《环境政策与管理》课程教学资源（参考资料）The Cost of Air Pollution——Strengthening the Economic Case for Action（World Bank 2016）

The Cost of Air Pollution Strengthening the Economic Case for Action WORLD BANK GROUP IHME

The Cost of Air Pollution Strengthening the Economic Case for Action 1700234_Cost of Pollution_Cvr.indd 1 8/26/16 10:16 AM Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized

Contents Foreword...... ...vii Acknowledgments.… Abbreviatic0ns.… Executive Summary… X 1 Introduction................................. .1 Air Pollution:A Threat to Sustainable Prosperity 1 The Focus of This Report.…… ￥ > The Context for This Report................................................... Notes.……………… 8 References .................................... 2 Health Impacts of Air Pollution.............................................11 Introduction................................................................11 Method for Satellite-and Model-Derived Estimates of Ambient Air Pollution 11 Method for Estimating Exposure to Household Air Pollution from Cooking with Solid Fuels.................. 16 Method for Estimating Health Outcomes from Ambient and Household Air Pollution Exposure...................................................18 Trends in Exposure and Health Impacts from Ambient and Household Air Pollution.............................................................22 Trends in Ambient Air Pollution Exposure and Health Impacts.................... 25 Trends in Household Air Pollution Exposure and Health Impacts..................35 The Evolution of GBD Estimates..............................................42 44 References........... 45 3 Economic Impacts of Air Pollution.......................................... 47 ntroduction.………… 47 Methods and Data........................................................... 47 Results:Welfare Losses and Forgone Labor Output...............................50 Alternative Scenarios and Sensitivity Analysis of Uncertain Parameters............. 60 Notes......................................................................74 References........................................75 4 A Synthesis and the Way Forward...........................................78 Air Pollution:A Costly and Persistent Challenge.................................78 Ambient Air Pollution:A Growing Challenge................................... 79 Indoor Air Pollution:A Remaining Challenge Despite Some Gains.................79 TheWayForward...........................................................80 Improving Estimates................. 82 87 八、、、]0 References........................................................8 The Cost of Air Pollution:Strengthening the Economic Case for Action 讯

The Cost of Air Pollution: Strengthening the Economic Case for Action iii Contents Foreword......................................................................................................................................... vii Acknowledgments.......................................................................................................................... viii Abbreviations................................................................................................................................... ix Executive Summary ......................................................................................................................... x 1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Air Pollution: A Threat to Sustainable Prosperity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Focus of This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 The Context for This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2 Health Impacts of Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Method for Satellite- and Model-Derived Estimates of Ambient Air Pollution . . . . . . . . 11 Method for Estimating Exposure to Household Air Pollution from Cooking with Solid Fuels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Method for Estimating Health Outcomes from Ambient and Household Air Pollution Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Trends in Exposure and Health Impacts from Ambient and Household Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Trends in Ambient Air Pollution Exposure and Health Impacts . . . . . . . . . . . . . . . . . . . . 25 Trends in Household Air Pollution Exposure and Health Impacts . . . . . . . . . . . . . . . . . . 35 The Evolution of GBD Estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3 Economic Impacts of Air Pollution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Methods and Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Results: Welfare Losses and Forgone Labor Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Alternative Scenarios and Sensitivity Analysis of Uncertain Parameters . . . . . . . . . . . . . 60 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 4 A Synthesis and the Way Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Air Pollution: A Costly and Persistent Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Ambient Air Pollution: A Growing Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Indoor Air Pollution: A Remaining Challenge Despite Some Gains . . . . . . . . . . . . . . . . . 79 The Way Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Improving Estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 1700234_Cost of Pollution.indd 3 8/29/16 1:55 PM

Appendixes A Supplementary Materials on Health Impacts. 88 B Country Data.. 92 Boxes 1.1 Air Pollution:Harming Countries'Economies in Many Ways......... 5 1.2 Using an Air Quality Management Study and Economic Valuation to Help Ulaanbaatar Forge a Strategy to Combat Air Pollution..........................6 1.3 Accounting for the Costs and Benefits of Air Pollution Control in the United States........................................................6 2.1 Dust and Dust Storm Health Effects.........................................13 2.2 Underestimation of Ground Measurements in Locations with High Concentrations.................................................15 2.3 Integrated Exposure-Response(IER)........................................19 4.1 Transport:Valuing the Health Impacts of Air Pollution in Transport Project Cost-Benefit Analyses......................................................81 4.2 Morocco:Using Ground-Level and Satellite Data to Estimate the Cost of Air Pollution.........................83 4.3 China:Estimating the Impact of Pollution Sources on Disease Burden...........84 4.4 Mexico:Subnational Estimates Matter.......................................85 Figures ES.1 Welfare Losses Due to Air Pollution by Region,2013..........................xii ES.2 Welfare Losses from Ambient PM,and Household Air Pollution in Low- and Middle-Income Countries,1990-2013...................................xiii 1.1 Percentage of Attributable Deaths by Risk Factor:Globally,2013.................1 1.2 Percentage of Attributable Deaths by Risk Factor:Low-,Lower-Middle-Income, and Upper-Middle-Income Countries,2013...................................3 B2.2.1 Calibration Regression Simple(Pink)versus Advanced(Green)Model by Super-.Region.…l5 2.1 Integrated Exposure-Response(IER)Functions for Ischemic Heart Disease(a), Stroke(b),Lung Cancer and COPD(c),and Lower Respiratory Infections(d).....20 2.2 Total Deaths from Air Pollution by Region,2013..............................23 2.3 Percentage of Total Deaths from Air Pollution by Region,2013.... 23 2.4 Percentage of Total Deaths from Air Pollution by Income Group,2013...........24 2.5 Total Deaths from Ambient PM,Pollution by Region,1990 and 2013...........28 2.6 Leading Modifiable Risks by Number of Deaths:Globally,1990 and 2013.........29 2.7 Trends in Ischemic Heart Disease Death Rates from Ambient PM,Pollution, 1990-2013...29 2.8 Deaths per 100,000 People from Ambient PM,Pollution by Region, 1990and2013.............................30 2.9 Total Deaths(a)and Disability-Adjusted Life Years(DALYs)(b)from Ambient PMs Pollution by Age Group,2013....................33 2.10 Percentage of Total Deaths from Ambient PM,Pollution by Income Group, 1990and2013...........................34 iv The Cost of Air Pollution:Strengthening the Economic Case for Action

