Is it time to rethink health-economics?

Updated: Apr 19, 2021

How one little girl challenges the health service to redevelop health-economic modelling with climate targets appropriate, for our health, our planet and our wallet

The landmark Coroner's ruling on the tragic death of 9 year old Ella Adoo-Kissi-Debrah of South London, confirmed a recording of air quality as a cause of death for the first time in the United Kingdom. A legislative bow tied on top of repeated public health calls for a reduction in climate impacts to save health.

Air quality is a proven, direct contributor to the health and economic cost of respiratory conditions. Per year, it costs the NHS £345 million to treat and lowers a sufferer quality of life to the point that 40,000 tragically die.

In young Ella's case, she was admitted to hospital 27 times in 3 years having suffered multiple seizures and finally succumbed to acute respiratory failure caused by asthma, contributed to by exposure to excessive air pollution and died on the 15th February 2013.

Adoo-Kissi-Debrah's second coroner's enquiry since her death not only highlighted gross social inequity, given the disproportionate proximity of inner city BAME families to toxicity risks like roads, it also highlighted how far behind evaluation and operating models are from the reality of their own effects on air pollution contained in each buying decision.

7 years is not only a long wait by Ella's mother for justice, it's also a long time to continue emitting dangerous Nitrogen Dioxide into a municipal air space. Much at a time when Diesel was still wrongly considered the "greener choice" of fuel.

Despite this, diesel continues to power every single freight, haulage and logistics platform around the world. Enabled and necessitated by the UK's public procurement sector. Every kilo of food; every mass manufactured care product. All with an 'on-cost' in health impact and finance.

Current Health Economics

Health-economic models are the gold standard of evaluation. All HealthTech, MedTech, medicines and medical practise evaluation undergoes a risk appropriate level of health-economic evaluation that seamlessly applies all the way up to NICE's medical efficacy evaluations. It also aligns procurement with the makings of outcome focused purchasing and supply. Introduced through the new Category Towers. Fundamental to this, is the evaluation of total lifetime cost and total quality of life benefits which a health establishment must consider.

The 13 NHS Category Towers
NHS Supply Chain, Category Towers

Climate factors clearly influence both of those primary dependent variables within health economic models that vector into every respiratory patient and out again through health and through public money.

The health impacts of plastic care products are not limited to the direct effects of delivery emissions and plastic.

For the UK NHS, 133,000 tonnes of plastic waste goes through this process. The weight of almost 4,000 average UK houses or 400 Boeing 747 commercial aircraft. Some of which degenerating into microplastics and making their way to waterways to be eaten by fish, which in turn, are consumed by humans. Microplastics as large as 5 um in size have now been found in human placenta.

The climate and health effects of plastic stretch far beyond the plastic itself. More plastic delivered, means more emissions from haulage and logistics which means a greater respiratory impact. Every 1Kg of Polypropylene tubing clamps, is the sum of energy consumed processing 4kg of oil into petroleum and then on to ever-refined plastic products. Add to that the transportation to and from intermediary chains by haulage and logistics (at circa 190g CO2/Kg/km) before getting into the hands of care workers, only to be processed through the expulsion of energy for storage and then on through waste disposal trucks and industrial reprocessing, to be burnt for energy or disposed of in landfill, releasing the carbon or simply being disposed of in landfilled. Every 1kg of plastic is accompanied by more than 20Kg of CO2 added to it in that lifecycle, through energy, freight, logistics and disposal.

Lifecycle impact of carbon on health and populations