Assessing the health benefits of air pollution reduction for children

Benefit-cost analyses of environmental regulations are increasingly mandated in the United States. Evaluations of criteria air pollutants have focused on benefits and costs associated with adverse health effects. Children are significantly affected by the health benefits of improved air quality, yet key environmental health policy analyses have not previously focused specifically on children's effects. In this article we present a "meta-analysis" approach to child-specific health impacts derived from the U.S. Clean Air Act (CAA). On the basis of data from existing studies, reductions in criteria air pollutants predicted to occur by 2010 because of CAA regulations are estimated to produce the following impacts: 200 fewer expected cases of postneonatal mortality; 10,000 fewer asthma hospitalizations in children 1-16 years old, with estimated benefits ranging from $20 million to $46 million (1990 U.S.$); 40,000 fewer emergency department visits in children 1-16 years old, with estimated benefits ranging from $1.3 million to $5.8 million; 20 million school absences avoided by children 6-11 years old, with estimated benefits of $0.7-1.8 billion; and 10,000 fewer infants of low birth weight, with estimated benefits of $230 million. Inclusion of limited child-specific data on hospitalizations, emergency department visits, school absences, and low birth weight could be expected to add $1-2 billion (1990 US$) to the $8 billion in health benefits currently estimated to result from decreased morbidity, and $600 million to the $100 billion estimated to result from decreased mortality. These estimates highlight the need for increased consideration of children's health effects. Key needs for environmental health policy analyses include improved information for children's health effects, additional life-stage-specific information, and improved health economics information specific for children.