Health Cost of Unsustainable Infrastructure Policy: Evidence from the BRICS Countries

Abstract

Background: Infrastructure projects are undertaken by states for public benefit but they often have negative environmental impacts which impact public health. This means such projects could be detrimental towards the very people for whom they are undertaken. This phenomenon is studied in the cases of Brazil, Russia, India, China, and South Africa who represent a geopolitical bloc that could alter infrastructure policy affecting the health of approximately 3 billion people and shift the global sustainable development paradigm. 

Objective: To study the role of environmental sustainability in the relationship between infrastructural development and public health as seen in the BRICS countries.

Methods: Open-source panel data for the years 2000–2014 were used in a random effects panel data regression to determine the association of the energy sector on out-of-pocket health expenditures and death rate. Open-source data for the years 2011–2014 were used in a fixed effects panel data regression to study the relation of the transportation sector on the incidence of tuberculosis while considering environmental policy and its implementation. 

Results: An increase in total energy generated was associated with a marginal decrease in out-of-pocket health expenditures but an increase in crude death rates. However, increase in fossil fuels used in the production of electricity was associated with an increase both in the crude death rate and out-of-pocket health expenditures. Increase in investment in transportation was associated with an increase in new cases of tuberculosis per year. A higher Environmental Policy Stringency Index score was negatively correlated with new cases of tuberculosis. The model improved (adjusted R-squared = 91.8%) by including variables accounting for implementation of environmental safeguards, namely the emissions from transportation and Corruption Perceptions Index. 

Discussion: This analysis shows mixed associations of infrastructural growth with public health. It repeatedly finds that unsustainable means of infrastructure development are associated with worse public health outcomes than their more sustainable counterparts. Accounting for environmental policy and indicators of its implementation greatly improves our understanding of the situation. 

Varying impact of infrastructure projects on public health