iv The Cost of Air Pollution: Strengthening the Economic Case for Action Appendixes A Supplementary Materials on Health Impacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 B Country Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Boxes 1.1 Air Pollution: Harming Countries’ Economies in Many Ways . . . . . . . . . . . . . . . . . . . . 5 1.2 Using an Air Quality Management Study and Economic Valuation to Help Ulaanbaatar Forge a Strategy to Combat Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.3 Accounting for the Costs and Benefits of Air Pollution Control in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.1 Dust and Dust Storm Health Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.2 Underestimation of Ground Measurements in Locations with High Concentrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.3 Integrated Exposure-Response (IER) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 4.1 Transport: Valuing the Health Impacts of Air Pollution in Transport Project Cost-Benefit Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 4.2 Morocco: Using Ground-Level and Satellite Data to Estimate the Cost of Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 4.3 China: Estimating the Impact of Pollution Sources on Disease Burden . . . . . . . . . . . 84 4.4 Mexico: Subnational Estimates Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Figures ES.1 Welfare Losses Due to Air Pollution by Region, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . xii ES.2 Welfare Losses from Ambient PM2.5 and Household Air Pollution in Low￾and Middle-Income Countries, 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii 1.1 Percentage of Attributable Deaths by Risk Factor: Globally, 2013 . . . . . . . . . . . . . . . . . 1 1.2 Percentage of Attributable Deaths by Risk Factor: Low-, Lower-Middle-Income, and Upper-Middle-Income Countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 B2.2.1 Calibration Regression Simple (Pink) versus Advanced (Green) Model by Super-Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.1 Integrated Exposure-Response (IER) Functions for Ischemic Heart Disease (a), Stroke (b), Lung Cancer and COPD (c), and Lower Respiratory Infections (d). . . . . 20 2.2 Total Deaths from Air Pollution by Region, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2.3 Percentage of Total Deaths from Air Pollution by Region, 2013 . . . . . . . . . . . . . . . . . . 23 2.4 Percentage of Total Deaths from Air Pollution by Income Group, 2013 . . . . . . . . . . . 24 2.5 Total Deaths from Ambient PM2.5 Pollution by Region, 1990 and 2013 . . . . . . . . . . . 28 2.6 Leading Modifiable Risks by Number of Deaths: Globally, 1990 and 2013 . . . . . . . . . 29 2.7 Trends in Ischemic Heart Disease Death Rates from Ambient PM2.5 Pollution, 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.8 Deaths per 100,000 People from Ambient PM2.5 Pollution by Region, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.9 Total Deaths (a) and Disability-Adjusted Life Years (DALYs) (b) from Ambient PM2.5 Pollution by Age Group, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.10 Percentage of Total Deaths from Ambient PM2.5 Pollution by Income Group, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 1700234_Cost of Pollution.indd 4 9/2/16 9:59 AM

