25th November 2011, Volume 124 Number 1346

John Hoare

Developed countries currently spend about 50% of their health budget on people aged over 65 comprising about 13% of their populations.1 Since per capita health costs rise steeply towards the end of life,4 the ethical and other problems referred to by Dr Victor Fuchs3 mainly entail care of elderly people.

Considerable incentive for preserving life via control of urban air quality undoubtedly is provided by the availability of established, fixed, values for a statistical life [VOSL] of about NZ$3M.4 As commonly utilised in this context, such sums are multiplied by the number of allegedly avoidable deaths derived from statistically-based mortality associations related to variable air pollution yielding highly encouraging [$] benefit/cost ratios.5 However, because of the assumptions made and uncertainties involved6,7 such results are purely conjectural notwithstanding the convictions of those favouring regulation supposedly founded on firm economic grounds.

For most urban-dwelling New Zealanders the overall quality of ambient air experienced nowadays, during the colder months especially, is markedly superior to that enjoyed 30 or more years ago. Also, the incidence of tobacco smoking continues to fall while living standards generally have continued to improve. Thus it is not surprising that the average life expectancy in New Zealand continues to increase; by about 2–3 years each decade, currently.8

Compared to other more obviously harmful/toxic airborne substances or influences, existing levels of air pollution measured as PM10/PM2.5 normally constitute a relatively small intrinsic health risk [acute mortality RR ≈ 1].6 Because of this, the nett result of additional improvements to air quality is expected to be extension of the life of mainly elderly people leading to enhancement of ‘population ageing’ occurring simultaneously. In this case, the dollar benefits attributed to the National Air Quality Standards could very well turn out to be non-existent with additional costs accruing instead.

Hence, given present fiscal and similar constraints, considerable relaxation of stated “life-saving” objectives pertaining to such environmental contexts in New Zealand would seem to be fully justified.

John Hoare
Retired Chemistry Graduate [Auckland University]/Wool Scientist-Technologist (PhD)
Christchurch, New Zealand

Author Information

John Hoare, Retired Chemistry Graduate [Auckland University]/Wool Scientist-Technologist (PhD), Christchurch, New Zealand

References

  1. Half of Canterbury’s Health Budget Spent on Elderly. Christchurch Press, 18 November 2010.http://www.gmi.co.nz/news/864/half-of-canterburys-health-budget-spent-on-elderly.aspx
  2. Chan WC, Jackson G, Winnard D, et al. 2011. Healthcare services funded by Counties Manukau District Health Board for people in the last year of life. N Z Med J 2011;124(1335):40-51. http://journal.nzma.org.nz/journal/124-1335/4689/content.pdf
  3. Fuchs V. The Doctor’s Dilemma – What Is “Appropriate Care? N Eng J Med 2011; 365:585-587.
  4. Miller TR. Variations between Countries in Values of Statistical Life. J Transport Economics and Policy May 2000; 34(Part 2):169-188.
  5. New Zealand Ministry for the Environment. Regulatory Impact Statement. Amending the PM10 Air Quality Standards: Final Recommendations [29 January, 2011]. http://www.treasury.govt.nz/publications/informationreleases/ris/pdfs/ris-mfe-aaqs-jan11.pdf
  6. Hoare JL. Limitations of the scientific basis for the management of air quality in urban New Zealand. N Z Med J 2011;124(1330):66-73. http://journal.nzma.org.nz/journal/124-1330/4558/content.pdf 
  7. Hoare JL. Consequences of a flawed epidemiological approach to air quality regulation. N Z Med J 2011;124(1336):107–109.http://journal.nzma.org.nz/journal/124-1336/4724/content.pdf
  8. Ministry of Social Development. 2010 the social report. http://socialreport.msd.govt.nz/health/life-expectancy.html