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The impact of air pollution on urban residents’ health expenditure: spatial evidence from Yangtze River Delta, China

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Han Sun at China University of Geosciences
Han Sun
Zhihui Leng at China University of Geosciences
Zhihui Leng
Zhao Hengsong at Xiamen University
Zhao Hengsong
Shan Ni
Shan Ni
Shan Ni
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Currently, preventing and controlling air pollution and inhibiting the excessively rapid growth of medical expenditures to reduce the living burden of residents have become a focus of general concern of society as a whole. It is of great significance to conduct an in-depth study of the relationship between air pollution and public health expenditure and clarify to what extent air pollution affects health expenditure. Thus, this paper adopted spatial econometric methods to measure the impact of air pollution on residents’ health expenditure via panel data from 16 core cities in the Yangtze River Delta in China from 2005 to 2017. The results indicate that (1) at present, the air pollution in the Yangtze River Delta core urban agglomeration is still relatively prominent and has obvious spatial aggregation phenomena, and the particulate matter 2.5 (PM2.5) concentration shows the characteristic of decreasing gradually from northwest to southeast; (2) air pollution is the main factor that promotes the increase in residents’ health expenditure; (3) the spatial spillover effect of air pollution is obvious, accounting for half of the total effect; and (4) the impact of government public services on residents’ health expenditure varies. Finally, this paper proposes corresponding policy implications based on the findings.
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The impact of air pollution on urban residents’health expenditure:
spatial evidence from Yangtze River Delta, China
Han Sun
1,2
&Zhihui Leng
1
&Hengsong Zhao
1
&Shan Ni
1
&Chao Huang
1
Received: 22 May 2020 /Accepted: 1 September 2020
#Springer Nature B.V. 2020
Abstract
Currently, preventing and controlling air pollution and inhibiting the excessively rapid growth of medical expenditures to reduce
the living burden of residents have become a focus of general concern of society as a whole. It is of great significance to conduct
an in-depth study of the relationship between air pollution and public health expenditure and clarify to what extent air pollution
affects health expenditure. Thus, this paper adopted spatial econometric methods to measure the impact of air pollution on
residents’health expenditure via panel data from 16 core cities in the Yangtze River Delta in China from 2005 to 2017. The
results indicate that (1) at present, the air pollution in the Yangtze River Delta core urban agglomeration is still relatively
prominent and has obvious spatial aggregation phenomena, and the particulate matter 2.5 (PM
2.5
) concentration shows the
characteristic of decreasing gradually from northwest to southeast; (2) air pollution is the main factor that promotes the increase
in residents’health expenditure; (3) the spatial spillover effect of air pollution is obvious, accounting for half of the total effect;
and (4) the impact of government public services on residents’health expenditure varies. Finally, this paper proposes corre-
sponding policy implications based on the findings.
Keywords Air pollution .Health expenditure .Spatial panel model .Yangtze River Delta
Introduction
Improving the quality of the air environment and the health
level of the people to alleviate the burden of medical expenses
on residents is a proposition put forward by major national
strategies in China, such as ecological civilization construc-
tion and healthy China. Air pollution has become the greatest
adverse environmental factor causing premature human death
(Zhou et al. 2019). The main pollutants considered by envi-
ronmental protection departments in China to evaluate and
rank the air quality of cities are sulfur dioxide (SO
2
), nitrogen
dioxide (NO
2
), inhalable particulate matter (PM
10
), particulate
matter (PM
2.5
), carbon monoxide (CO), and ozone (O
3
).
Atmospheric particulate matter (PM), especially with a diam-
eter less than 2.5 μm(PM
2.5
), is considered one of the priority
pollutants in the atmosphere. PM
2.5
is rich in a large number
of toxic and harmful substances and easily enters the blood
through the lungs; thus, frequent exposure to PM
2.5
can cause
damage to human health.
According to the most recent “Global Burden of Disease
Report”released by The Lancet magazine in 2019, China and
India are the countries with the highest disease burden of air
pollution in the world. In recent years, China’s per capita
health care expenditure has increased significantly not only
in absolute terms but also in proportion to disposable income.
According to the National Bureau of Statistics, from 1990 to
2019, China’s urban residents’per capita health care expen-
diture increased from 25.67 CNY to 2283 CNY, accounting
for 1.85 to 5.39% of per capita disposable income. A large
number of studies have shown that air pollution has adverse
effects on multiple systems of the human body and directly or
indirectly causes damage to residents' health, leading to an
increase or aggravation of disease symptoms (Garcia et al.
2015;Toetal.2015), an increase in the number of outpatient
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11869-020-00939-y) contains supplementary
material, which is available to authorized users.