2.11 Ambient PM,Death Rate versus Income per Capita,2013.....................34 2.12 Total Deaths from Ambient Ozone Pollution by Region,1990 and 2013..........35 2.13 Total Deaths(a)and Deaths per 100,000 People(b)from Household Air Pollution,1990-2013.... 37 2.14 Deaths from Ischemic Heart Disease Attributable to Exposure to Household Air Pollution by Age Category for Males and Females,2013........................ 38 2.15 Deaths per 100,000 People by Age Group,1990 and 2013.......................40 2.16 Total Deaths(a)and Deaths per 100,000 People(b)from Household Air Pollution by Region,1990 and 2013...................................... 41 2.17 Total Deaths(a)and Deaths per 100,000 People(b)from Household Air Pollution by Income Group,1990 and 2013...............................42 2.18 Household PM,Death Rate versus Gross National Income(GNI) perCapita,2013.......................................................... 43 3.1 Welfare Losses Due to Air Pollution by Region,2013..........................52 3.2 Forgone Labor Output Due to Air Pollution by Region,2013...................52 3.3 Age Profile of Total Deaths and Welfare Losses Due to Air Pollution by Region, 1990and2013....… .53 3.4 Age Profile of Total Forgone Labor Output Due to Air Pollution by Region, 1990and2013.............54 3.5 Welfare Losses Due to Air Pollution by Income Group,2013..... 54 3.6 Decomposing Changes in Total Welfare Losses Due to Air Pollution,by Income Group:1990-2013...............57 3.7 Changes in Ambient PM,Death Rates and Per Capita Welfare Losses by Income Group,1990-2013.......... 3.8 Changes in Household PM,.Death Rates and Per Capita Welfare Losses by Income Group,.1990-2013....................59 3.9 Breakdown of Changes in Total Forgone Labor Output Due to Air Pollution by Income Group,1990-2013........ ….61 3.10 Age Profile of Welfare Losses from Air Pollution as Estimated Using VSL versus VSLY2013..64 3.11 Uncertainty in Welfare Loss Parameters:Low-Income Countries,2013...........68 3.12 Uncertainty in Welfare Loss Parameters:Lower-Middle-Income Countries,2013..69 3.13 Uncertainty in Welfare Loss Parameters:Upper-Middle-Income Countries,2013..69 3.14 Uncertainty in Welfare Loss Parameters:High-Income Non-OECD Countries,2013.........................70 3.15 Uncertainty in Welfare Loss Parameters:High-Income OECD Countries,2013....70 3.16 Uncertainty in Forgone Labor Output Parameters:Low-Income Countries,2013..72 3.17 Uncertainty in Forgone Labor Output Parameters:Lower-Middle-Income Countries,,2013.............................72 3.18 Uncertainty in Forgone Labor Output Parameters:Upper-Middle-Income Countries,.2013.........… ..73 3.19 Uncertainty in Forgone Labor Output Parameters:High-Income Non-OECD Countries,,2013............ …73 3.20 Uncertainty in Forgone Labor Output Parameters:High-Income OECD Countries,2013.... .74 B4.3.1 Deaths Attributable to Ambient PM,Pollution in China,by Source of Emissions,.2013............... 84 The Cost of Air Pollution:Strengthening the Economic Case for Action

The Cost of Air Pollution: Strengthening the Economic Case for Action v 2.11 Ambient PM2.5 Death Rate versus Income per Capita, 2013 . . . . . . . . . . . . . . . . . . . . . 34 2.12 Total Deaths from Ambient Ozone Pollution by Region, 1990 and 2013 . . . . . . . . . . 35 2.13 Total Deaths (a) and Deaths per 100,000 People (b) from Household Air Pollution, 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2.14 Deaths from Ischemic Heart Disease Attributable to Exposure to Household Air Pollution by Age Category for Males and Females, 2013 . . . . . . . . . . . . . . . . . . . . . . . . 38 2.15 Deaths per 100,000 People by Age Group, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . 40 2.16 Total Deaths (a) and Deaths per 100,000 People (b) from Household Air Pollution by Region, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 2.17 Total Deaths (a) and Deaths per 100,000 People (b) from Household Air Pollution by Income Group, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 2.18 Household PM2.5 Death Rate versus Gross National Income (GNI) per Capita, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 3.1 Welfare Losses Due to Air Pollution by Region, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . 52 3.2 Forgone Labor Output Due to Air Pollution by Region, 2013 . . . . . . . . . . . . . . . . . . . 52 3.3 Age Profile of Total Deaths and Welfare Losses Due to Air Pollution by Region, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 3.4 Age Profile of Total Forgone Labor Output Due to Air Pollution by Region, 1990 and 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 3.5 Welfare Losses Due to Air Pollution by Income Group, 2013 . . . . . . . . . . . . . . . . . . . . 54 3.6 Decomposing Changes in Total Welfare Losses Due to Air Pollution, by Income Group: 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 3.7 Changes in Ambient PM2.5 Death Rates and Per Capita Welfare Losses by Income Group, 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 3.8 Changes in Household PM2.5 Death Rates and Per Capita Welfare Losses by Income Group, 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 3.9 Breakdown of Changes in Total Forgone Labor Output Due to Air Pollution by Income Group, 1990–2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 3.10 Age Profile of Welfare Losses from Air Pollution as Estimated Using VSL versus VSLY, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 3.11 Uncertainty in Welfare Loss Parameters: Low-Income Countries, 2013 . . . . . . . . . . . 68 3.12 Uncertainty in Welfare Loss Parameters: Lower-Middle-Income Countries, 2013 . . 69 3.13 Uncertainty in Welfare Loss Parameters: Upper-Middle-Income Countries, 2013 . . 69 3.14 Uncertainty in Welfare Loss Parameters: High-Income Non-OECD Countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 3.15 Uncertainty in Welfare Loss Parameters: High-Income OECD Countries, 2013 . . . . 70 3.16 Uncertainty in Forgone Labor Output Parameters: Low-Income Countries, 2013 . . 72 3.17 Uncertainty in Forgone Labor Output Parameters: Lower-Middle-Income Countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 3.18 Uncertainty in Forgone Labor Output Parameters: Upper-Middle-Income Countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 3.19 Uncertainty in Forgone Labor Output Parameters: High-Income Non-OECD Countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 3.20 Uncertainty in Forgone Labor Output Parameters: High-Income OECD Countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 B4.3.1 Deaths Attributable to Ambient PM2.5 Pollution in China, by Source of Emissions, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 1700234_Cost of Pollution.indd 5 8/29/16 1:55 PM

