atmosphere Article Human Health and Economic Costs of Air Pollution in Utah: An Expert Assessment Isabella M. Errigo 1,* , Benjamin W. Abbott 1,* , Daniel L. Mendoza 2,3 , Logan Mitchell 3 , Sayedeh Sara Sayedi 1, Jeffrey Glenn 4 , Kerry E. Kelly 5, John D. Beard 4 , Samuel Bratsman 1, Thom Carter 6, Robert A. Chaney 4, Andrew Follett 7, Andrew Freeman 2, Rebecca J. Frei 8, Mitchell Greenhalgh 1 , Heather A. Holmes 5, Peter D. Howe 9, James D. Johnston 4 , Leslie Lange 1, Randal Martin 10, Audrey Stacey 1, Trang Tran 11 and Derrek Wilson 12 1 Plant & Wildlife Sciences, Brigham Young University, Provo, UT 84602, USA; [email protected] (S.S.S.); [email protected] (S.B.); [email protected] (M.G.); [email protected] (L.L.); [email protected] (A.S.) 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; [email protected] (D.L.M.); [email protected] (A.F.) 3 Department of Atmospheric Sciences, University of Utah, Salt Lake City, UT 84112, USA; [email protected] 4 Public Health, Brigham Young University, Provo, UT 84602, USA; jeff[email protected] (J.G.); [email protected] (J.D.B.); [email protected] (R.A.C.); [email protected] (J.D.J.) 5 Department of Chemical Engineering, University of Utah, Salt Lake City, UT 84112, USA; [email protected] (K.E.K.); [email protected] (H.A.H.) 6 Utah Clean Air Partnership (UCAIR), Salt Lake City, UT 84116, USA; [email protected] 7 Yale Law School, New Haven, CT 06511, USA; [email protected] 8 Renewable Resources, University of Alberta, Edmonton, AB T6G 2R3, Canada; [email protected] 9 Environment and Society, Utah State University, Logan, UT 84322, USA; [email protected] 10 Civil and Environmental Engineering, Utah State University, Logan, UT 84322, USA; [email protected] 11 Bingham Research Center, Utah State University, Vernal, UT 84078, USA; [email protected] 12 Law School, University of Colorado, Boulder, CO 80309, USA; [email protected] * Correspondence: [email protected] (I.M.E.); [email protected] (B.W.A.); Tel.: +1-801-422-8000 (B.W.A.) Received: 14 September 2020; Accepted: 10 November 2020; Published: 18 November 2020 Abstract: Air pollution causes more damage to health and economy than previously understood, contributing to approximately one in six deaths globally. However, pollution reduction policies remain controversial even when proven effective and cost negative, partially because of misunderstanding and growing mistrust in science. We used an expert assessment to bridge these research–policy divides in the State of Utah, USA, combining quantitative estimates from 23 local researchers and specialists on the human health and economic costs of air pollution. Experts estimated that air pollution in Utah causes 2480 to 8000 premature deaths annually (90% confidence interval) and decreases the median life expectancy by 1.1 to 3.6 years. Economic costs of air pollution in Utah totaled $0.75 to $3.3 billion annually, up to 1.7% of the state’s gross domestic product. Though these results were generally in line with available estimates from downscaled national studies, they were met with surprise in the state legislature, where there had been an almost complete absence of quantitative health and economic cost estimates. We discuss the legislative and personal responses of Utah policy makers to these results and present a framework for increasing the assimilation of data into decision making via regional expert assessment. In conclusion, combining quantitative assessments from local experts is a responsive and cost-effective tool to increase trust and information uptake during time-sensitive policy windows. Keywords: air pollution; expert assessment; environmental policy; science communication; ecological economics; knowledge co-generation Atmosphere 2020, 11, 1238; doi:10.3390/atmos11111238 www.mdpi.com/journal/atmosphere Atmosphere 2020, 11, x FOR PEER REVIEW 2 of 30 Keywords: air pollution; expert assessment; environmental policy; science communication; ecological economics; knowledge co-generation Atmosphere 2020, 11, 1238 2 of 28 1. Introduction 1. Introduction Research published in the past three years has revealed that environmental pollution causes muchResearch more damage published to human in the health past three and the years econom has revealedy than previously that environmental understood pollution [1–3]. The causes best longitudinalmuch more damageand cross-sectional to human health studies and now the economy suggest thanthat previouslyone in four understood deaths is [attributable1–3]. The best to environmentallongitudinal and pollution—approximately cross-sectional studies now15.2 suggestmillion thatpremature one in deaths four deaths worldwide is attributable every year to (Figureenvironmental 