A systematic review of economic analyses of active transport interventions that include physical activity benefits

Physical inactivity is one of the leading causes for the growing prevalence of non-communicable diseases worldwide and there is a need for more evidence on the effectiveness and cost-effectiveness of interventions that aim to increase physical activity at the population level. This study aimed to update a systematic review published in 2008 by searching peer-reviewed and unpublished literature of economic evaluations of transport interventions that incorporate the health related effects of physical activity. Our analysis of methods for the inclusion of physical activity related health effects into transport appraisal over time demonstrates that methodological progress has been made. Thirty-six studies were included, reflecting an increasing recognition of the importance of incorporating these health effects into transport appraisal. However, significant methodological challenges in the incorporation of wider health benefits into transport appraisal still exist. The inclusion of physical activity related health effects is currently limited by paucity of evidence on morbidity effects and of more rigorous evidence on the effectiveness of interventions. Significant scope exists for better quality and more transparent reporting. A more consistent approach to the inclusion of benefits and disbenefits would reinforce the synergies between the health, environmental, transport and other sectors. From a transport sector perspective the inclusion of physical activity related health benefits positively impacts cost effectiveness, with the potential to contribute to a more efficient allocation of scarce resources based on a more comprehensive range of merits. From a public health perspective the inclusion of physical activity related health benefits may result in the funding of more interventions that promote active transport, with the potential to improve population levels of physical activity and to reduce prevalence of physical activity related diseases.

Diminishing and negative welfare returns of economic growth : an index of sustainable economic welfare (ISEW) for Thailand

Thailand has achieved remarkable levels of economic growth over the last three decades. This sustained economic growth has played a major role in reducing absolute poverty levels from nearly one third of the population in 1975 to presently less than 10%, thus increasing the welfare of many Thais. This performance ranks Thailand as one of the world's most successful economies during this period. However, an increasing number of studies have begun to find that at a certain point achieving economic growth stops improving welfare and actually begins to diminish it due to the hidden and traditionally unreported costs of associated with this growth. With one exception, these new studies have focussed on high-income countries. This study will estimate an index of sustainable economic welfare (ISEW) for a developing country, Thailand, over a 25-year period, 1975–1999. This paper concludes that even low–middle income countries are beginning to approach the point in which economic growth produces both diminishing and, at times, negative welfare returns as the costs of achieving economic growth begin to outweigh the benefits. These results are important for policy makers and highlight the importance of implementing alternative welfare enhancing interventions that must be considered in place of simply achieving economic growth. The emphasis of this paper is not on the methodology of estimating the ISEW for Thailand, but rather on the policy implications for developing countries of diminishing and negative welfare returns brought about through the achievement of economic growth.

Widening development prescriptions: policy implications of an index of sustainable economic welfare (SEW) for Thailand

Over the past three decades, Thailand has recorded consistently high levels of economic growth, making it one of the most successful economies in the world during this period. However, economic growth has associated costs that can also reduce social welfare. This study will estimate an Index of Sustainable Economic Welfare (ISEW) for Thailand over a twenty-five year period, 1975–1999. This paper concludes that even low-middle income countries are beginning to approach the point at which economic growth produces both diminishing and, at times, negative welfare returns as the costs of achieving growth begin to outweigh the associated benefits. These results are important for policy makers and highlight the importance of widening policy prescriptions in order to increase social welfare. However, the policy guidelines that are suggested must be critically accepted before being adopted due to possible weaknesses of the ISEW approach.

A comparative study on economic factors of construction industries in Australia and China

The construction sector produces the facilities needed for a large majority of the production of goods and services, in which a sizeable proportion of Gross Domestic Product is generated. Recent trends in the globalisation of construction markets indicate that many countries consider construction industry competitiveness as crucial, and are working to increase construction productivity, in particular where the construction industries play an important role in their economic development. This paper first points out the research importance in international construction. Based on economic analyses of construction industries, a study is then carried out to focus on the economic sizes and benefits of the Chinese construction industry and to compare them with the Australian construction industry. Results derived from such an international construction comparison will assist in the Australian construction communities understanding the construction markets and industries in China and will benefit in international construction participation and cooperation.

Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications

Objectives: Stroke is the world’s second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money.

Methods: Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews.

Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered.

Results: Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion.