Maps 2.1 Locations Where 2013 Annual Average PM,Concentrations(ug/m3)Meet or Exceed World Health Organization's(WHO)Air Quality Guidelines or Exceed Interim Targets.................................................... 26 2.2 Ratio of Estimated 2013:1990 Annual Average PM,Concentrations at 0.1X 0.1 Resolution.. 27 2.3 Age-Standardized Death Rates from Ambient PM,Pollution,2013.............32 2.4 Age-Standardized Death Rates from Household Air Pollution,2013 39 B4.4.1 Deaths per 100,000 Persons Attributable to Air Pollution at the Provincial Level: Mexico,2013.......… 85 A.1 Differences in Grid-Cell Estimates of(2011)Annual Average PM,s Concentrations from TM5-FASST and from Satellite-Based Estimates...........89 Tables 3.1 Working Life Expectancy for 15-and 40-Year-Olds by Region,2013.............51 3.2 Working Life Expectancy for 15-and 40-Year-Olds by Income Group,2013.......51 3.3 Total Welfare Losses from Air Pollution,by Region:1990-2013................. 3.4 Welfare Losses from Ambient PM,,by Region:1990-2013.....................55 3.5 Welfare Losses from Household Air Pollution,by Region:1990-2013............55 3.6 Total Forgone Labor Output from Air Pollution,by Region:1990-2013..........59 3.7 Forgone Labor Output from Ambient PM,s,by Region:1990-2013......... 3.8 Forgone Labor Output from Household Air Pollution,by Region:1990-2013.....60 3.9 Total Welfare Losses from Air Pollution,VSL-versus VSLY-Based Estimates, by Region:2013.............................63 3.10 Total Welfare Losses from Air Pollution,VSL-versus VSLY-Based Estimates, by Income Group:20l3..................64 3.11 Total Welfare Losses from Air Pollution in Low-and Middle-Income Countries, Base Case VSL Estimates versus Using VSL from Middle-Income Country Studies:20l3...… .65 3.12 Total Welfare Losses from Air Pollution in Base Case Estimates versus Alternate Scenario Using a Base VSL in Line with That Assumed by U.S.Regulatory Agencies,by Income Group:2013...........................................66 3.13 Total Welfare Losses from Air Pollution in Base Case Estimates versus Alternate Scenario Using a Base VSL in Line with That Assumed by U.S.Regulatory Agencies,by Income Group:2013...........................................67 B4.2.1 Comparison of Ambient PM,Concentrations from Ground-Level Monitors and Satellite Observations at the City Level...................................83 A.1 Regions Included in GBD 2013 Ambient Air Pollution PM,Mapping Database...88 A.2 Countries and Regions Included in GBD 2013 Household Air Pollution PM.s Mapping Database......................88 B.1 Mean Annual PM,,Total Deaths from Pollution,Total Welfare Losses,and Total Forgone Labor Output,by Country......... vi The Cost of Air Pollution:Strengthening the Economic Case for Action

vi The Cost of Air Pollution: Strengthening the Economic Case for Action Maps 2.1 Locations Where 2013 Annual Average PM2.5 Concentrations (μg/m3 ) Meet or Exceed World Health Organization's (WHO) Air Quality Guidelines or Exceed Interim Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.2 Ratio of Estimated 2013:1990 Annual Average PM2.5 Concentrations at 0.1° 3 0.1° Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.3 Age-Standardized Death Rates from Ambient PM2.5 Pollution, 2013 . . . . . . . . . . . . . 32 2.4 Age-Standardized Death Rates from Household Air Pollution, 2013 . . . . . . . . . . . . . 39 B4.4.1 Deaths per 100,000 Persons Attributable to Air Pollution at the Provincial Level: Mexico, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 A.1 Differences in Grid-Cell Estimates of (2011) Annual Average PM2.5 Concentrations from TM5-FASST and from Satellite-Based Estimates . . . . . . . . . . . 89 Tables 3.1 Working Life Expectancy for 15- and 40-Year-Olds by Region, 2013 . . . . . . . . . . . . . 51 3.2 Working Life Expectancy for 15- and 40-Year-Olds by Income Group, 2013 . . . . . . . 51 3.3 Total Welfare Losses from Air Pollution, by Region: 1990–2013 . . . . . . . . . . . . . . . . . 51 3.4 Welfare Losses from Ambient PM2.5 , by Region: 1990–2013 . . . . . . . . . . . . . . . . . . . . . 55 3.5 Welfare Losses from Household Air Pollution, by Region: 1990–2013 . . . . . . . . . . . . 55 3.6 Total Forgone Labor Output from Air Pollution, by Region: 1990–2013 . . . . . . . . . . 59 3.7 Forgone Labor Output from Ambient PM2.5 , by Region: 1990–2013 . . . . . . . . . . . . . . 60 3.8 Forgone Labor Output from Household Air Pollution, by Region: 1990–2013 . . . . . 60 3.9 Total Welfare Losses from Air Pollution, VSL- versus VSLY-Based Estimates, by Region: 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 3.10 Total Welfare Losses from Air Pollution, VSL- versus VSLY-Based Estimates, by Income Group: 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 3.11 Total Welfare Losses from Air Pollution in Low- and Middle-Income Countries, Base Case VSL Estimates versus Using VSL from Middle-Income Country Studies: 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 3.12 Total Welfare Losses from Air Pollution in Base Case Estimates versus Alternate Scenario Using a Base VSL in Line with That Assumed by U.S. Regulatory Agencies, by Income Group: 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 3.13 Total Welfare Losses from Air Pollution in Base Case Estimates versus Alternate Scenario Using a Base VSL in Line with That Assumed by U.S. Regulatory Agencies, by Income Group: 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 B4.2.1 Comparison of Ambient PM2.5 Concentrations from Ground-Level Monitors and Satellite Observations at the City Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 A.1 Regions Included in GBD 2013 Ambient Air Pollution PM2.5 Mapping Database . . . 88 A.2 Countries and Regions Included in GBD 2013 Household Air Pollution PM2.5 Mapping Database . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 B.1 Mean Annual PM2.5 , Total Deaths from Pollution, Total Welfare Losses, and Total Forgone Labor Output, by Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 1700234_Cost of Pollution.indd 6 8/29/16 1:55 PM

