I am interested in
what conservation can learn from other scientific disciplines as it strives to
tackle two of its biggest problems, a lack of knowledge and a lack of
funds. Adopting an evidence based
approach to selecting conservation interventions, as has been achieved in
medicine, has been proposed as a solution to tackling the lack of knowledge
conservation suffers from. With regards
to funds, conservation must generate more funds and use these funds as
effectively as possible. Here again, the
NHS offers a lesson. The NHS’ budget has
long been insufficient to offer all treatments to all patients, as a solution a
scientific method has been put in place to ensure that the resources are used optimally,
to save the most lives and increase life quality as much as possible. I will explore what conservation can learn
from how the NHS achieves this.
Finite resources force tradeoffs.
Tradeoffs entail valuation, either implicit or explicit.
When utilising finite
resources, a decision to pursue one course of action/invest in one intervention
means deciding not to invest in another option.
Thus, the intervention which is chosen is valued (implicitly or
explicitly) more highly than the option(s) not chosen. When different interventions require
different amounts of resources then the situation becomes more complicated but
the principle remains, the option which is chosen is judged to be of greater
value than the options not chosen.
The NHS’ finite budget forces it to make tradeoffs between different
treatments.
The NHS has a finite
budget which it can spend on treatments.
This budget is not large enough to provide every proven treatment. As a result, according to the NICE (the
National Institute for Health Care and Excellence) website
‘The enormous costs (of different treatments) mean that choices have to be
made’. These choices are tough choices,
choosing between offering a drug to extend the life of a cancer patient by a
few months or years and using this money to provide other treatments. As stated on the NICE website ‘It makes sense
to focus on treatments that improve the
quality and/or length of someone's life and, at the same time, are an effective use of NHS resources’ (my
emphasis). It is because health and life are so important that these choices are so
difficult and it is because these choices are so difficult that a rigorous and
scientific system needs to be in place to ensure the correct decisions are
made. In this blog I will examine in
more detail how the NHS does this, paying particular attention to the two
phrases I’ve highlighted in bold, considering similarities in and lessons for
conservation science.
‘Focus on treatments that improve the quality and/or length of
someone’s life’:
The NHS’ finite
budget means that choices must be made between different treatments for the
same and different conditions. This
raises the question ‘how do you compare the cost of losing a leg against the
cost of losing sight in one eye or both eyes against the cost of chronic back
pain taking into account the effect of the treatment on the patient’s life
expectancy?’ What is required is a
common currency which allows the benefits of different treatments to be
compared. The currency used is the QALY
(Quality Adjusted Life Year).
To calculate the QALY
for a treatment the quality of life of an individual with and without treatment
must first be quantified as between 0 (death), and 1 (that of a healthy
individual). By multiplying the
additional quality of life resulting from the treatment against the patient’s
life expectancy, the Quality Adjusted Life Years resulting from the treatment
is calculated (more information can be found here). The resulting QALY is a standardised measure
of the benefit of a treatment and can be compared to any other treatment.
‘It makes sense to focus on
treatments that ... are an effective use of NHS resources’
Not all treatments
offer equally high QALYs and not all treatments are equally expensive. A treatment which resulted in a great
increase in the patient’s quality of life and/or life expectancy may not be
offered on the NHS if the price is too high.
Again, NICE use a simple and explicit method to overcome this problem:
the cost of the treatment is divided by its QALY value to give £ per QALY (the
chosen measure of cost effectiveness) as you can see on their website here.
I believe that QALYs
offer conservation two lessons:
1.
When choosing between different conservation
options a common currency is required to compare these different options
2.
The calculation of the benefits of pursuing each
option (expressed in the common currency) must be made explicit
I
will explore these lessons throughout this blog.
Optimally utilising a predetermined, finite budget.
So what would be the
equivalent of a QALY in conservation? I
suggest that the simplest currency,
which requires the least number of assumptions and arbitrary valuations, should
be used to compare the costs and benefits of different options. Take for instance a zoo deciding how best to
use its resources. The zoo may aim to
maximise the number of different species in the zoo in which case the cost per
extra species maintained in zoo could be used.