Conclusions: Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke
is warranted

Broadband : benefits and problems

The striving of nations to build a broadband-based information society is paralleled by individuals striving to improve their personal lot and by organisations seeking a competitive advantage—all supposedly to be achieved via broadband. However, the social and economic impact of broadband may be surrounded in controversies. This paper argues that these controversies need to be identified and addressed if public policy decisions about broadband are to be made with confidence. While literature on broadband abounds, it is rarely directed at the impact of broadband on social and personal issues. Rather, that literature typically focuses on broadband's economic aspects, but with poor benefit identification and measure difficulties, the findings tend to be steeped in rhetoric. Largely, what we are left with is literature on the impact of narrowband Internet. While research on the Internet abounds, its findings are typically indeterminate and often disputed. The paper works with literature on broadband and extrapolates from the literature on narrowband with its disputed impacts to identify possible impacts of broadband. In so doing it identifies a core set of controversies regarding broadband at the national, individual and organisational levels. It then calls for diversity of analysis of possible broadband outcomes. Only with such analysis will it be possible to place the likely broadband future in the context of broader national, individual and organisational aspirations.

Stem cell research and ethics : a socio-economic and marketing perspective

This paper addresses the ethical and moral issues surrounding stem cell research (SCR) and development within the socio-economic and macro marketing environments. A two dimensional conceptual framework is developed towards broadening the understanding of the complexities of these issues in an international context. The conceptual model captures the two dimensions of narrow moral/ethical to broader imperatives and the cost-benefits realm of SCR. Four quadrants emerge within these two dimensions which are likely to help identify the dominant views and the people associating themselves with these views in terms of their demographics and psychographic characteristics. These findings have important socio-economic and marketing implications which are highlighted in the paper.

People, places and public health : evaluating the benefits of civic environmentalism in an urban local government context

Recent political, economic and social trends pose threats to the sustainability both of ecosystems and of human health. Australia’s environmental management record is poor, and while by international standards Australians enjoy good health, this is variable (AIHW, 2000). Within developed nations, heart disease, depression, alcohol dependence and stroke are major health issues (Mathers et al. 2002). In Australia, mental disorder is the number one contributor to the disease burden (Vos & Mathers 2000). Recent research has highlighted the role of social capital as a key determinant of health (Kawachi et al., 1997). Despite this, Putnam (1995) observes that social connectedness and civic engagement are in decline. People have less time for leisure and for volunteering, as many juggle paid work and caring for children. Anecdotal evidence suggests that engagement in civic environmentalism has human health benefits, relating to a combination of exposure to natural environments and increased social capital (Maller, Brown, Townsend & St. Leger, 2002). This link is supported by Furnass (1996) who defines well-being as including: satisfactory human relationships, meaningful occupation, opportunities for contact with nature, creative expression, and making a positive contribution to human society. Research conducted by Deakin University confirms the efficacy of linking people and places through civic environmentalism for addressing both ecosystem sustainability and human health and wellbeing. The research has included a pilot study to explore the human health benefits of membership of a local parkland ‘Friends’ group, and a more detailed follow-up study. The aims of the pilot study included:- To identify the range of motivations for joining the Friends group;- To document members’ perceptions of the benefits gained from membership of the group;- To assess the potential for Friends groups to be used as an ‘upstream’ health promotion measure.Face-to-face interviews were conducted with eleven members of a ‘Friends’ group in the eastern suburbs of Melbourne. Data was analysed thematically and key findings included:- Motivations: environmental; social; and pragmatic.- General benefits: community belonging; personal satisfaction; learning opportunities; physical activity; and better environment.- Health benefits: physical health; mental health; and social support. There was unanimous support for the use of ‘Friends’ groups as a tool for health promotion.The follow-up study, in the western suburbs of Melbourne, expanded on the pilot study by measuring the group’s social capital and by collecting self-report data on levels of health service usage. Data was collected through face-to-face interviews and a questionnaire. The findings were similar to the pilot study in relation to the motivations, benefits and the health promotion potential of such groups. However, health service usage data highlighted an apparent anomaly: while respondents perceived significant health benefits, some were nevertheless utilising health services at a relatively high level. This poses some questions requiring further exploration: Is this due to the poorer baseline health of the high health service usage members compared with their fellow members? Does involvement in the group offer health benefits that enable people who would otherwise be too unhealthy to participate in community groups to continue such involvement?If this is the case, then we may do well to look to locally-based mechanisms for promoting ecological sustainability as a tool also for promoting human health. Instead of prescribing a pill, connecting people and places through engagement with a local friends group may address our health problems at the same time as addressing local environmental problems.

Economic Evaluation of a Primary Care Trial to Reduce Weight Gain in Overweight/Obese Children: The LEAP Trial

Background:- A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory.

