Genuine Progress Index for Atlantic Canada Indice de progr

1
Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - AtlantiqueECONOMIC
EVALUATIONSMaking the Case with Dollars and
SensePrevention Dividend ProjectOctober 28-30,
Ottawa
2
Presentation in 3 Parts

• The context Prevalent economic valuations of
  wellbeing the need for more accurate and
  comprehensive measures the GPI
• Sample results Costs of illness and
  cost-effectiveness of preventive interventions
• Detailed case study Second-hand Smoke

3
Economic Evaluations of Wellbeing -- The Current
System

• We currently measure how well off we are as a
  society by how fast the economy is growing.
• The language of health A growing economy is
  robust healthy dynamic.
• If people spend less money, consumer confidence
  is weak. Shopping is patriotic.
• If economy shrinks, we have a depression

4
Current Economic Valuations of Wellbeing

• Count crime, war, sickness, pollution, addiction
  and stress as contributions to economic growth
  and prosperity.
• Count the depletion of our natural resources as
  gain. The more trees we cut down, the more fish
  we catch, the more fossil fuels we burn, the
  faster the economy will grow.

5
Current Economic Valuations of Wellbeing

• Ignore the value of voluntary work and unpaid
  household work.
• Count longer work hours as contributions to
  economic growth and prosperity.
• Ignore the value of free time.
• Assign no value to health, security, wisdom,
  environmental quality or strong communities.

6
Current Measures of Wellbeing

• Give no value to equity Economy can grow even as
  inequality and poverty increase (1990s)
• In sum Make no distinction between economic
  activities that create benefit and those that
  cause harm Misleading signals to policy makers
• More is always better when GDP is used to
  measure wellbeing

7
Measurement system impacts health of Canadian
society e.g.

• Materialism, excess vs balance, prevention
• Poverty, growing inequity invisible, yet key
  determinant of health
• Long hours and health (Stats Canada study),
  womens double burden of paid unpaid work
• Stress, loss of free time,, physical inactivity,
  obesity (StatCan), decline in voluntary activity

8
Total Work Hours, Couple with Children, Canada,
1900 and 2000

• 1900 2000
• Male, paid work 58.5 42
• Female, paid work -- 36.5
• Male, unpaid work N.A. 22.4
• Female, unpaid work 56 33.6
• Total work hours 114.5 134.5

9
Indicators are Powerful

• What we measure
• - reflects what we value as a society
• - determines what makes it onto the policy
  agenda.
• - Analogy of student assignments

10
What Doesnt Make it onto the Policy Agenda. E.g.

• Shorter work time (Europe)
• Voluntary work decline
• Prevention (e.g. health promotion, disease
  prevention 2.6 Ontario health budget)
• Natural resource health and energy conservation
• Initiatives to reduce GHG emissions are blunted

11
There is a better way!

• Four hundred leading economists, including Nobel
  Laureates, said
• Since the GDP measures only the quantity of
  market activity without accounting for the social
  and ecological costs involved, it is both
  inadequate and misleading as a measure of true
  prosperity....New indicators of progress are
  urgently needed to guide our society....The GPI
  is an important step in this direction.

12
GPI Atlantic founded 1997 to address that need

• Independent non-profit research group
• Mandate Create better measures of progress
• Nova Scotia pilot project for Canada, working
  closely with Statistics Canada
• Can provide more accurate and comprehensive
  measures of wellness that demonstrate
  cost-effectiveness of prevention

13
Partnerships

• Statistics Canada, Canadian Population Health
  Initiative (community GPI)
• Dalhousie Univ. Population Health Research Unit
• Maritime Centre of Excellence for Womens Health
• Cape Breton Wellness Centre, UCCB
• Community health boards public health
  authorities community development groups

14
In the Genuine Progress Index

• Natural resources are seen as capital assets
  subject to depreciation and requiring
  re-investment.
• Crime, sickness, disasters and pollution clean up
  are counted as costs rather than contributions to
  well-being.
• Voluntary work, unpaid household work, free time,
  health, educational attainment are valued.