Foreword The science is clear:breathing polluted air increases the risk of debilitating and deadly diseases such as lung cancer,stroke,heart disease,and chronic bronchitis.Air pollution is now the world's fourth-leading fatal health risk,causing one in ten deaths in 2013. At the same time,air pollution from industries,construction sites,agricultural practices,vehi- cles,and the combustion of dirty energy sources continues to grow.About 87 percent of the world's population now live in countries in which ambient pollution levels exceed air quality guidelines set by the World Health Organization.In low-and middle-income countries,the danger is even more pronounced:90 percent of the population in these countries was exposed to dangerous levels of ambient air pollution in 2013. To reduce the number of people gradually being contaminated by the air they breathe,pollu- tion control would need to be at the top of the agenda for most governments.However,in most countries,such expenditure competes with other budgetary priorities and policy objec- tives.Demonstrating the economic burden of pollution can help tilt the balance of decisions in favor of investments in clean air. This study is the result of a collaboration between the World Bank and the Institute for Health Metrics and Evaluation(IHME)at the University of Washington,Seattle.It represents an effort to merge cutting edge science and rigorous economic analysis for the good of public health. The study has found that premature deaths due to air pollution in 2013 cost the global econ- omy about $225 billion in lost labor income,or about $5.11 trillion in welfare losses world- wide.That is about the size of the gross domestic product of India,Canada,and Mexico combined-and a sobering wake-up call. However impressive and abstract these large numbers are,it is our hope that the cost of pre- mature deaths for countries'economies will leave the pages of this study and inform public debate and policy decisions at the national level.In country after country,the cost of pollution in human lives and on the quality of life is too high.We must work together to reduce it. Laura Tuck Vice President,Sustainable Development,World Bank Ta Keith Hansen, Vice President,Human Development,World Bank 以火？法t Christopher Murray Director,Institute for Health Metrics and Evaluation,University of Washington The Cost of Air Pollution:Strengthening the Economic Case for Action vi

The Cost of Air Pollution: Strengthening the Economic Case for Action vii Foreword The science is clear: breathing polluted air increases the risk of debilitating and deadly diseases such as lung cancer, stroke, heart disease, and chronic bronchitis. Air pollution is now the world’s fourth-leading fatal health risk, causing one in ten deaths in 2013. At the same time, air pollution from industries, construction sites, agricultural practices, vehi￾cles, and the combustion of dirty energy sources continues to grow. About 87 percent of the world’s population now live in countries in which ambient pollution levels exceed air quality guidelines set by the World Health Organization. In low- and middle-income countries, the danger is even more pronounced: 90 percent of the population in these countries was exposed to dangerous levels of ambient air pollution in 2013. To reduce the number of people gradually being contaminated by the air they breathe, pollu￾tion control would need to be at the top of the agenda for most governments. However, in most countries, such expenditure competes with other budgetary priorities and policy objec￾tives. Demonstrating the economic burden of pollution can help tilt the balance of decisions in favor of investments in clean air. This study is the result of a collaboration between the World Bank and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. It represents an effort to merge cutting edge science and rigorous economic analysis for the good of public health. The study has found that premature deaths due to air pollution in 2013 cost the global econ￾omy about $225 billion in lost labor income, or about $5.11 trillion in welfare losses world￾wide. That is about the size of the gross domestic product of India, Canada, and Mexico combinedand a sobering wake-up call. However impressive and abstract these large numbers are, it is our hope that the cost of pre￾mature deaths for countries’ economies will leave the pages of this study and inform public debate and policy decisions at the national level. In country after country, the cost of pollution in human lives and on the quality of life is too high. We must work together to reduce it. Laura Tuck Vice President, Sustainable Development, World Bank, Keith Hansen, Vice President, Human Development, World Bank Christopher Murray Director, Institute for Health Metrics and Evaluation, University of Washington 1700234_Cost of Pollution.indd 7 9/1/16 4:24 PM