Methods:- Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002-2003 that targeted overweight/ mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children.

Results:- The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 {P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved.

Conclusions:- This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

Economic analysis of a community-based falls prevention program

Objectives: To undertake a cost–benefit analysis of ‘Stay on Your Feet’, a community-based falls prevention program targeting older people at all levels of risk in New South Wales, Australia. Hospital separations were monitored in the intervention region, a control region and for the state of New South Wales as a whole. Changing admission patterns over the intervention period were used to assess the impact of the program.

Methods: Cost–benefit analysis compared the costs of the program with two estimates of savings from avoided hospital admissions. The first compared the cost of hospital admissions in the intervention region to a control region of similar demographics, while the second compared hospital utilization in the intervention region with the state of New South Wales as a whole using falls-related hospital diagnosis related group (DRG) codes.

Results: The total direct costs of the program were estimated at A$781 829. Both methods identified clear overall net benefits ranging from A$5.4 million for avoided hospitalizations alone to A$16.9 million for all avoided direct and indirect costs. The confidence intervals around these estimates were small. The average overall benefit to cost ratio for the intervention as a whole was 20.6:1.

Conclusions: These findings suggest that well-designed community-based interventions targeting falls prevention among older people are highly cost effective and a wise investment for all levels of government. The models used are conservative and are likely to underestimate the real benefit of the intervention, which may have lasted for some time beyond the life of the program.

Measuring the economic impact of falls prevention interventions

The objective of this paper is to assess the appropriateness of available health economic models and concepts in the development of a best practice model to assess community based multifactorial falls prevention programs. To this end, a critical review and synthesis of contemporary published and unpublished  methodological approaches to economic evaluation of health initiatives in general and falls prevention initiatives in particular, has been carried out. The review  indicates that costs, time and utility all need to be taken into consideration when economically evaluating a falls prevention program.

A recommended approach that takes into account a full consideration of relevant costs and benefits associated with falls prevention programs is outlined. This approach can help demonstrate the true relative efficacy of preventing falls over the treatment of their consequences.

Integrating sociological concepts into the study of accounting : yielding the benefits of team teaching

In response to recent criticisms of business and accounting education, a team of educators introduced a new course in social and critical perspectives on accounting. The course sought to integrate sociological concepts into the study of accounting, with key themes of social construction and social power forming a core of the course. The express intention was to raise student awareness of the nature and functions of accounting in contemporary society. The core teaching strategy involved team teaching, which was used to enhance learning and develop higher order generic skills. Feedback from two diverse cohorts of students vindicated the approach undertaken and reinforced the importance of linking teaching and research in accounting programs. Change in accounting education can be directed towards regaining and rebuilding social relevance for a discipline too often associated with a narrow economic imperative rather than the broader public interest.

The end of economic growth? A contracting threshold hypothesis

This paper argues that GDP growth in both developed and developing countries has associated costs that can outweigh the benefits and thus reduce sustainable well-being. This conclusion is based upon the findings of empirical applications of the Genuine Progress Indicator (GPI) to a range of countries in the Asia-Pacific region. The studies conducted on seven Asia-Pacific countries indicate that, in the case of five of the seven nations, more recent GDP growth has reduced the sustainable well-being experienced by the average citizen residing within them. Moreover, the threshold point at which the costs of GDP growth outweigh the benefits appears to be contracting (i.e., occurring at a much lower per capita level of GDP). This paper therefore introduces a new contracting threshold hypothesis: as the economies of the Asia-Pacific region and the world collectively expand in a globalised economic environment, there is a contraction over time in the threshold level of per capita GDP. As a consequence, the threshold point confronting growth late-comers (i.e., developing countries) occurs at a much lower level of sustainable welfare than what wealthy nations currently enjoy. The consequences of this for developing countries are clearly significant and require a new approach to economic development.

Understanding the economic dynamics behind growth-inequality relationships

In this paper, a dynamic general equilibrium (DGE) model of growth–inequality relationships, with missing credit markets, knowledge spillover and self-employed agents, is calibrated to New Zealand data. The model explains how two distinct policy shocks involving redistribution and immigration imply, subsequently, two completely opposite outcomes. Agents’ inability to borrow aggravates a negative macroeconomic effect of heterogeneity on growth. Redistribution mitigates that effect but creates microeconomic disincentives on saving and work-effort. Consequently, immigration shocks that perturb variance of efficiency induce a negative growth–inequality relationship, while redistribution shocks, in New Zealand’s case, produce larger fluctuations in incentives than in macro benefits, implying a positive growth–inequality relationship.