15
In the Genuine Progress Index

• Reductions in greenhouse gas emissions,
  pollution, crime, poverty, ecological footprint
  are signs of genuine progress that make the index
  rise. Unlike measures based on GDP, "less" is
  sometimes "better" in the GPI
• Growing equity makes the GPI go up
• Economic valuations key. E.g. voluntary work
  worth 53.2 billion 8.7 loss costs Canadians
  4.7 billion

16
GPI has 22 Components

• Natural Resource Accounts (forests, fish, soils,
  water, energy)
• Measures of Environmental Quality (air, GHG
  emissions, solid waste, footprint,
  transportation)
• Time Use (paid unpaid work, free time)
• Social Capital (health, education, income
  distribution, livelihood security, crime, debt)

17
Health Reports to Date

• Cost of Obesity 8 provinces (each 53pp)
• Cost of Tobacco in NS (87pp)
• Economic Impact of Smoke-Free Workplaces (115pp)
• Womens Health in Atlantic Canada (61pp)
• Cost of HIV/AIDS in Canada (11pp)
• (Jan. 2002) Cost of Preventable Illness in NS

18
Costs of Illness. Sample results

• Tobacco costs NS health system 168 mill/year
  Cost to economy 650 million. Plus employer
  costs of 250 million (Conf. Board)
• Obesity costs Ontario health system 1.1 bill/yr
  5.3 of health budget. Total costs to economy
  2.4 0.75 of Ontario GDP
• HIV/AIDS costs Canadians 560 health care and 2
  billion in 1999 total to economy

19
Value of Prevention. E.g.Tobacco

• 10 NS smokers quit NS saves 1 billion over 30
  years and 92,000 potential years of life
• Restoring tobacco taxes to pre-1994 levels would
  save NS 3 billion over 30 years
• Illegal sales to minors in NS yield 6.4 million
  in taxes 8x current tobacco control budget.
  Price elasticity studies show 10 price increase
  will reduce teen smoking by 7.

20
Benefit-cost ratios of prevention

• School-based smoking prevention 151 (delivered
  to all 76,000 10-15 year olds, would save 70
  million in avoided costs and losses)
• Brief advice by physician 121 (41 receive)
• Prenatal counseling 101 (savings in intensive
  neonatal care for low birth weight babies,
  long-term infant care, avoided health care for
  mothers
• Media advertising 71 Mayo Clinic 41 etc.

21
Costs of Second-Hand Smoke

• 42 of NS children under 12 are regularly exposed
  to environmental tobacco smoke (ETS) in the home.
• 24 of Nova Scotians are exposed to ETS at work.
• Second-hand smoke kills 200 Nova Scotians a
  year,(140 from heart disease, 60 from cancers).
• Second-hand smoke costs 21 million a year in
  health costs and 57 million in productivity
  losses

22
5 STEPS

• The physical and medical evidence
• Economic valuations secondary, derivative
• Policy issues
• Cost-effectiveness of interventions
• Practicalities How to get from here to there

23
1) Economic Valuations Always Based on Physical
and Medical Evidence.

• ETS causes heart disease, lung cancer, nasal
  sinus cancer and respiratory ailments in adults.
• ETS causes sudden infant death syndrome, fetal
  growth impairment, bronchitis, pneumonia, middle
  ear disease and asthma exacerbation in infants
  and children.

24
Health Hazards of ETS Recognized by

• World Health Organization (1986 and 1999),
• U.S. National Academy of Sciences/National
  Research Council (1986),
• Australian National Health and Medical Research
  Council (1987),
• U.K. Department of Health and Social Security
  (1988),
• U.S. Environmental Protection Agency (EPA)
  (1992),
• U.S. Public Health Service (1986),
• U.S. National Institute for Occupational Safety
  and Health (1991),
• American College of Occupational Environmental
  Medicine (2000),
• California Environmental Protection Agency
  (1997),
• The Australian National Health and Medical
  Research Council (1997),
• United Kingdom Scientific Committee on Tobacco
  and Health (1998)
• U.S. National Toxicology Program (9th Annual
  Report on Carcinogens, 2000)

25
Recent Research Also Shows

• ETS has been linked to cervical and breast
  cancer, stroke, and miscarriages in adults and
  to asthma induction, decreased lung function,
  cystic fibrosis, and cognition and behaviour
  problems in children

