Health economics of well-being and well-becoming, climate change and the need for transdisciplinary system thinking

From: R. T. Edwards

As 24 solar panels are attached to our roof, and two huge batteries are installed along with an air source heating system, finally I am starting to read about the climate emergency. In her seminal book, This changes everything, Naomi Klein (2015) speaks of us turning our heads from this emergency, leaving it up to the environmentalists and climate change scientists. Our solar panels, battery and air source heating system will produce half our electricity needs and our use of oil will fall by 85 per cent. Living in rural Anglesey, we drive an old Land Rover, which I predict will be in a museum in 20 years. I remember summers with consistent dry weather when we made hay – proper small bale hay – on the fields; now we just, like everyone else, wrap damp silage into round plastic bales. I remember snow down to the tide line on the beach and getting the sledge out with the children down a particularly steep field. We have had no snow like that for fifteen years. My solar panels are not me virtue-signalling. Quite the opposite. I feel dismayed that it has taken this long for me to wake up and start reading about climate change and turning my research interests in public health and prevention towards the overriding threat of climate change. In terms of my work as a health economist, who has devoted over thirty years to applying health economics to public health and prevention of avoidable chronic disease, disability and premature death, it is only now that I am realising the magnitude of the negative health effects of the climate change we are already experiencing. 

A UK report lists twelve top health threats from climate change (shown in the infographic below), amongst them are extremes of heat and cold, flooding, poor air quality, allergies, infectious diseases, vector-borne diseases, wildfires, drought and food security, and poor housing (UK Health Security Agency, 2023).

Figure 1. UK health threats from climate change (UK Health Security Agency, 2023)

I have been quite late as a health economist reading the One Health literature, linking human health to that of animals and the planet (Leandri & Dalmas, 2024). Our newly published book entitled Health economics of well-being and well-becoming across the life-course (Edwards & Lawrence, 2024) discusses climate change threats in the final chapter, when I now realise these threats should probably have been in the first chapter, on grounds of magnitude. 

How can we, as health economists, be of any use to this global challenge? We are used to a micro focus on calculating the cost-effectiveness of new drugs and health services on health systems. We have, through developments in public health economics, to which I am proud to have made a contribution (see Edwards & MacIntosh, 2019), widened the evaluative space to take a more societal perspective across sectors, along with work of others (Walker et al., 2019). Such frameworks for the evaluation of costs and outcomes, when they fall across many different sectors of the economy, still have not really grasped the enormity of the effect of climate change and their international impact.

Only last week did I feel I had some potential means of contributing as a health economist to the evidence-base for arguing the case for international collective action on climate change threats to health and well-being. My colleague, Dr Sofie Roberts, and I joined a World Health Organization (WHO) hosted webinar to consult on the health effects of climate change. I sat mesmerised as caller after caller joined the webinar from across the globe. Questions and comments came from public health practitioners in Pakistan, NGOs in Nigeria, academics in London, and students in Germany. I was surprised to see Sofie and I were amongst only a handful of academics from the UK and the only health economists on the call. Following the call, we had the opportunity to view the draft report being prepared by the WHO team for submission to COP29 in Azerbaijan. I spent the next day completing a spreadsheet asking for evidence, references and data sources relevant to each section of the draft report. After thirty years in academia there are few moments now that really inspire and excite me. This was one of them. Potentially, just potentially, we were sending material that might make it into the WHO report for COP29. In the same week, Sofie and I contributed to the European Society for Prevention Research (EUSPR) Climate Change Roundtable on the topic of Mobilizing Communities for Climate Action: Strategies for Effective Engagement and Prevention. Again, we were the only health economists on the call.

As health economists we can choose to work within our close sphere of professional interest, but potentially we can make a more positive impact on research and population health and well-being by working with researchers across different disciplines. We can do this in several distinct ways. We can work in a multidisciplinary way, whereby people from different disciplines work together, each drawing on their disciplinary knowledge. We can work in an interdisciplinary way, whereby we contribute to the integration of knowledge and methods from different disciplines, using a real synthesis of approaches. And most adventurous of all, we can work in a transdisciplinary way, whereby we can create a unity of intellectual frameworks beyond our specific disciplinary frameworks.