This might be adjusted to reflect preference for different species (in
the same way different treatments are weighted depending on the change in
quality of life they offer) e.g. an ape may be worth 3 (other) mammal species
and each mammal may be worth 10 bird species (with the exception of penguins)
which in turn may each be worth 10 invertebrate species. Or perhaps, if the zoo’s aim was to
reintroduce species to the wild, the zoo would use estimated cost per
successful reintroduction of a species. If
the zoo aims to maximise visitor stay at the zoo then sum visitor time spent at
enclosure per species could be used. If
education was the aim then a measure of change in knowledge and/or values
resulting from visitors visiting the enclosure could be used. I’m not suggesting how every zoo should be
run, I’m trying to demonstrate that making your decision process explicit
forces you to identify what it is that you base your decisions on and how you
weight these decisions. When public
money is being spent then this is especially important.
Using economic valuation as the common currency
Suppose a
conservation organisation has to choose between 3 projects, one will safeguard
water quality, another will improve the health of pollinator populations and
the third will increase carbon sequestration.
If all three projects cost the same, how should the organisation choose
between the alternative uses of its resources?
I suggest that a common currency (like the QALY) is needed so that the
projects can be compared. This currency
should require the minimal number of assumptions and arbitrary valuations. The best attempt to achieve this so far is the
Ecosystem Services approach which uses, as its common currency, monetary
valuation. For example, the avoided cost
of building a new water treatment plant, the avoided cost of pesticide and
benefit or larger crop yield and the avoided cost of climate change (calculated
using carbon prices which already exist).
These conversions between different currencies, from water quality to
avoided cost of a water treatment plant can be calculated scientifically,
minimising the need for assumptions and arbitrary valuations whilst making
those assumptions and arbitrary valuations explicit.
Comparing conservation to non conservation options, conservation must
use the currency of decision makers.
Now suppose that a
government has to decide between 3 project proposals concerning a plot of land,
a large motorway verge for example. The
first project is a conservation one which will entail the planting native tree
species leading to an increase in carbon sequestration and water quality, the
second will build shops which will generate revenue via rent and VAT and the
third will ensure that the land use, which has no net economic cost, does not
change. As when comparing different
conservation options, a common currency is required to directly compare the 3
different projects. The benefits of the
second and third projects are easily estimated and expressed in monetary
terms. To compare these benefits to that
of the first project either the economic benefit (or cost if the benefit is
negative) of the second project must be converted into an equivalent amount of
carbon sequestration and water quality improvement or vice versa. As the first is very unlikely, the Ecosystem
Services approach, by converting the value of the carbon sequestration and
water quality improvement to monetary terms, allows comparison of all three
projects such that the conservation option is included and well represented in
the decision making process.
NICE doesn’t have to
make decisions between increasing health or increasing GDP, that’s why they can
stick to QALYs, a currency one step removed from explicit economic
valuation. But individuals and organisations
comparing conservation with business opportunities use the currency of
money. Economic valuation is the
language spoken. This must be the QALY
of conservation. It is this which
conservation must adopt in order to ensure the value of nature can be compared
to the value of other options so that it may be included in the decision making
process. I acknowledge that
occasionally, and only occasionally, the currency the government uses to make
decisions is public support/protest. In
these instances public support for a conservation option/opposition to the
alternative may influence a decision.
However, public support for conservation options has, historically, been
hugely insufficient. This is why I
believe that economic valuation is required.
We are a long way off
of accurately valuating Ecosystem Services.
In fact, before conservation ‘treatments’ can even been assigned a QALY
value they must be demonstrated to be effective via a rigorous scientific
valuation. Many conservation
‘treatments’ are used without ever being effective; conservation’s knowledge
problem. This is why a transparent
method, like that used by NICE, is so necessary. By making our implicit valuations and
assumptions explicit, we make criticism and adjustment in the face of new
information simpler. It is because
nature, like our health, is so important, that a rational, scientific method is
required when it comes to using our limited resources. If you still disagree, if you believe that
explicitly valuing nature is fundamentally wrong then please stop to consider
that, if you live in the UK, every aspect of your health is valued relative to
every other and has its value. If you are
unfortunate to contract renal cancer then the NHS won’t cover the full cost of
treatment ‘sunitinib’, proven to be effective, because it is too expensive (http://news.bbc.co.uk/1/hi/health/7546879.stm).
