“Placebo Tests” for the Impacts of Air Pollution on Health: The Challenge of Limited Health Care Infrastructure†

AEA Papers and Proceedings 2021, 111: 371–375 https://doi.org/10.1257/pandp.20211031 AIR POLLUTION CHALLENGES IN DEVELOPING COUNTRIES “Placebo Tests” for the Impacts of Air Pollution on Health: The Challenge of Limited Health Care Infrastructure By Bruna Guidetti , Paula Pereda, and Edson Severnini* When examining the impacts of exposure to of air pollution under hospital capacity con- air pollution on health outcomes, researchers straints. To identify the health effects of air usually carry out “placebo tests” to provide epollution, we in vi- vestigate how daily pediatric dence in support of their identification assump-hospitalizations for respiratory diseases in pub- tion. In general, this exercise targets health lic hospitals respond to short-term e xposure conditions seemingly unrelated to air pollution. to PM10 in the Sao Paulo metropolitan area For instance, if the main analysis focuses on the (SPMA) over the period 2015–2017. For the impacts of air pollution on respiratory or car - health conditions seemingly unrelated to air pol- diovascular diseases, whose effects have been lution, we focus on epilepsy-related procedures, widely documented for decades (e.g., Pope, such as video-EEG (electroencephalograph) Dockery, and Schwartz 1995; Schlenker and monitoring; phimosis surgery; appendectomy; Walker 2016), then falsification tests may focus and bone fracture repair. The first two are elec- on selected gastrointestinal disorders. tive care procedures, while the last two are In this study, we argue that one should pro ur-gent procedures. ceed with caution when running such falsifica- Using wind as an instrument for PM10 (e.g., tion tests. If health care infrastructure is limited, Deryugina et al. 2019), we document two then when we observe health shocks such as main findings. First, consistent with previous those driven by air pollution (e.g., Chay and research, exposure to PM10 increases pediatric Greenstone 2003, Currie...