Acknowledgments This is a joint report of the World Bank and the Institute for Health Metrics and Evaluation (IHME)at the University of Washington,Seattle.The core team,led by Urvashi Narain (World Bank),comprised Christopher Sall(World Bank),Michael Brauer(The University of British Columbia),Aaron Cohen(Health Effects Institute),Kara Estep(IHME),Mohammad Forou- zanfar (IHME),Zhiyun Jiang(World Bank),and Kevin O'Rourke (IHME).Contributions were also received from Lelia Croitoru(World Bank),Andreas Kopp(World Bank),and Maria Sarraf(World Bank). The team thanks Paula Caballero (World Bank),Valerie Hickey (World Bank)and Carter Brandon(World Bank)for their overall support and guidance.The report benefited greatly from discussions with Maureen Cropper(University of Maryland),Alan Krupnick(Resources for the Future (RFF)and peer reviewer),Jostein Nygard(World Bank)and Yewande Awe (World Bank).Constructive comments were received from the following peer reviewers for the study:Anjali Acharya(World Bank),Alan Krupnick,Montserrat Meiro-Lorenzo(World Bank),and Michael Toman (World Bank).The team would also like to acknowledge numer- ous other colleagues for their suggestions,including Sameer Akbar(World Bank),Michael Brody (World Bank),Gary Kleiman (World Bank),Kseniya Lvovsky (World Bank),Anna Malinovskaya(RFF),Klas Sanders(World Bank),and Elena Strukova(World Bank) The authors would also like to thank Flore Martinant de Preneuf(World Bank),Adam Broadfoot (World Bank),and Diana Manevskaya(World Bank)for production management.The manu- script was edited by Sabra Ledent.Any remaining errors or omissions are the authors'own. Last but not least,the team gratefully acknowledges the support of the University of British Colombia and the Health Effects institute,and the financial support provided for the report by the Pollution Management and Environmental Health Program of the World Bank. viⅷi The Cost of Air Pollution:Strengthening the Economic Case for Action

viii The Cost of Air Pollution: Strengthening the Economic Case for Action Acknowledgments This is a joint report of the World Bank and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. The core team, led by Urvashi Narain (World Bank), comprised Christopher Sall (World Bank), Michael Brauer (The University of British Columbia), Aaron Cohen (Health Effects Institute), Kara Estep (IHME), Mohammad Forou￾zanfar (IHME), Zhiyun Jiang (World Bank), and Kevin O’Rourke (IHME). Contributions were also received from Lelia Croitoru (World Bank), Andreas Kopp (World Bank), and Maria Sarraf (World Bank). The team thanks Paula Caballero (World Bank), Valerie Hickey (World Bank) and Carter Brandon (World Bank) for their overall support and guidance. The report benefited greatly from discussions with Maureen Cropper (University of Maryland), Alan Krupnick (Resources for the Future (RFF) and peer reviewer), Jostein Nygard (World Bank) and Yewande Awe (World Bank). Constructive comments were received from the following peer reviewers for the study: Anjali Acharya (World Bank), Alan Krupnick, Montserrat Meiro-Lorenzo (World Bank), and Michael Toman (World Bank). The team would also like to acknowledge numer￾ous other colleagues for their suggestions, including Sameer Akbar (World Bank), Michael Brody (World Bank), Gary Kleiman (World Bank), Kseniya Lvovsky (World Bank), Anna Malinovskaya (RFF), Klas Sanders (World Bank), and Elena Strukova (World Bank). The authors would also like to thank Flore Martinant de Preneuf (World Bank), Adam Broadfoot (World Bank), and Diana Manevskaya (World Bank) for production management. The manu￾script was edited by Sabra Ledent. Any remaining errors or omissions are the authors’ own. Last but not least, the team gratefully acknowledges the support of the University of British Colombia and the Health Effects institute, and the financial support provided for the report by the Pollution Management and Environmental Health Program of the World Bank. 1700234_Cost of Pollution.indd 8 9/7/16 9:20 AM

Abbreviations AAP ambient air pollution ALRI acute lower respiratory infection ANS adjusted net savings AOD aerosol optical depth APM ambient PM2s ASDR age-standardized death rate COPD chronic obstructive pulmonary disease DALYs disability-adjusted life years EPA Environmental Protection Agency(U.S.) GBD Global Burden of disease GDP gross domestic product GPR Gaussian process regression HAP household air pollution IARC International Agency for Research on Cancer IER integrated exposure-response IHD ischemic heart disease IHME Institute for Health Metrics and Evaluation ILO International Labour Organization LFPR labor force participation rate LRI lower respiratory infection OECD Organisation for Economic Co-operation and Development OMB Office of Management and Budget(U.S.) PAF population attributable fraction PAH polycyclic aromatic hydrocarbon PM particulate matter PMEH Pollution Management and Environmental Health(World Bank) PPP purchasing power parity RR relative risk RFF Resources for the Future SAR Special Administrative Region TM5-FASST FAst Scenario Screening Tool VI uncertainty interval VSL value of statistical life VSLY value per statistical life year WHO World Health Organization WTP willingness to pay YLDs years lived with disability YLLs years of life lost All dollar amounts are U.S.dollars unless otherwise indicated. The Cost of Air Pollution:Strengthening the Economic Case for Action ix