26
Restaurant, Bar and Casino Workers Most at Risk

• In restaurants, second-hand smoke levels are
  twice as high as in other workplaces without
  smoke bans. In bars and casinos they are 3-6
  times as high.
• Food service workers have a 50 higher rate of
  lung cancer than the general population.
• Excess mortality for workers in smoking lounges,
  bars, restaurants, casinos and bowling alleys is
  15-26 times higher than OSHAs significant risk
  level.
• Establishment of smoke-free bars and taverns was
  associated with a rapid improvement of
  respiratory health. Eisner, 1998

27
2) Economic ValuationCosts of Second-Hand
Smoke, NS, 1999

• Deaths 200
• Potential years of life lost 2,900
• Hospitalizations 1,400
• Hospital Days 15,000

28
Direct Health Care Costs of ETS (1999 mill.)

• Hospitals 15.2
• Ambulance Services 0.3
• Physician fees 1.5
• Prescription Drugs 3.2
• Other Health Care Costs 0.3
• Total Direct Health Care Costs 20.5

29
Indirect Costs of ETS (1999 millions)

• Productivity loss (sickness) 0.7
• Productivity loss (mortality) (6 discount rate)
  57.1
• TOTAL COST TO ECONOMY 77.6
• Sources Costs based on Canadian Centre for
  Substance Abuse, The Costs of Substance Abuse in
  Canada, Colman, The Cost of Tobacco in Nova
  Scotia, pages 15-20, and mortality rates in
  Glantz and Parmley, (1995), op. cit., and
  Steenland, (1992),op. cit..

30
3) Policy Issues E.g. Do Non-Smoking Areas
Provide Protection from ETS? The evidence

• Simple separation of smokers and non-smokers
  within the same air space ... does not eliminate
  exposure of non-smokers to environmental tobacco
  smoke.
• U.S. Surgeon-General and National Research
  Council
• The non-smoking (casino) tables, as currently
  situated, did not measurably decrease employee
  exposure to ETS.
• U.S. National Institute for Occupational Safety
  and Health
• Simple separation of smoking and non-smoking
  indoor workers fails to prevent involuntary
  exposure to ETS.
• American College of Occupational and
  Environmental Medicine (2000)

31
The Courtesy of Choice Program

• Courtesy of Choice makes it possible for smokers
  and non-smokers to live in harmony. It is a
  program of self-regulation that uses scientific
  air-flow analysis to guarantee that non-smoking
  areas are truly smoke-free....(It) involves
  effective ventilation and filtration systems to
  ensure that smoke and other contaminants in the
  air are removed. Hotel Association of
  Canada
• The Canadian Tobacco Manufacturers Council has
  given the Hotel Association of Canada 3.2
  million to implement its Courtesy of Choice
  program.

32
Does Ventilation Protect from Second-hand Smoke?

• Accommodation of tobacco smoke in the workplace,
  the solution proposed by the tobacco industry,
  was found to have no basis in science or public
  health protection.... The ventilation system
  capable of removing tobacco smoke from the air
  does not exist. ASHRAE no longer provides
  ventilation standards for air with tobacco smoke
  in it, only for air in smoke-free buildings....
  Ventilation provides no solution to the problem
  of exposure to second-hand tobacco smoke.
  
• Ontario Tobacco Research Unit, University of
  Toronto (2001)

33
Would restaurants build ventilated smoking areas?

• A random survey of 401 Quebec restaurants found
  that most would not construct ventilated smoking
  areas, even if they were effective, for financial
  and technical reasons. Cremieux and
  Oulette, 2001

34
Therefore

• A limited policy offers no advantage over no
  policy at all. (T)he only way to protect
  nonsmokers health is with a smoke-free work
  site. Borland, JAMA
• U.S. Surgeon-General recommends 100 percent
  smoke-free environments in all public areas and
  workplaces, including all restaurants and bars.
• All involuntary exposure to tobacco smoke is
  harmful and should be eliminated. Ontario
  Tobacco Research Unit, University of Toronto
  (2001)
• Smoking bans remain the only viable control
  measure to ensure that workers and patrons of the
  hospitality industry are protected from exposure
  to the toxic wastes from tobacco combustion.
  Repace (2000)

35
4) Smoke-Free Workplaces Will Save Lives and
Money

• 80 of ETS exposure is in the workplace.
• Smoke-free workplaces cut cigarette consumption
  among smokers by 20.
• Smoke-free workplaces can save 400-500 lives a
  year, 50 million in avoided health costs, and
  150 million in avoided productivity losses.

