Health not health insurance policy

There is a nifty new NBER working paper that looks at what happened to asthma in Stockholm after that city instituted a congestion pricing fee. Asthma attacks went down.

We demonstrate that the tax reduced ambient air pollution by 5 to 15 percent, and that this reduction in air pollution was associated with a significant decrease in the rate of acute asthma attacks among young children. The change in health was more gradual than the change in pollution suggesting that it may take time for the full health effects of changes in pollution to be felt….

Reductions in air pollution from traffic by one unit (1 mg/m3) decreased visits for acute asthma to inpatient and outpatient providers by 4 to 15 percent, depending on the length of exposure to reduced pollution. The estimated health effects are comparable with evidence from the epidemiology literature …

I found this paper to be really interesting for three reasons. The first is that this is a clear example of what is called a social determinant of health (SDOH) where health status is driven by non-healthcare factors. Healthcare providers at this point are merely functioning as goalies trying to keep kids out of the hospital while the congestion pricing gets closer to the root cause of the asthma driver — poor air quality. Moving the treatment upstream from the provider officer by reducing pollution saves medical costs while actually raising government revenue instead.

Secondly, this is a pretty cool example of how addressing one externality (congestion time) by putting a price on it addresses a related externality. There might be an argument that the social cost of congestion is higher than the current congestion tax because of the asthma and other related medical costs but solely focusing on congestion, it is also reducing the social cost of respiratory distress.

Finally, I have a personal interest as I’ve mentioned that my son has asthma. I often wonder how much of it was bad luck from his parents and how much of it was living 1.5 miles from the Edgar Thompson steel mill in Braddock and 400 yards from the biggest morning rush hour chokepoint in the Pittsburgh highway system?






10 replies
  1. 1
    otmar says:

    David, so did your son’s asthma improve after the move?

  2. 2

    @otmar: Until this week, yes, significantly

  3. 3
    Ohio Mom says:

    This week, the maples started blooming and I started sneezing. I haven’t seen an increase in my asthma symptoms —yet. But I won’t be surprised if I need to break out the abuterol.

    When I asked my internist why it was that I developed asthma as an adult, she asked if I had ever smoked. I said No, but I grew up in a haze of smoke: both parents were heavy smokers.

    I wonder if the big drop in smoking in some socio-economic groups is leading to a decrease in asthma among the members of those groups.

  4. 4
    sheila in nc says:

    Check out the USC Children’s Health Study at
    The homepage includes links to study findings. Improvement of air quality in Southern California has been accompanied by improvement in lung function and lung development in children everywhere they have looked. Your government at work — research supported by the State of California and the feds (National Institute of Environmental Health Sciences at NIH, and USEPA).

    ETA I can’t tell if the link posted. It’s https://healthstudy.usc.edu/index.php

  5. 5
    Redshift says:

    On a related note, I read an article recently about how part of the reason African-American and Latino children die more frequently from asthma is that Albuterol inhalers are much less effective, which we didn’t know because (like much medical research) they had been studied almost entirely on people of European descent. (The actual article I read linked it with other medical studies, and the compounding risk factor of being more likely to live with bad air quality, but I can’t find that one.)

  6. 6
    laura says:

    IMHO, every NBER working paper is nifty.

  7. 7
    Ohio Mom says:

    @Redshift: That is very interesting. Although I am a whitecof European descent, abuterol is only of limited effectiveness for me. Still better than nothing.

  8. 8
    VeniceRiley says:

    It’ll be anger-making when the Trump EPA regulation kill-off results in an increase in childhood asthma!

  9. 9
    Joe says:

    Let me just say that I completely misunderstood the word “congestion” in that first sentence.

  10. 10
    Stan says:

    Thank you, this is great. I’ve passed it on to friends. Our city has a terrible problem with childhood asthma, of course concentrated in poor neighborhoods of color because hey, it’s the USA and that’s where we dump our problems.

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