*Zhihui Leng
zhihui_leng@163.com
Han Sun
sunhan2004@126.com
1
School of Economics and Management, China University of
Geosciences (Wuhan), Wuhan 430074, China
2
Resource and Environmental Economics Research Center, China
University of Geosciences (Wuhan), Wuhan 430074, China
https://doi.org/10.1007/s11869-020-00939-y
/ Published online: 12 September 2020
Air Quality, Atmosphere & Health (2021) 14:343–350
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Moreover, based on the perspective of collaborative governance, more government health expenditure should be used for health policies dealing with the corresponding health problems caused by environmental pollution. As for the impact of air pollution on health expenditure, scholars have found that the spillover effect is as much as half of the total effect, suggesting that greater attention should be paid to the spatial correlation between adjacent regions [2,29]. As Chen has indicated, if industrial sulfur dioxide emissions in a city increase by 10,000 tons, the mortality rates from lung cancer and respiratory diseases will grow by 0.217 and 1.543 per ten thousand persons, respectively, in neighbouring areas . ...
... To improve the cost-effectiveness ratio of government health expenditure, different measures need to be taken for different characteristics (according to the city), rather than a large number of expenses that are repeatedly incurred to make up for the adverse health outcomes caused by air pollution. First of all, for cities whose government health expenditure is only restricted by air pollution, the existing literature has proven that the air pollution in this area is a serious concern and that there is spatial spillover effect [29], which may be related to the industrial belt located throughout the region. Although industrial agglomeration areas provide employment opportunities for residents and promote the development of the local economy, it is evident that it also increases the burdens related to health expenditure for local governments. ...
The superposition effects of air pollution on government health expenditure in China— spatial evidence from GeoDetector
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... Sun et al. demonstrated that air pollution is also the main factor that influences residents' expenditures on health management [37]. Theoretically, air pollution affects health mainly in two ways: first, the reduction in sleep time caused by ambient air pollution is not conducive to health; second, people spend more time on sedentary activities to avoid exposure to air pollution, which will indirectly lead to an increase in personal medical expenditure [38]. Additionally, from the empirical results, air pollution will lead to a significant increase in medical expenses, hospitalization expenses and extrabudgetary expenses [38]. ...
... Theoretically, air pollution affects health mainly in two ways: first, the reduction in sleep time caused by ambient air pollution is not conducive to health; second, people spend more time on sedentary activities to avoid exposure to air pollution, which will indirectly lead to an increase in personal medical expenditure [38]. Additionally, from the empirical results, air pollution will lead to a significant increase in medical expenses, hospitalization expenses and extrabudgetary expenses [38]. For example, Liu et al. estimated age-and cause-specific premature deaths and quantified related health damage with the measurement of the age-adjusted value of statistical life (VSL). ...
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... It is evident to find that the coefficient values of lnPM 2.5 and W*lnPM 2.5 are both negative, and the coefficient value of W*lnPM 2.5 is greater than that of lnPM 2.5 , which is consistent with the above conclusions. It is worth noting that previous literature studies have also reached similar conclusions, namely, that residents in surrounding areas have significantly higher lung cancer mortality and respiratory disease mortality than local residents, and that residents in surrounding areas also spend significantly more on medical and health expenses than local residents (Chen et al., 2017;Feng et al., 2019;Sun et al., 2021). This finding suggests that the results of previous literature studies are consistent with the findings of this paper. ...
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Regional haze pollution is a serious atmospheric environmental problem in China, it seriously affects residents’ health. This paper uses ArcGIS software to analyse the spatial and temporal distribution maps of haze pollution and residents’ health in China, and empirically examines the spatial non-linear effects of haze pollution on residents’ health by using spatial econometric models and threshold models. The results are shown as follows: First, the level of haze pollution in China is gradually decreasing, and the level of residents’ health is gradually improving. It is worth noting that the areas with high level of haze pollution are mainly located on the southeast side of the Hu line. Coincidentally, the areas with high level of residents’ health are also mainly located in the southeast side of the Hu line. Second, haze pollution has significant spatial spillover effect on residents’ health, with inter-regional spillover effect being much greater than intra-regional spillover effect. Third, economic development increases the health risk from haze pollution, while environmental regulation does not reduce the health risk from haze pollution. The effect of population agglomeration on the health risk from haze pollution shows a trend of improvement followed by deterioration, while the effect of industrial agglomeration on the health risk from haze pollution shows a trend of deterioration followed by improvement. Therefore, this paper provides valuable insights for the ongoing and comprehensive efforts to fight for a blue sky and promote the implementation of the national strategies of “Beautiful China” and “Healthy China”.
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... On the one hand, some scholars studied the relationship between air pollution and population migration. They found that when there is a localized deterioration in air quality, residents will pay more attention to air pollution (Chen et al. 2020b;Ji et al. 2022), and then they have a stronger willingness to migrate (Zhao et al. 2021b), so as to reduce economic losses from air pollution (Chen and Chen 2021;Sun et al. 2021), and avoid health damage (Gao et al. 2022;Schraufnagel et al. 2019). As indicated in some literature, with the increasing frequency of Internet searches on migration (Pinchas-Mizrachi et al. 2020), people eventually shift from a willingness to migrate to an active flight (Guo et al. 2022) and often to more environmentally friendly regions (Chen et al. 2022). ...
