Marcus R. Keogh-Brown

The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment

Objectives To estimate the potential economic impact of pandemic influenza, associated behavioural responses, school closures, and vaccination on the United Kingdom. Design A computable general equilibrium model of the UK economy was specified for various combinations of mortality and morbidity from pandemic influenza, vaccine efficacy, school closures, and prophylactic absenteeism using published data. Setting The 2004 UK economy (the most up to date available with suitable economic data). Main outcome measures The economic impact of various scenarios with different pandemic severity, vaccination, school closure, and prophylactic absenteeism specified in terms of gross domestic product, output from different economic sectors, and equivalent variation. Results The costs related to illness alone ranged between 0.5% and 1.0% of gross domestic product (£8.4bn to £16.8bn) for low fatality scenarios, 3.3% and 4.3% (£55.5bn to £72.3bn) for high fatality scenarios, and larger still for an extreme pandemic. School closure increases the economic impact, particularly for mild pandemics. If widespread behavioural change takes place and there is large scale prophylactic absence from work, the economic impact would be notably increased with few health benefits. Vaccination with a pre-pandemic vaccine could save 0.13% to 2.3% of gross domestic product (£2.2bn to £38.6bn); a single dose of a matched vaccine could save 0.3% to 4.3% (£5.0bn to £72.3bn); and two doses of a matched vaccine could limit the overall economic impact to about 1% of gross domestic product for all disease scenarios. Conclusion Balancing school closure against “business as usual” and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself. Prophylactic absence from work in response to fear of infection can add considerably to the economic impact.

Health, agricultural, and economic effects of adoption of healthy diet recommendations

Transition to diets that are high in saturated fat and sugar has caused a global public health concern, as the pattern of food consumption is a major modifiable risk factor for chronic non-communicable diseases. Although agri-food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities, policy, and analysis, with neither side considering the complex inter-relation between agri-trade, patterns of food consumption, health, and development. We show the importance of connection of these perspectives through estimation of the eff ect of adopting a healthy diet on population health, agricultural production, trade, the economy, and livelihoods,with a computable general equilibrium approach. On the basis of case-studies from the UK and Brazil, we suggest that benefits of a healthy diet policy will vary substantially between different populations, not only because of population dietary intake but also because of agricultural production, trade, and other economic factors.

The economic impact of SARS: How does the reality match the predictions?

Abstract Objectives To perform a retrospective analysis of the macro-economic impact of the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. Methods As several years have now passed, it is possible to interrogate national statistics that have become available since the outbreak to provide a more accurate estimate of the actual macro-economic impact of SARS. National statistics were examined for anomalies that corresponded to the timing of the SARS outbreak and, where possible, the size of any gain or loss found estimated. Results Estimates and models produced at the time of the outbreak suggested that SARS could have a catastrophic effect on the global economy. Our analysis suggests that the scale of the SARS impact on affected economies was far smaller than suggested by contemporary media reports and model estimates. Conclusions This exercise holds important lessons for estimating the economic impact of future outbreaks – such as pandemic influenza – and measures to control or prevent them. We suggest that further work is needed to develop a more comprehensive macro-economic model able to more accurately estimate the relative cost and effect of a global response to outbreaks of international concern. The implications of our findings are discussed in the light of a prospective influenza pandemic.

Estimating the economic impact of pandemic influenza: An application of the computable general equilibrium model to the UK

Abstract There is concern regarding the impact that a global infectious disease pandemic might have, especially the economic impact in the current financial climate. However, preparedness planning concentrates more upon population health and maintaining a functioning health sector than on the wider economic impact. We developed a single country Computable General Equilibrium model to estimate the economic impact of pandemic influenza (PI) and associated policies. While the context for this development was the United Kingdom, there are lessons to be drawn for application of this methodology, as well as indicative results, to other contexts. Disease scenarios were constructed from an epidemiological model which estimated case fatality rates (mild, moderate and severe) as 0.06%, 0.18% and 0.35%. A clinical attack rate of 35% was also used to produce influenza scenarios, together with preparedness policies, including antivirals and school closure, and the possible prophylactic absence of workers. UK cost estimates (in Sterling) are presented, together with relative percentage impacts applicable to similar large economies. Percentage/cost estimates suggest PI would reduce GDP by 0.3% (£3.5bn), 0.4% (£5bn) and 0.6% (£7.4bn) respectively for the three disease scenarios. However, the impact of PI itself is smaller than disease mitigation policies: combining school closure with prophylactic absenteeism yields percentage/cost effects of 1.1% (£14.7bn), 1.3% (£16.3bn) and 1.4% (£18.5bn) respectively for the three scenarios. Sensitivity analysis shows little variability with changes in disease parameters but notable changes with variations in school closure and prophylactic absenteeism. The most severe sensitivity scenario results in a 2.9% (£37.4bn), 3.2% (£41.4bn) and 3.7% (£47.5bn) loss to GDP respectively for the three scenarios.

