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Health Shocks under Hospital Capacity Constraint: Evidence from Air Pollution in Sao Paulo, Brazil

Author

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  • Guidetti, Bruna

    (University of Michigan)

  • Pereda, Paula

    (University of Sao Paulo)

  • Severnini, Edson R.

    (Carnegie Mellon University)

Abstract

When a health shock hits a location, the healthcare infrastructure needs to be adjusted to meet the increased demand. This may be a challenge in developing countries because of limited hospital capacity. In this study, we examine the consequences of health shocks induced by air pollution in a megacity in the developing world: Sao Paulo, Brazil. Using daily data from 2015-2017, and an instrumental variable approach based on wind speed, we provide evidence that exposure to particulate matter (PM10) causes an increase in pediatric hospitalizations for respiratory diseases, which in turn leads to a decrease in hospital admissions for elective care – phimosis surgery and epilepsy-related procedures such as video-EEG (electroencephalograph) monitoring. Importantly, emergency procedures such as appendectomy and bone fracture repair are not affected. While strained Sao Paulo hospitals seem to absorb the increased demand induced by poor air quality, our results imply that the common practice of using health outcomes unrelated to pollution as "placebo tests" in studies on the effects of air pollution might be inadequate in settings with limited healthcare infrastructure. This is often the case in developing countries, where severe pollution is also ubiquitous, but also happens in deprived areas in the developed world.

