Economic Evaluation of Environmental Health Interventions to Support Decision Making

Environmental burden of disease represents one quarter of overall disease burden, hence necessitating greater attention from decision makers both inside and outside the health sector. Economic evaluation techniques such as cost- effectiveness analysis and cost-benefi t analysis provide key information to health decision makers on the effi ciency of environmental health interventions, assisting them in choosing interventions which give the greatest social return on limited public budgets and private resources. The aim of this article is to review economic evaluation studies in three environmental health areas—water, sanitation, hygiene (WSH), vector control, and air pollution—and to critically examine the policy relevance and scientifi c quality of the studies for selecting and funding public programmers. A keyword search of Medline from 1990-2008 revealed 32 studies, and gathering of articles from other sources revealed a further 18 studies, giving a total of 50 economic evaluation studies (13 WSH interventions, 16 vector control and 21 air pollution). Overall, the economic evidence base on environmental health interventions remains relatively weak—too few studies per intervention, of variable scientifi c quality and from diverse locations which limits generalisability of fi ndings. Importantly, there still exists a discon- nect between economic research, decision making and programmer implementation. This can be explained by the lack of translation of research fi ndings into accessible documentation for policy makers and limited relevance of research fi ndings, and the often low importance of economic evidence in budgeting decisions. These fi ndings underline the importance of involving policy makers in the defi ning of research agendas and commissioning of research, and improving the awareness of researchers of the policy environment into which their research feeds.