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  Human Health Metrics for Environmental Decision Support Tools: Lessons From Health Economics and Decision Analysis (EPA/600/R-01/104) September 2001

Environmental decision support tools often provide information that predicts a multitude of different human health effects due to environmental stressors. Medical decision making and health economics offer many metrics that allow aggregation of these different health outcomes. This paper provides a review of the literature, with special attention to aspects relevant in the environmental context.

Recommendations for the use of human health metrics in different environmental decision support tools have been derived from a characterization of medical and environmental applications. Furthermore, three metrics (quality adjusted life years [QALYs], disability adjusted life years [DALYs], and willingness-to-pay [WTP]) have been used to compare a wide range of different environmental risk factors. In this example, WTP tends to reflect mortality outcomes only. QALYs and DALYs are sensitive to mild illnesses that are difficult to assess without bias and that affect large numbers of people. Since health metrics tend to follow the paradigm of utility maximization, these metrics may be supplemented with a semi-quantitative discussion of distributional and ethical aspects. Finally, the magnitude of age-dependent disutility due to mortality for both monetary and nonmonetary metrics may bear the largest practical relevance out of a series of suggested research questions.


Jane Bare

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