Suggested Citation

  • Guidetti, Bruna & Pereda, Paula & Severnini, Edson R., 2020. "Health Shocks under Hospital Capacity Constraint: Evidence from Air Pollution in Sao Paulo, Brazil," IZA Discussion Papers 13211, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp13211
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    1. Tatyana Deryugina & Garth Heutel & Nolan H. Miller & David Molitor & Julian Reif, 2019. "The Mortality and Medical Costs of Air Pollution: Evidence from Changes in Wind Direction," American Economic Review, American Economic Association, vol. 109(12), pages 4178-4219, December.
    2. Eva Arceo & Rema Hanna & Paulina Oliva, 2016. "Does the Effect of Pollution on Infant Mortality Differ Between Developing and Developed Countries? Evidence from Mexico City," Economic Journal, Royal Economic Society, vol. 126(591), pages 257-280, March.
    3. Giuntella, Osea & Nicodemo, Catia & Vargas-Silva, Carlos, 2018. "The effects of immigration on NHS waiting times," Journal of Health Economics, Elsevier, vol. 58(C), pages 123-143.
    4. Alberto Salvo & Yi Wang, 2017. "Ethanol-Blended Gasoline Policy and Ozone Pollution in Sao Paulo," Journal of the Association of Environmental and Resource Economists, University of Chicago Press, vol. 4(3), pages 731-794.
    5. Clay, Karen & Lewis, Joshua & Severnini, Edson, 2018. "Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic," The Journal of Economic History, Cambridge University Press, vol. 78(4), pages 1179-1209, December.
    6. Niven, Robert K., 2005. "Ethanol in gasoline: environmental impacts and sustainability review article," Renewable and Sustainable Energy Reviews, Elsevier, vol. 9(6), pages 535-555, December.
    7. Kritee Gujral & Anirban Basu, 2019. "Impact of Rural and Urban Hospital Closures on Inpatient Mortality," NBER Working Papers 26182, National Bureau of Economic Research, Inc.
    8. Jonathan Proctor & Solomon Hsiang & Jennifer Burney & Marshall Burke & Wolfram Schlenker, 2018. "Estimating global agricultural effects of geoengineering using volcanic eruptions," Nature, Nature, vol. 560(7719), pages 480-483, August.
    9. Kenneth Y. Chay & Michael Greenstone, 2003. "The Impact of Air Pollution on Infant Mortality: Evidence from Geographic Variation in Pollution Shocks Induced by a Recession," The Quarterly Journal of Economics, Oxford University Press, vol. 118(3), pages 1121-1167.
    10. Salvo, A & Geiger, F, 2014. "Reduction in Local Ozone Levels in Urban São Paulo Due to a Shift from Ethanol to Gasoline Use," MPRA Paper 57868, University Library of Munich, Germany, revised 18 Feb 2014.
    11. Matthew Neidell, 2009. "Information, Avoidance Behavior, and Health: The Effect of Ozone on Asthma Hospitalizations," Journal of Human Resources, University of Wisconsin Press, vol. 44(2).
    12. Janet Currie & Joshua Graff Zivin & Jamie Mullins & Matthew Neidell, 2014. "What Do We Know About Short- and Long-Term Effects of Early-Life Exposure to Pollution?," Annual Review of Resource Economics, Annual Reviews, vol. 6(1), pages 217-247, October.
    13. Resul Cesur & Erdal Tekin & Aydogan Ulker, 2017. "Air Pollution and Infant Mortality: Evidence from the Expansion of Natural Gas Infrastructure," Economic Journal, Royal Economic Society, vol. 127(600), pages 330-362, March.
    14. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, Oxford University Press, vol. 115(2), pages 617-650.
    15. Slusky, David J.G. & Zeckhauser, Richard J., 2021. "Sunlight and Protection Against Influenza," Economics & Human Biology, Elsevier, vol. 40(C).
    16. Adam Isen & Maya Rossin-Slater & W. Reed Walker, 2017. "Every Breath You Take—Every Dollar You’ll Make: The Long-Term Consequences of the Clean Air Act of 1970," Journal of Political Economy, University of Chicago Press, vol. 125(3), pages 848-902.
    17. Mireille Jacobson & Heather Royer, 2011. "Aftershocks: The Impact of Clinic Violence on Abortion Services," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 189-223, January.
    18. Seema Jayachandran, 2009. "Air Quality and Early-Life Mortality: Evidence from Indonesia’s Wildfires," Journal of Human Resources, University of Wisconsin Press, vol. 44(4).
    19. Janet Currie & Reed Walker, 2011. "Traffic Congestion and Infant Health: Evidence from E-ZPass," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 65-90, January.
    20. Clay, Karen & Lewis, Joshua & Severnini, Edson R., 2016. "Canary in a Coal Mine: Infant Mortality, Property Values, and Tradeoffs Associated with Mid-20th Century Air Pollution," IZA Discussion Papers 9884, Institute of Labor Economics (IZA).
    21. Arden Pope III, C., 1989. "Respiratory disease associated with community air pollution and a steel mill, Utah Valley," American Journal of Public Health, American Public Health Association, vol. 79(5), pages 623-628.
    22. W. Walker Hanlon & Yuan Tian, 2015. "Killer Cities: Past and Present," American Economic Review, American Economic Association, vol. 105(5), pages 570-575, May.