1) [1,2,4]. pollution—approximately This immense health burden 15.2 millionamounts premature to 5 times deaths more deaths worldwide than everycaused year by tuberculosis,(Figure1)[ 1 ,AIDS,2,4]. This and immensemalaria comb healthined; burden 10 times amounts more deaths to 5 times than from more transportation deaths than causedaccidents; by 30tuberculosis, times more AIDS, deaths and than malaria global combined;malnutrition; 10 timesand 90 more times deaths more thandeaths from than transportation caused by all accidents;wars and terrorism30 times more(Figure deaths 1). Estimates than global of the malnutrition; health burden and associated 90 times morewith outdoor deaths than (ambient) caused air by pollution all wars haveand terrorismincreased (Figurethe most1). due Estimates to the availability of the health of high-resolution burden associated datasets with and outdoor new analytical (ambient) tools air [1,4].pollution Consequently, have increased many the commonly most due to cited the availability estimates ofof high-resolutionpollution consequences datasets and are new substantially analytical underestimated.tools [1,4]. Consequently, For example, many the commonly reported cited ambien estimatest air ofpollution pollution deaths consequences from the are World substantially Health Organizationunderestimated. are 54% For example,lower than the current reported estimates ambient (Figure air pollution 1) [5], and deaths even fromthe Lancet the World Commission Health onOrganization Pollution and are Health 54% lower is 41% than lower current than estimates current es (Figuretimates1 )[of 5overall], and evendeaths the attributableLancet Commission to pollution on [2,6].Pollution and Health is 41% lower than current estimates of overall deaths attributable to pollution [2,6]. Global causes of death Pollution 9.2 2.9 1.8 0.8 0.5 Tobacco 7.6 Air (outdoor) Obesity 3.8 Air (indoor) TB, AIDS, malaria 2.7 Water Alcohol use disorders 1.7 Occupational Road accidents 1.3 Soil COVID-19 1.1 Suicide 0.8 Malnutrition 0.5 Homicide 0.4 Drug use disorders 0.4 War and terrorism 0.2 Natural disasters 0.0 0246810121416 Millions of premature deaths per year Figure 1. EstimatesEstimates of of premature premature deaths deaths caused caused by by pollution pollution and and other other causes causes and risk factors worldwide. Data forfor outdooroutdoor airair pollutionpollution are are from from Burnett Burnett and and others others [1 ][1] and and Lelieveld Lelieveld and and others others [4]. [4].Data Data for otherfor other pollution pollution deaths deaths are are from from Landrigan Landrigan and and others others [2]. [2]. Occupational Occupational pollution pollution refers refers to toexposure exposure in in the the workplace. workplace. Data Data for for other other causes causes of of deathdeath oror riskrisk factorsfactors areare thethe average of values reported by the World Health Organization [7] and Our World in Data [8]. Deaths associated with reported by the World Health Organization [7] and Our World in Data [8]. Deaths associated with COVID-19 were current on 9 October 2020. We note that each of these estimates has an uncertainty range, COVID-19 were current on 9 October 2020. We note that each of these estimates has an uncertainty but because they are compiled from different studies with different metrics of variance (e.g., standard range, but because they are compiled from different studies with different metrics of variance (e.g., deviation and confidence intervals), we show only the central estimate. standard deviation and confidence intervals), we show only the central estimate. Outdoor air pollution is the single largest contributor to pollution-related deaths, accounting for 61% of the loss of life from pollution worldwide (Figure1). Outdoor air pollution accounts for even higher proportions of the pollution burden in developed countries, where water, soil, and indoor air pollution are typically less severe [1,2,6,9]. It is estimated that 80 to 90% of outdoor air pollution is produced by fossil fuel combustion (e.g., transportation, electricity, and heating) and biomass burning Atmosphere 2020, 11, 1238 3 of 28 (e.g., heating, cooking, and fabrication) [2,9–12]. Fossil fuel and biomass burning produce primary and secondary combustion products, including particulate matter, ozone, and oxides of nitrogen, sulfur, and carbon [13–16]. The link between outdoor air pollution and health is well established for a wide range of health conditions, including cardiovascular and respiratory diseases, central nervous system disorders, psychological problems, metabolic conditions, and reproductive disfunction [17–23]. Exposure to polluted air