36
And savings to employers

• It costs Canadian employers 2,280 more to employ
  a smoker compared to a non-smoker.
  Conference Board of Canada
• Smoke-free workplaces can save NS employers 25
  million a year in avoided absenteeism and smoking
  areas costs, and lower insurance premiums.
• Strong economic incentives exist for rapid
  adoption of smoke-free workplaces.
  American College of Occupational and
  Environmental Medicine

37
Are Smoke Bans Bad for Business?

• Without exception, every objective study using
  actual sales data finds that smoke-free
  legislation has no adverse impact on restaurant,
  bar, hotel and tourism receipts. (Studies
  conducted in California, Colorado, Massachusetts,
  New York, Arizona, Texas, Utah, Vermont, North
  Carolina, and British Columbia.)
• Two of the 16 studies found an initial decline in
  receipts in the first 1-2 months following
  enactment, but no overall or aggregate decline in
  the longer term.
• Several studies find smoke-free legislation is
  good for business as non-smokers eat and drink
  out more often.

38
The Researchers Conclude

• Legislators and government officials can enact
  health and safety regulations to protect patrons
  and employees in restaurants and bars from the
  toxins in secondhand tobacco smoke without fear
  of adverse economic consequences.... these data
  further discredit tobacco industry claims that
  smoke-free bar laws are bad for the bar business.
  Quite the contrary, these laws appear to be good
  for business. Glantz 1997 and 2000 (California)

39
Conclusions from the 16 Studies

• All models indicate that smoke-free restaurant
  restrictions increased restaurant receipts in
  towns adopting smoke-free policies, by 5 to 9
  percent. Pope Bartosch, 1997
  (Mass.)
• Other cities can enact similar laws, which
  protect restaurant patrons and food service
  workers from tobacco smoke, without concerns that
  restaurants will lose business. Sciacca
  Ratcliffe (Az)

40
More Conclusions

• Smoke-free restaurant ordinances did not hurt,
  and may have helped, international tourism
  From tourism/hotel sales in 6 U.S. States
• The statistical results strongly confirm that
  there are no long-term impacts from restrictive
  smoking regulations. CRD, BC, 2000

41

• Nine months after tough anti-smoking legislation
  was imposed in B.C.s capital, business remains
  steady and liquor sales are up.
  Victoria, B.C. 1999
• In one study after another, covering multiple
  states within the US, analysts have found no
  adverse effect of smoking restrictions, including
  complete bans, on local restaurants business.
  Indeed, several of the studies have found a
  tendency for smoking restrictions to increase
  business. Similar findings derive from analysis
  of the effects of smoking restrictions on bars
  ...(and) tourism. Warner, 2000

42
Smoke Bans May Increase Sales

• Our results indicate that these nonsmokers are
  more than making up the revenues lost from
  inconvenienced diners who smoke.... At the very
  least restaurateurs should make business
  decisions based on data, not opinion. Ultimately,
  smoke-free legislation is likely to have a
  positive impact on restaurant-industry revenues.
  Our advice to other cities and municipalities is
  to consider similar legislation. The restaurant
  industry collectively may experience higher
  revenues through smoke-free legislation.
  Cornell Hotel and Restaurant Administration
  Quarterly, 1996

43
Restaurateur Fears Unfounded

• A survey of Arizona restaurateurs before
  smoke-free legislation found 44 concerned that
  customers would be upset. Afterwards, the same
  restaurateurs reported that most customer
  reactions were positive. Only 15 found negative
  reactions. 88 said the law was positive or
  neutral for staff, and 94 said it was easy to
  enforce. Sciacca 1996

44
5) How to e.g. Occupational Health and Safety
Laws require employers to provide a safe working
environment

• Employees...should have the right to refuse to
  work in environments with high levels of ETS.
  Canadian OHS legislation that could apply
  indirectly to ETS include the regulation of
  substances found in tobacco smoke (possibly
  through the national Workplace Hazardous
  Materials Information System. Health Canada
  
• Smoke-free workplaces avoid potential litigation
  based on unhealthy workplaces.........