I believe that with respect to the potential contribution of health economists to addressing the health and well-being threats of inevitable climate change, we need to work in a transdisciplinary way. Examples of multidisciplinary collaboration where health economists are already making a contribution include: incorporating carbon emissions into health technology assessments (including cost-effectiveness analysis) (McAlister et al., 2022); highlighting the carbon emissions of health care systems (Pichler et al., 2019), and finally the benefits of increasing green space in the health system estate (Holt et al., 2023).

What is more exciting is how health economists are now beginning to think through, at a systems level, the circular and life-course nature of the impact of climate change on social justice and health care systems at an international level (Borghi & Kuhn, 2024; Edwards, 2022).

With a background in economics, I am only just appreciating now the close relationship between climate change, social justice and capitalism. As Professor of Climate Justice at University of British Colombia, Vancouver, Naomi Klein challenges the view that we will be saved by new technology. She disabuses us that monetising carbon emissions and the natural environment through markets for ecosystems services and the right to damage them is going to provide a solution. ‘’Her solution requires a radical reconfiguration of our economic system’’ (New York Times).

Yesterday our new solar panels generated 18 kilowatt-hours of energy. This is enough energy to run a dishwasher 18 times. The enormity of climate change is suddenly within reach where it is possible for us at home to do something small ourselves. It is important at both the professional and personal level to stay positive. I recall the writing of Peter Marshall (lived 1902–1949; Chaplain of the United States Senate): ‘‘With stout hearts may we see in every calamity an opportunity, and not give way to the pessimism that sees in every opportunity a calamity’’.

References

Borghi, J., & Kuhn, M. (2024). A health economics perspective on behavioural responses to climate change across geographic, socio-economic and demographic strata. Environmental Research Letters, 19(8), 081001.

Edwards, R. T. (2022). Well-being and well-becoming through the life-course in public health economics research and policy: A new infographic. Frontiers in Public Health, 10, 1035260.

Edwards, R. T., & Lawrence, C. L. (Eds.). (2024). Health economics of well-being and well-becoming across the life-course. Oxford University Press.

Edwards, R. T., & McIntosh, E. (Eds.). (2019). Applied health economics for public health practice and research. Oxford University Press.

Holt, A., Cowap, C., Johnson, N., & Edwards, R. T. (2023). NatureScot Research Report 1338-Valuing the health and well-being benefits of the NHS outdoor estate in Scotland. https://www.nature.scot/doc/naturescot-research-report-1338-valuing-health-and-well-being-benefits-nhs-outdoor-estate-scotland

Klein, N. (2015). This changes everything: Capitalism vs. the climate. Simon and Schuster.

Leandri, M., & Dalmas, L. (2024). One Health Economics: why and how economics should take on the interdisciplinary challenges of a promising public health paradigm. Frontiers in Public Health, 12, 1379176.

McAlister, S., Morton, R. L., & Barratt, A. (2022). Incorporating carbon into health care: adding carbon emissions to health technology assessments. The Lancet Planetary Health, 6(12), e993-e999.

Pichler, P. P., Jaccard, I. S., Weisz, U., & Weisz, H. (2019). International comparison of health care carbon footprints. Environmental Research Letters, 14(6), 064004.

UK Health Security Agency. (2023). Health effects of climate change (HECC) in the UK. State of the evidence 2023. https://assets.publishing.service.gov.uk/media/659ff6a93308d200131fbe78/HECC-report-2023-overview.pdf

Walker, S., Griffin, S., Asaria, M., Tsuchiya, A., & Sculpher, M. (2019). Striving for a societal perspective: a framework for economic evaluations when costs and effects fall on multiple sectors and decision makers. Applied Health Economics and Health Policy, 17, 577-590.