The Impact of Alzheimer's Disease on the Chinese Economy

Background Recent increases in life expectancy may greatly expand future Alzheimers Disease (AD) burdens. Chinas demographic profile, aging workforce and predicted increasing burden of AD-related care make its economy vulnerable to AD impacts. Previous economic estimates of AD predominantly focus on health system burdens and omit wider whole-economy effects, potentially underestimating the full economic benefit of effective treatment. Methods AD-related prevalence, morbidity and mortality for 2011–2050 were simulated and were, together with associated caregiver time and costs, imposed on a dynamic Computable General Equilibrium model of the Chinese economy. Both economic and non-economic outcomes were analyzed. Findings Simulated Chinese AD prevalence quadrupled during 2011–50 from 6–28 million. The cumulative discounted value of eliminating AD equates to Chinas 2012 GDP (US

Macroeconomic impact of pandemic influenza and associated policies in Thailand, South Africa and Uganda

8 trillion), and the annual predicted real value approaches US AD cost-of-illness (COI) estimates, exceeding US

Macroeconomic impact of a mild influenza pandemic and associated policies in Thailand, South Africa and Uganda: a computable general equilibrium analysis

1 trillion by 2050 (2011-prices). Lost labor contributes 62% of macroeconomic impacts. Only 10% derives from informal care, challenging previous COI-estimates of 56%. Interpretation Health and macroeconomic models predict an unfolding 2011–2050 Chinese AD epidemic with serious macroeconomic consequences. Significant investment in research and development (medical and non-medical) is warranted and international researchers and national authorities should therefore target development of effective AD treatment and prevention strategies.

A whole-economy model of the health co-benefits of strategies to reduce greenhouse gas emissions in the UK

Research has shown the value of conducting a macroeconomic analysis of the impact of influenza pandemics. However, previous modelling applications focus on high‐income countries, and there is a lack of evidence concerning the potential impact of an influenza pandemic on lower‐ and middle‐income countries.

The welfare implications of public healthcare financing: a macro–micro simulation analysis of Uganda

Previous research has demonstrated the value of macroeconomic analysis of the impact of influenza pandemics. However, previous modelling applications focus on high‐income countries and there is a lack of evidence concerning the potential impact of an influenza pandemic on lower‐ and middle‐income countries.

Capturing human behaviour: is it possible to bridge the gap between data and models?

Abstract Background The UK Government has set specific targets for greenhouse gas emissions to lower the risk of dangerous climate change. Previous research has shown that important health co-benefits could result from strategies targeting the domains of transport, built environment, and agriculture. This study assesses the full general equilibrium economy-wide macroeconomic effects of health co-benefits from three similar UK strategies to meet locally specific 2030 greenhouse gas emission targets. Methods Economy-wide effects of health co-benefits were modelled with a dynamic extension of the widely used International Food Policy Research Institute standard computable general equilibrium model for 2011–30. Four forms of economic agents are modelled: firms (who combine resource inputs to maximise profits), consumers (who consume and save to maximise their welfare), government, and foreign agents. The method consists of simulation of three greenhouse gas policy scenarios and a counterfactual do-nothing scenario. Basic health co-benefits (years lived with disability [YLD] and years of life lost [YLL]) were measured for a range of illnesses, on the basis of the comparative risk assessment approach. Combined with incidence numbers and prevalence trends, these basic YLD (morbidity) and YLL (mortality) co-benefits were used to calculate dynamic sequences of demographic and labour market effects on population and productive labour supply, and public budget implications for averted health-care costs and increased social security transfers (including benefit payments for working-age individuals and pension payments for old-age individuals). These economic shocks were subsequently imposed on the computable general equilibrium model and used to measure the combined macroeconomic effect of health co-benefits. The method for measuring averted health-care costs was published in The Lancet in 2012. Three scenarios were modelled: active travel (transport sector; health co-benefits of an assumed transformation of urban transport behaviour to reduce motorised transportation and increase walking [2·5-times] and cycling [8·0-times] in urban England and Wales); healthy diet (food and agriculture sector; health co-benefits of an assumed UK-wide 30% reduction in consumption of dietary saturated fat); and household energy (household energy sector; health co-benefits of an assumed UK-wide improvement in home insulation and ventilation, including reduced household energy use, improved indoor temperature, and associated changes in indoor pollutants). Findings For all scenarios, the macroeconomic effects of health co-benefits are positive. Overall, substantial savings on health-care costs represent the main contributing factor. Increased labour supplies also contribute positively, whereas increased social security transfers (due to larger working-age and old-age population segments) detract. The largest potential cumulative gross domestic product gains from health co-benefits are associated with the active travel scenario (around £19 billion), in which increased physical activity averts large-scale and long-term chronic disease burdens and health-system costs. The healthy diet scenario also leads to important potential gains (around £5 billion), whereas the full potential health co-benefits from the household energy scenario will not be realised until beyond 2030. Three economic sensitivity analyses were undertaken to test the sensitivity of results to variations in assumptions concerning: the substitutability of labour for other factors of production; the effectiveness of the interventions; and changes in the discount rate (the present value of the economic effects). Overall, the core results can be considered relatively robust to changes in these three factors. Interpretation Strategies to reduce greenhouse gas emissions and improve health are likely to result in substantial and increasing positive contributions to the economy. This effect might offset some economic costs and thereby allow such strategies to be seen more favourably, especially in times of economic austerity. Funding Department of Health Policy Research Programme.