45
Nova Scotias 1996 Occupational Health and Safety
Act (chapter 7), section 13 (1)

• requires every employer to ensure the health and
  safety of persons at or near the workplace and
  to ensure that employees are not exposed to
  health or safety hazards. Employers shall
  render harmless all gases, vapours, dust or
  other impurities that are likely to endanger the
  health or safety of any person therein.

46
The Politics of Smoke-Free Legislation

• The tobacco industry resists smoke-free
  legislation by
• Denying the overwhelming scientific evidence on
  the health hazards of ETS, finding fault with
  study methodologies and funding scientists to
  publish articles to that effect.
• Working through third parties, especially
  restaurant, bar and hotel associations by
  spreading fears (never empirically substantiated)
  that the legislation will harm their business.
• Watering down legislation delaying its
  implementation shifting the focus of debate from
  public health to market choice and
  self-regulation and arguing that ventilation can
  remove ETS despite scientific evidence to the
  contrary.

47
In the Tobacco Industrys Own Words

• The immediate implication (of smoking bans) for
  our business is clear If our consumers have
  fewer opportunities to enjoy our products, they
  will use them less frequently and the result will
  be an adverse impact on our bottom line
  (Philip Morris)
• Our objective is to contain and refine the
  environmental smoke issue in order to decrease
  the pressure for safety measures. (Tobacco
  Institute)

48
If No one Believes You, Use Others

• Evidence from tobacco industry documents now on
  the public record proves the existence of an
  extensive industry campaign to undermine the
  scientific consensus on the health risks of
  second-hand smoke. A particular target of this
  campaign has been the hospitality industry, whose
  representatives have (often unwittingly) repeated
  tobacco industry arguments against second-hand
  smoke controls in their establishments.
  Report to Ontario Minister of Health, 1999

49
Using third party sources to gain credibility

• We try to keep Philip Morris out of the media
  on issues like taxation, smoking bans, and
  marketing restrictions. Instead we try to provide
  the media with statements in support of our
  positions from third party sources, which carry
  more credibility than our company and have no
  apparent vested interest. (Philip Morris)

50
...and talk about anything except public health

• We try to change the focus on the issues.
  Cigarette tax become(s) an issue of fairness and
  effective tax policy. Cigarette marketing is an
  issue of freedom of commercial speech.
  Environmental tobacco smoke becomes an issue of
  accommodation. Cigarette-related fires become an
  issue of prudent fire safety programs. And so
  on. (Philip Morris)
• Portray the debate as one between the
  anti-tobacco lobby and the smoker, instead of
  pro-health public citizens versus the tobacco
  industry. (Philip Morris)

51
What Enables Smoke-Free Legislation to Succeed?

• Legislators must be well aware of the facts and
  evidence and also of tobacco industry strategies
  to prevent smoke bans.
• An in-depth analysis of the politics of tobacco
  control in California also concluded
  Despite the tobacco industrys superior
  financial resources, the outcome of proposed
  local tobacco control legislation appears to
  depend on how seriously the health advocates
  mobilize in support of the local legislation.
  When the health community makes a serious
  commitment of time and resources, it wins. When
  it fails to make such a commitment, the tobacco
  industry prevails, more by default than by its
  superior financial resources. Samuels Glantz,
  1991

52
Tourism and Hospitality Industries Can Protect
their Employees and their Business

• Smoke bans are popular (76 of Nova Scotians),
  and protect hospitality industry employees who
  are most at risk from ETS.
• 97.2 of visitors to NS are from other parts of
  Canada and the US, where smoke-free legislation
  is common.

53
Protecting Hospitality Employees and Business

• The California Restaurant Association fully
  supported the smoke-free workplace law that
  applies to all restaurants, bars and gaming
  places.
• Why not take the high road and promote NS as a
  healthy, trend-setting, visionary, smoke-free
  environment a marketing opportunity for the new
  century and new generation of visitors?
• Response to a TIANS survey on smoke-free
  legislation

54
The Evidence Clearly Shows

• Second-hand smoke causes heart disease, cancer
  and respiratory illness. Smoke-free workplace
  legislation will save the lives of hundreds of
  Nova Scotians, prevent serious illnesses, and
  save 200 million in avoided health costs and
  productivity losses.
• Restaurant, bar and casino workers are exposed to
  the highest levels of ETS and have the greatest
  health risks.
• Designated non-smoking areas and ventilation do
  not work. Only 100 smoke-free environments
  protect employees/patrons.
• Smoke-free legislation will not harm restaurant,
  bar, hotel and tourism sales, and may be good for
  business.