The Cost of Air Pollution: Strengthening the Economic Case for Action ix Abbreviations AAP ambient air pollution ALRI acute lower respiratory infection ANS adjusted net savings AOD aerosol optical depth APM ambient PM2.5 ASDR age-standardized death rate COPD chronic obstructive pulmonary disease DALYs disability-adjusted life years EPA Environmental Protection Agency (U.S.) GBD Global Burden of Disease GDP gross domestic product GPR Gaussian process regression HAP household air pollution IARC International Agency for Research on Cancer IER integrated exposure-response IHD ischemic heart disease IHME Institute for Health Metrics and Evaluation ILO International Labour Organization LFPR labor force participation rate LRI lower respiratory infection OECD Organisation for Economic Co-operation and Development OMB Office of Management and Budget (U.S.) PAF population attributable fraction PAH polycyclic aromatic hydrocarbon PM particulate matter PMEH Pollution Management and Environmental Health (World Bank) PPP purchasing power parity RR relative risk RFF Resources for the Future SAR Special Administrative Region TM5-FASST FAst Scenario Screening Tool UI uncertainty interval VSL value of statistical life VSLY value per statistical life year WHO World Health Organization WTP willingness to pay YLDs years lived with disability YLLs years of life lost All dollar amounts are U.S. dollars unless otherwise indicated. 1700234_Cost of Pollution.indd 9 8/29/16 1:55 PM

Executive Summary Introduction Air pollution is recognized today as a major health risk.Exposure to air pollution,both ambi- ent and household,increases a person's risk of contracting a disease such as lung cancer,stroke, heart disease,and chronic bronchitis.According to the latest available estimates,in 2013, 5.5 million premature deaths worldwide,or 1 in every 10 total deaths,were attributable to air pollution.Air pollution has posed a significant health risk since the early 1990s,the earliest period for which global estimates of exposure and health effects are available.In 1990,as in 2013,air pollution was the fourth leading fatal health risk worldwide,resulting in 4.8 million premature deaths. Air pollution is especially severe in some of the world's fastest-growing urban regions,where greater economic activity is contributing to higher levels of pollution and to greater exposure. But air pollution is also a problem outside cities.Billions of people around the world continue to depend on burning solid fuels such as wood,charcoal,coal,and dung in their homes for cooking and heating.Consequently,the health risk posed by air pollution is the greatest in developing countries.In 2013 about 93 percent of deaths and nonfatal illnesses attributed to air pollution worldwide occurred in these countries,where 90 percent of the population was exposed to dan- gerous levels of air pollution.Children under age 5 in lower-income countries are more than 60 times as likely to die from exposure to air pollution as children in high-income countries. Air pollution is not just a health risk but also a drag on development.By causing illness and premature death,air pollution reduces the quality of life.By causing a loss of productive labor, it also reduces incomes in these countries.Air pollution can have a lasting effect on productiv- ity in other ways as well-for example,by stunting plant growth and reducing the productivity of agriculture,and by making cities less attractive to talented workers,thereby reducing cities' competitiveness. Motivation for This Study This study sets out to calculate the economic costs of premature mortality from air pollution to strengthen the business case for governments to act ambitiously in reducing pollution.The costs of pollution to society are many,but a full accounting is beyond the scope of this report. Instead,it will focus on what many studies have shown to be the largest and most damaging cost of pollution:premature mortality. The number of deaths each year attributable to air pollution makes a compelling case for reducing pollution.Valuing the costs of premature deaths associated with pollution helps to further highlight the severity of the problem.Governments face a wide array of competing development challenges,and monetizing the costs of pollution can help them decide how to allocate scarce resources to better the lives of their citizens.Monetary values can also help The Cost of Air Pollution:Strengthening the Economic Case for Action

x The Cost of Air Pollution: Strengthening the Economic Case for Action Executive Summary Introduction Air pollution is recognized today as a major health risk. Exposure to air pollution, both ambi￾ent and household, increases a person’s risk of contracting a disease such as lung cancer, stroke, heart disease, and chronic bronchitis. According to the latest available estimates, in 2013, 5.5 million premature deaths worldwide, or 1 in every 10 total deaths, were attributable to air pollution. Air pollution has posed a significant health risk since the early 1990s, the earliest period for which global estimates of exposure and health effects are available. In 1990, as in 2013, air pollution was the fourth leading fatal health risk worldwide, resulting in 4.8 million premature deaths. Air pollution is especially severe in some of the world’s fastest-growing urban regions, where greater economic activity is contributing to higher levels of pollution and to greater exposure. But air pollution is also a problem outside cities. Billions of people around the world continue to depend on burning solid fuels such as wood, charcoal, coal, and dung in their homes for cooking and heating. Consequently, the health risk posed by air pollution is the greatest in developing countries. In 2013 about 93 percent of deaths and nonfatal illnesses attributed to air pollution worldwide occurred in these countries, where 90 percent of the population was exposed to dan￾gerous levels of air pollution. Children under age 5 in lower-income countries are more than 60 times as likely to die from exposure to air pollution as children in high-income countries. Air pollution is not just a health risk but also a drag on development. By causing illness and premature death, air pollution reduces the quality of life. By causing a loss of productive labor, it also reduces incomes in these countries. Air pollution can have a lasting effect on productiv￾ity in other ways as well—for example, by stunting plant growth and reducing the productivity of agriculture, and by making cities less attractive to talented workers, thereby reducing cities’ competitiveness. Motivation for This Study This study sets out to calculate the economic costs of premature mortality from air pollution to strengthen the business case for governments to act ambitiously in reducing pollution. The costs of pollution to society are many, but a full accounting is beyond the scope of this report. Instead, it will focus on what many studies have shown to be the largest and most damaging cost of pollution: premature mortality. The number of deaths each year attributable to air pollution makes a compelling case for reducing pollution. Valuing the costs of premature deaths associated with pollution helps to further highlight the severity of the problem. Governments face a wide array of competing development challenges, and monetizing the costs of pollution can help them decide how to allocate scarce resources to better the lives of their citizens. Monetary values can also help 1700234_Cost of Pollution.indd 10 9/7/16 10:45 AM