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The energy sector is one of the most important pollutants in the atmosphere and causes significant emissions of greenhouse gases. In Russia, coal is the main contributor to the fossil fuel consumption of thermal power plants and boilers, thus affecting atmospheric air pollution by releasing particulate matter and nitrogen oxides, which are strongly associated with a negative impact on human health. This problem is especially acute for the resource regions of Yenisei, Siberia, a 2.5+ mln sq km macro-region in the very heart of Russia. In this paper, we analyze the impact of the structure of electricity and heat generation on emissions of pollutants and climate-active gases in Yenisei, Siberia, and give an overview of their social, ecological, and economic effects. More than 75% of electricity in Yenisei, Siberia, is produced by hydroelectric power plants that do not pollute the atmosphere. The rest of the electricity is generated in the cogeneration mode by thermal power plants, which are cores of the heat supply designs of cities. The share of individual coal-powered heat sources is still high. A detailed analysis of existing equipment and technologies at existing thermal power plants is needed to select options for their modernization to reduce emissions while keeping coal in use. Our calculations for the biggest cities of Krasnoyarsk Krai show that investments in the transition to heating with pellets will require RUB 184.7 million for Nazarovo and RUB 313.9 million for Kansk. At the same time, switching to electric heating is more than twice as expensive: RUB 498.6 million for Nazarovo and RUB 847.5 million for Kansk. The additional costs will range from RUB 21 to RUB 45.4 thousand per household per year for the pellet variant and from RUB 56.8 to RUB 122.5 thousand per year for electric heating, which could triple the annual heating costs. Thus, these options are unlikely to be implemented without direct state support. We argue that creating an attractive living environment in Yenisei, Siberia, must begin with intensive public investment in mitigating the environmental externalities caused by coal emissions.
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... In addition, we consider air quality as another mediating factor. Sun, et al. [87] reported that air pollution is the main factor that promotes the increase in residents' health expenditures. Das and Ivaldi [88] similarly pointed to environmental pollution, including air pollution, as a cause of health expenditures in many developed countries. ...
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Article
  • Feb 2020
Pollution-intensive industrial agglomeration has become a trend of industrial distribution in China. Does pollution-intensive industrial agglomeration significantly increase residents’ health expenditure? By clarifying the environmental effect, economic effect and public service effect of pollution-intensive industrial agglomeration on residents’ health expenditure, this paper combined with provincial data to prove the environmental effect, economic effect and public service effect. The results show that: (1) Every 1 % increase in pollution-intensive industries will reduce rural residents’ health expenditure by 1.1844 % and increase the health expenditure of urban residents by 1.206 %. (2) The pollution-intensive industrial agglomeration increases the health expenditure by expanding the scale of pollution, reduces the health expenditure by promoting the technological innovation. (3) Pollution-intensive industrial agglomeration increases the health expenditure by enhancing residents’ income and reduces the health expenditure by enhancing employment rate. (4) Pollution-intensive industrial agglomeration increases the health expenditure by improving medical services and reduces the residents’ health expenditure by promoting the construction of environmental infrastructure. (5) There are a single threshold and a double threshold effects of pollution-intensive industrial agglomeration on health expenditure of rural residents and urban residents, respectively. When the location entropy is higher than 0.4669, the pollution-intensive industrial agglomeration can reduce residents’ health expenditure. When the location entropy is less than 0.9861 or greater than 1.027, the pollution-intensive industrial agglomeration increases urban residents’ health expenditure. The conclusion of this paper is of great significance in adjusting the distribution of pollution-intensive industries and increasing the health expenditure of residents.
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Energy consumption, air quality, and air pollution spatial spillover effects: evidence from the Yangtze River Delta of China
Article
  • Aug 2019
Based on analysis of the theoretical impact of energy consumption on air quality, taking 20 heavily polluted cities in the Yangtze River Delta of China as the object, we construct a Spatial Dubin Model, and estimate the effect of energy consumption on air quality and the spatial spillover effects of air pollution. We come to the following conclusions: First, the regional air quality has significant spatial dependence and spatial heterogeneity. Second, under three kinds of spatial associated mode, energy consumption has a negative impact on air quality, and the air pollution arising from energy consumption has a negative intra-regional spillover effect. The effect is strongest under the spatial distance weight matrix, followed by the economic distance, and the adjacent spatial weight matrix, which are −0.7926, −0.4547, and −0.4539, respectively. Third, in addition, under the adjacent space and economic distance space matrix, energy consumption has a significant negative effect on air quality, and the inter-regional spillover effects are −0.1513 and −2.5736, respectively. Meanwhile, considering spatial distance and economic development, the inter-regional spillover effect is much larger than is the intra-regional spillover effect. In general, the total spillover effect is at −0.6053 and −3.0284.
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