I would be remiss if I didn't talk about economics as it relates to climate and health adaptations. So there is a substantial literature on economic evaluations for general adaptation. But what we didn't do, and I didn't incorporate this into your adaptation action plan, because I didn't want you to become overwhelmed with the logistics of thinking about economics. That is not to say that it is not important. I am sure, as I went through some examples and as you searched some of those websites and tools, you came across case studies that were really impressive, but they were so massive in budget and scope that you almost couldn't identify with that. And so, I didn't want you to have to think about what that might be and how that might look in your adaptation action plan. I wanted to get to the real, the main pieces of what that plan would need to be, and then make sure we come back to talking about how you can incorporate economic evaluations, and you can do that. It's important to note that right now in the field of climate and health, since it's at those early stages, there's not a lot of evidence that we can go to on some of the economic benefits or costs or pieces that are related to certain adaptation actions. And it's in part and parcel because things aren't documented. There might not be resources to do that type of work. But the reality is is that there's not a lot of evidence that's there. And so, that means that it makes it very difficult for us to convince leaders to put a resources into doing climate health adaptations. If we can't say that it might save you X number of dollars, it might be a little bit harder for us to say, give me 100,000 or a couple hundred thousand or thousands or millions of dollars to do an adaptation. Similarly, that means that a lot of the work that would incorporate economic evaluation would require that it's done from scratch. So you might see those as positives and negatives, but that's the reality and that's kind of where we're at. Although, like many other components of the content that we have in this course, we can borrow from a lot of already established literature and science and knowledge around how to do economic evaluation. And so, economic evaluation is not something that's new to public health. And in fact, there's some really wonderful examples. And the examples that I'm going to be going through pull from the CDC asthma evaluation program's documents on economic evaluations. And so from these resources, they have identified four general types of economic analyses that you can do, and the first, and I've translated them on the right. So the first is called a cost description and a cost analysis. And so this is very much just saying, how much? How much is this going to cost? And so this is probably the most common of the economic evaluations that you would have, because that's a thing that you can estimate fairly well. You just need to be able to think about who, what your materials are, who is doing the activity, how much time they're going to be doing the activity. So it's in some ways thinking about what the overhead would be. The next stage of economic analysis would be this cost-effective analysis. And really that's saying how much better is one type of, in this case, let's call it adaptation action for asthma. They might be calling it an intervention. So how much better is one action for reducing the disease burden than another action? And that might be a qualitative analysis. But what that requires is that you have some idea of the baseline. And we're not necessarily there yet with some of our examples or some of our scenarios on the climate or the health effects of climate change. The next level of detail for an economic evaluation would be a benefit-cost analysis, which is also referred to as a cost-benefit analysis. And these are also related to the idea of a return on investment. So you're asking the question, if I were to be comparing these two adaptation actions, how much better is one per dollar spent than another one? So the previous two types of economic evaluations don't really help you choose one over another. And maybe these next two will. So this would tell us that for every 50 cents I spend on a certain adaptation action, I save $1. So that might be an important piece of information that you would want to discuss with your stakeholders, or you would want to discuss during your planning stage, to determine whether or not this is something that you're actually going to do. And then this last economic evaluation type, the cost utility analysis is kind of the holy grail. That's what we try to get to, but very few examples in public health, in general, are able to get here because of the amount of time that's required to adequately answer those questions. And so, what this does is this tells you how much healthier a population or your population of concern would be if you implement one adaptation action or intervention versus another. So that is something that incorporates a commonly used term in epidemiology, the quality adjusted life years. So this would require having health data, information about people's outcomes, and the cost of their care over a very long period of time. And since we don't have a lot of that type of information just yet as it relates to climate and health adaptations, we're not there yet, but we can move in that direction. We certainly can move in that direction, and you can think about that. So it can be kind of hard to figure, if this is new to you and you're not sure what type. You want to incorporate economic evaluation into your activities, because it's required of you. Because you don't feel comfortable going to your stakeholders without actually presenting this ahead of time or presenting this with at least some consideration of it ahead of time before you implement something. But you don't know yet what type of evaluation you would do. So again, the asthma program at CDC has some really helpful documents, and this is a really nice one. So for somebody like me who's new to the idea of economic evaluation, and I don't really know what I might focus on, I can use this flow chart essentially to help me figure out what I would want to do. So in the top or on the left, we have areas that they're calling partial economic evaluation. So we'd assess either the costs or the outcomes of a program, but not both of them. And on the right is the full economic evaluation, which is assessing both the costs and the outcomes of the program. And so you could ask yourself the question, am I focusing only on program costs, then I would do a cost description or analysis. Am I focusing only on the program outcomes, then I would do some type of effectiveness or efficacy evaluation. And those mean two different things in epidemiology. So if you start thinking about that, you might want to look up those terms. So what in reality for our field, we're probably going to be over on the left for a while. And that is totally okay, because at a certain point in all of the universe of interventions and adaptations, somebody started on the left and that's where we're at. So for our examples that we saw with the rain garden, I'm probably, since I mentioned that I'm interested in the cost, I probably would do some type of cost analysis. So what is it going to take to put into play the rain gardens, and what would I expect that I would need to have on hand in my coffers to be able to afford to do that? But for the wildfire psychological first aid training, I might actually be able to use some information that was collected previously. So I actually might be able to do some type of effectiveness evaluation, because if I can get let's say health data, ED visit data on people who lived in areas where wildfires occur. And I want to look at how the change in those certain health outcomes or ED visits were before and after the training. So it might be looking at across two different seasons. I might be able to actually get at one of those economic evaluations.