55
Valuing Natural Capital

• For example, forest functions / values include
• Preventing soil erosion/sediment control
• Protecting watersheds
• Climate regulation/carbon sequestration
• Providing habitat for wildlife / biodiversity
• Recreation, tourism, aesthetic quality
• Providing timber

56
Natural Age Limits Maritime tree species

• White Ash 100-200
• American Beech 300-400
• White Birch 120-150
• Yellow Birch 150-250
• Eastn Hemlock 300-800
• Red Maple 100-150
• Sugar Maple 300-400

• Red Oak 200-350
• Red Pine 200-250
• White Pine 200-450
• Black Spruce 200-250
• Red Spruce 250-400
• White Spruce 150-200

57
Forest Area by Age Class, NS 1958-99
58
Total Forest Area by Age Class
59
Provincial Area (hectares) of Clearcut Harvest
and Silviculture (000s seedlings), Nova Scotia
1975-1997
60
Changes in Atlantic Bird Species Populations
61
Recreational Brook Trout Caught and Retained in
Nova Scotia 1975-1995
62
Total Expenditures on Angling Activities Nova
Scotia 1975-1995 (1997 millions)
63
Angling Cost Per Fish, Nova Scotia 1975-1995
(1997)
64
Old Forests Store More Carbon A new study
published in Science, reported that ...
replacing old-growth forest by young Kyoto stands
... will lead to massive carbon losses to the
atmosphere mainly by replacing a large pool with
a minute pool of regrowth and by reducing the
flux into a permanent pool of soil organic
matter. (Schulze et. al. 2000)
65
Provincial Value of Total Tree Carbon Storage in
Nova Scotia Forests 1999
66
Estimated Annual Cost of Carbon Released due to
Annual Timber Harvest, Nova Scotia, 1975 to
1997
67
Effect of Hardwood Content on Predicted Budworm
Damage
Source Qiong Su et.al., 1996
68
(No Transcript)
69
Examples of Retail Prices for Clear vs. Kotty
White Pine (January 2001 prices)

• Wood retailers White Pine knotty White
  Pine clear Increased value of clear
• per board foot per board foot
  per board foot
• Barrett Lumber Co. 1.04 3.43 2.39
• Hefler Forest Products 1.42 3.73 2.31
• Payzant Building Products 1.55 3.70 2.15
• Pierceys 1.79 4.79 3.00
• Beaver Lumber 2.10 4.99 2.98
• Millet .85 1.10 0.25
• Collicuts .85 2.00 1.15

70
Clearcut harvesting and loss of age and species
diversity have resulted in the loss of

• valuable species
• wide diameter and clear lumber that fetch premium
  market prices
• resilience and resistance to insect infestation
  that is enhanced by species diversity
• wildlife habitat, including decreasing
  populations of birds
• forest recreation values that can impact nature
  tourism
• valuable medicinal plants that are dependent on
  old-growth and mature forests

71
This represents a substantial depreciation of a
valuable natural capital asset.

• And
• a decline in forested watershed protection and a
  50 drop in shade-dependent brook trout
• soil degradation and the leaching of nutrients
  that can affect future timber productivity
• a substantial decline in carbon storage capacity
  and an increase in biomass carbon loss
• a decline in other essential forest ecosystem
  services.

72
Can we do it?Percentage Waste Diversion in Nova
Scotia
73
This represents a substantial depreciation of a
valuable natural capital asset.

• And
• a decline in forested watershed protection and a
  50 drop in shade-dependent brook trout
• soil degradation and the leaching of nutrients
  that can affect future timber productivity
• a substantial decline in carbon storage capacity
  and an increase in biomass carbon loss
• a decline in other essential forest ecosystem
  services.

74
Competitiveness and Genuine Progress