of exposure-response functions to update and expand the current functions from WHO used in risk assessments, i.e. EVA system (Economic Valuation of Air Pollution), and derive exposure-response functions for drinking water nitrates. A new systematic review will be conducted to cover important health endpoints for nitrates related to infants. Data gaps will be identified to guide future research.
For air pollution we focus on the following morbidity impacts: asthma incidence, lung cancer and chronic obstructive pulmonary disease (COPD), e.g. for ozone (O3), fine particulate matter (PM2.5) and nitrogen dioxide (NO2). Additionally, we will address a series of ‘new’ outcomes from air pollution identified in the health literature (i.e. diabetes, cognitive disorders/dementia, Parkinson’s disease, low birth weight, depression). For drinking water pollution with nitrate, MARCHES focuses on cancers related to gastro-intestinal sites (e.g. stomach cancer and colon cancer) and impacts on infants in terms of adverse birth outcomes and methemoglobinemia.
Economic valuation of new health endpoints of morbidity, disabilities and mortality (WP3)
Lead: prof. Ståle Navrud, MENON Economics
MARCHES will derive economic values for the key morbidity health endpoints identified in WP2. It will elicit willingness-to-pay (WTP) to avoid the disutility of the selected morbidity endpoints - differing in severity and/or duration - in order to provide disutility weights for estimation of a Quality Adjusted Life Year (QALY) and its economic value based on Value of a Life Year (VOLY) estimates. This will further extend recent attempts to monetize DALY’s (disability adjusted life years) and/or QALY’s (quality adjusted life years) with the disability weights from the Global Burden of Disease (GBD) project in combination with VOLY to value the losses as a preliminary assessment of the welfare loss from these endpoints.
MARCHES will further analyze the role of risk aversion and changing wealth in deriving VOLY, and consider the implications for generalization/benefit transfer of VOLY and QALY estimates. The economic values will include both the disutility from being ill (from the new studies) as well as Cost-Of-Illness estimates (from existing studies).
To achieve this, MARCHES will design, test and carry out new stated preference surveys in six countries (Denmark, Estonia, Kosovo, Spain, Sweden, and the Czech Republic). MARCHES will examine preferences of risk reductions in relation to the relevant morbidity and health endpoints, where the valued illnesses will be described with varying severity and duration.
Quality of life indicators (WP4)
Lead: prof. Hans Orru, Institute of Social Studies, Tartu University
MARCHES will develop and test explanatory models for understanding the drivers of environmental health concerns and the related psycho-somatic effects, while building synergies between the environmental exposure, psychological, socio-structural and socio-institutional study approaches. This may help detect and understand possible cross-national differences, including in the valuation results on health-related burdens.
MARCHES will for this purpose conduct a cross-national survey specifically addressing and mapping pollution concerns in six countries (Denmark, Estonia, Kosovo, Spain, Sweden, and the Czech Republic), to explore the prevalence of worries, symptoms, psycho-social stresses and perceived exposures across very different parts of Europe.
Innovative methodologies for exposure assessment and unit prices (WP5)
Lead: Dr. Camilla Geels, Dept. of Environmental Science, Aarhus University
MARCHES will assess the sector- and country-specific health effects from breathing polluted air, aiming to produce unit costs of individual pollutants for use across Europe and in MARCHES’ case studies (see WP6). MARCHES will further develop a novel and rigorous methodology for estimation of health effects from drinking water with elevated nitrate concentrations, aiming to arrive at unit costs relevant to MARCHES’ case studies and with guidelines for wider application.
Considering air pollution, the EVA (Economic Valuation of Air Pollution) model’s regional-scale calculations will be calibrated with recent results from the CAMS (Copernicus Atmosphere Monitoring Service) model ensemble validation, while local-scale calculations will be done based on high-resolution gridded emissions inventories for the three air pollution case study areas.
These procedures will enable MARCHES to derive estimates of the air pollution costs in €/kg for the main emission sectors, which will be an innovation in comparison to the more crude ‘catch-all’ estimates at Member State level in previous studies, and allowing analysts and public authorities to distinguish not only between the health costs of emissions from transport and larger stationary sources, but among all ten emission sectors.
Considering drinking water pollution, catchment-level modeling of nitrogen leaching with the SWAT/SWAT+ model will allow for disaggregation of health costs, backtracking to the costs in €/kg of nitrogen-fertilizer surplus lost to the rootzone, and eventually to €/kg of fertilizer-N (nitrogen) added to fields.
In accordance with the impact pathway approach WP5 will use the exposure-response functions identified in WP2 and valuation estimates developed in WP3 and link them with concentration values from the environmental modeling. This will provide estimates of the marginal costs of air pollution, and vice versa of the benefits of reductions in emissions and exposures, as required for state-of-the-art socio-economic/cost-benefit analysis.
Costs of inaction and action - case studies (WP6)
Lead: Fundacion Privada Instituto de Salud Global
The unit costs estimated in WP5 for the environmental stressors of air pollution and drinking water pollution will be applied in regional case studies, to explore how a reasonable societal balance between costs of inaction and the costs of action can be achieved.
MARCHES will identify the costs of action and inaction with socio-economic analysis in four air pollution cases (Denmark/Sweden, Estonia, Kosovo, and Spain) and two nitrate drinking water pollution cases (Denmark and the Czech Republic).
The specific mitigation scenarios to be explored will be framed upon consultation with the relevant public authorities. One case study is devoted to show how to scale calculations to regions with a paucity of data and local-scale modeling.