    23. Edson Severnini, 2017. "Impacts of nuclear plant shutdown on coal-fired power generation and infant health in the Tennessee Valley in the 1980s," Nature Energy, Nature, vol. 2(4), pages 1-9, April.
    24. Evan Herrnstadt & Erich Muehlegger, 2015. "Air Pollution and Criminal Activity: Evidence from Chicago Microdata," NBER Working Papers 21787, National Bureau of Economic Research, Inc.
    25. Michael Greenstone & B. Kelsey Jack, 2015. "Envirodevonomics: A Research Agenda for an Emerging Field," Journal of Economic Literature, American Economic Association, vol. 53(1), pages 5-42, March.
    26. Enrico Moretti & Matthew Neidell, 2011. "Pollution, Health, and Avoidance Behavior: Evidence from the Ports of Los Angeles," Journal of Human Resources, University of Wisconsin Press, vol. 46(1), pages 154-175.
    27. Buchmueller, Thomas C. & Jacobson, Mireille & Wold, Cheryl, 2006. "How far to the hospital?: The effect of hospital closures on access to care," Journal of Health Economics, Elsevier, vol. 25(4), pages 740-761, July.
    28. Yao Lu & David J. G. Slusky, 2016. "The Impact of Women's Health Clinic Closures on Preventive Care," American Economic Journal: Applied Economics, American Economic Association, vol. 8(3), pages 100-124, July.
    29. Olivier Deschênes & Michael Greenstone & Joseph S. Shapiro, 2017. "Defensive Investments and the Demand for Air Quality: Evidence from the NOx Budget Program," American Economic Review, American Economic Association, vol. 107(10), pages 2958-2989, October.
    30. Clay, Karen & Lewis, Joshua & Severnini, Edson, 2019. "What explains cross-city variation in mortality during the 1918 influenza pandemic? Evidence from 438 U.S. cities," Economics & Human Biology, Elsevier, vol. 35(C), pages 42-50.
    31. Janet Currie & Matthew Neidell, 2005. "Air Pollution and Infant Health: What Can We Learn from California's Recent Experience?," The Quarterly Journal of Economics, Oxford University Press, vol. 120(3), pages 1003-1030.
    32. Neidell, Matthew J., 2004. "Air pollution, health, and socio-economic status: the effect of outdoor air quality on childhood asthma," Journal of Health Economics, Elsevier, vol. 23(6), pages 1209-1236, November.
    33. Panle Jia Barwick & Shanjun Li & Deyu Rao & Nahim Bin Zahur, 2018. "The Morbidity Cost of Air Pollution: Evidence from Consumer Spending in China," Working Papers id:12825, eSocialSciences.
    34. Janet Currie & Lucas Davis & Michael Greenstone & Reed Walker, 2015. "Environmental Health Risks and Housing Values: Evidence from 1,600 Toxic Plant Openings and Closings," American Economic Review, American Economic Association, vol. 105(2), pages 678-709, February.
    35. Resul Cesur & Erdal Tekin & Aydogan Ulker, 2017. "Air Pollution and Infant Mortality: Evidence from the Expansion of Natural Gas Infrastructure," Economic Journal, Royal Economic Society, vol. 127(600), pages 330-362, March.
    36. Jiaxiu He & Nelson Gouveia & Alberto Salvo, 2019. "External Effects of Diesel Trucks Circulating Inside the São Paulo Megacity," Journal of the European Economic Association, European Economic Association, vol. 17(3), pages 947-989.
    37. Marcus, Michelle, 2017. "On the road to recovery: Gasoline content regulations and child health," Journal of Health Economics, Elsevier, vol. 54(C), pages 98-123.
    38. Wolfram Schlenker & W. Reed Walker, 2016. "Airports, Air Pollution, and Contemporaneous Health," Review of Economic Studies, Oxford University Press, vol. 83(2), pages 768-809.
    39. Marcos A. Rangel & Tom S. Vogl, 2019. "Agricultural Fires and Health at Birth," The Review of Economics and Statistics, MIT Press, vol. 101(4), pages 616-630, October.
    40. Panle Jia Barwick & Shanjun Li & Deyu Rao & Nahim Bin Zahur, 2018. "The Healthcare Cost of Air Pollution: Evidence from the World’s Largest Payment Network," NBER Working Papers 24688, National Bureau of Economic Research, Inc.
    41. Fletcher, Jason M. & Green, Jeremy C. & Neidell, Matthew J., 2010. "Long term effects of childhood asthma on adult health," Journal of Health Economics, Elsevier, vol. 29(3), pages 377-387, May.
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    More about this item

    Keywords

    air pollution; health outcomes; hospitalization for respiratory diseases and other causes; healthcare infrastructure; hospital capacity constraint;
    All these keywords.

    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • Q53 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Environmental Economics - - - Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling
    • Q56 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Environmental Economics - - - Environment and Development; Environment and Trade; Sustainability; Environmental Accounts and Accounting; Environmental Equity; Population Growth
    • O13 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Agriculture; Natural Resources; Environment; Other Primary Products

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