them measure the benefits of policies to tackle pollution and,when compared with costs of implementation,to devise cost-effective air quality management plans. This study also presents the results of 2013 Global Burden of Disease Study(GBD 2013 Col- laborators 2015).The GBD measures illnesses and premature deaths from a multitude of causes and risk factors around the world,including air pollution.It offers the most extensive estimates of exposure and trends in air pollution levels and their associated burden of disease. The GBD effort dates to the early 1990s when the World Bank commissioned the original GBD study for feature in its World Development Report 1993:Investing in Health.Since 2010, the Institute for Health Metrics and Evaluation(IHME)at the University of Washington,Seat- tle,has steered the GBD study,with the latest set of estimates for 2013. Methodology The disease burden attributable to air pollution is estimated by first measuring the severity of air pollution and the extent to which people are exposed to it (Brauer et al.2016; Cohen et al.n.d.).The GBD evaluates exposure to outdoor (ambient)air pollution as well as indoor air pollution in households cooking with solid fuels.The GBD approach to estimating ambient air pollution aims to make the greatest use of information from different sources in the most reasonable way possible,combining data from ground monitoring with satellite observations and chemical transport models.Exposure to household air pollution is estimated from a combination of data on the proportion of households using solid fuels,estimates of indoor pollution concentrations associated with fuel use,and the ratio of personal to area exposure. The GBD then evaluates how personal exposure raises people's relative risk of contracting ill- nesses such as ischemic heart disease,stroke,chronic obstructive pulmonary disease,lung cancer,acute lower respiratory infections,and pneumonia.Elevated risk among the exposed population translates into a higher portion of deaths from these conditions each year,which are attributed to air pollution. Using the GBD estimates of premature mortality attributable to pollution,this study values the economic costs in dollar terms following two different approaches:(1)a welfare-based approach that monetizes the increased fatality risk from air pollution according to individuals' willingness to pay(WTP);and(2)an income-based approach that equates the financial cost of premature mortality with the present value of forgone lifetime earnings.Each of these approaches is given equal weight in this report,although they are tailored to different purposes. The welfare-based approach is intended to measure the economic costs of fatal health risks to the individuals that make up a society.By increasing people's risk of contracting a deadly ill- ness,air pollution represents a threat to the many things they value,including consumption, leisure,good health,and simply being alive.This value is reflected in the WTP,which captures the trade-offs that individuals are willing to make to reduce their chances of dying.The value of statistical life(VSL)represents the sum of many individuals'WTP for marginal changes in The Cost of Air Pollution:Strengthening the Economic Case for Action xi

The Cost of Air Pollution: Strengthening the Economic Case for Action xi them measure the benefits of policies to tackle pollution and, when compared with costs of implementation, to devise cost-effective air quality management plans. This study also presents the results of 2013 Global Burden of Disease Study (GBD 2013 Col￾laborators 2015). The GBD measures illnesses and premature deaths from a multitude of causes and risk factors around the world, including air pollution. It offers the most extensive estimates of exposure and trends in air pollution levels and their associated burden of disease. The GBD effort dates to the early 1990s when the World Bank commissioned the original GBD study for feature in its World Development Report 1993: Investing in Health. Since 2010, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seat￾tle, has steered the GBD study, with the latest set of estimates for 2013. Methodology The disease burden attributable to air pollution is estimated by first measuring the severity of air pollution and the extent to which people are exposed to it (Brauer et al. 2016; Cohen et al. n.d.). The GBD evaluates exposure to outdoor (ambient) air pollution as well as indoor air pollution in households cooking with solid fuels. The GBD approach to estimating ambient air pollution aims to make the greatest use of information from different sources in the most reasonable way possible, combining data from ground monitoring with satellite observations and chemical transport models. Exposure to household air pollution is estimated from a combination of data on the proportion of households using solid fuels, estimates of indoor pollution concentrations associated with fuel use, and the ratio of personal to area exposure. The GBD then evaluates how personal exposure raises people’s relative risk of contracting ill￾nesses such as ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, acute lower respiratory infections, and pneumonia. Elevated risk among the exposed population translates into a higher portion of deaths from these conditions each year, which are attributed to air pollution. Using the GBD estimates of premature mortality attributable to pollution, this study values the economic costs in dollar terms following two different approaches: (1) a welfare-based approach that monetizes the increased fatality risk from air pollution according to individuals’ willingness to pay (WTP); and (2) an income-based approach that equates the financial cost of premature mortality with the present value of forgone lifetime earnings. Each of these approaches is given equal weight in this report, although they are tailored to different purposes. The welfare-based approach is intended to measure the economic costs of fatal health risks to the individuals that make up a society. By increasing people’s risk of contracting a deadly ill￾ness, air pollution represents a threat to the many things they value, including consumption, leisure, good health, and simply being alive. This value is reflected in the WTP, which captures the trade-offs that individuals are willing to make to reduce their chances of dying. The value of statistical life (VSL) represents the sum of many individuals’ WTP for marginal changes in 1700234_Cost of Pollution.indd 11 8/31/16 3:36 PM