Health affairs
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We used a dynamic simulation model of the US health system to test three proposed strategies to reduce deaths and improve the cost-effectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. ⋯ Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.
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Climate change and associated changing weather patterns, including severe weather events, are expected to increase the prevalence of a wide range of health risks. Yet there is uncertainty about the timing, location, and severity of these changes. Adaptive management, a structured process of decision making in the face of imperfect information, is an approach that can help the public health field effectively anticipate, plan for, and respond to the health risks of climate change. In this article I describe adaptive management and how it could increase the effectiveness of local and national strategies, policies, and programs to manage climate-sensitive health outcomes.
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Scores of foundations are supporting efforts to improve the environmental conditions that affect health outcomes. Environmental health philanthropy has grown from a few foundations in 1999 to more than 100 today, and to annual investments of at least $70 million. This dynamic area of philanthropy is assisting disaster-stricken communities in the Gulf Coast, supporting a national movement to reform chemicals policy, defending clean air and water standards, and underwriting environmental justice work in low-income communities and communities of color. We argue that these investments are yielding sizable returns, but more funding opportunities exist to deepen understanding of hazards, clean up communities, reform policies, and embed environmental health in new economic development.