131 – Triage in environmental management

The medical idea of triage has sometimes been discussed in relation to environmental management. Some aspects of the idea are relevant, but overall it is too limited to be useful for actual environmental decision making.

Link to page about a program on Triage on ABC Radio National where I was interviewed on Nov 4 2008 here

Imagine a medical emergency where there are many injured people and a shortage of medical resources. Some people are going to miss out on treatment. How should the doctors decide who to treat? By triage! They sort the injured into three groups: those who are too injured to survive even if they are treated, those who are not sufficiently injured to be worth treating, and the group in between that actually receives treatment.

Now imagine this idea applied to environmental problems. We would break down the environmental assets of interest into three groups. The first group is so degraded that we decide it is not worth attempting to recover them. This says something about the technical feasibility of recovery, and hints that, even if it was technically feasible, the cost of doing so would be high. The second group would be in such good condition that it doesn’t need our help. The third group, in between these extremes, gets the resources.

What’s wrong with this? Several things.

1. In the medical emergency, our aim in treating people is for them to survive (and hopefully recover fully, eventually). In the environmental case, our objective could be something quite different.

(a) Even if full recovery is not technically feasible, we may invest to seek partial recovery. In many situations, this is probably a more realistic goal. We need to weigh up the likely extent of recovery as part of the decision process.

(b) We may seek to stop the asset getting any worse than it already is. It might not be degraded at all at the moment (which would place it in one of our no-action categories if we apply the medical approach to triage) but be threatened with serious degradation if we don’t act.

(c) We may seek to stop the asset from degrading as much as it otherwise would have done. For example, in the case of dryland salinity in Australia, slowing the rate of degradation may be the most viable strategy in some cases. The extent of this reduction in future degradation would need to be factored into the decision.

(d) We may invest with the aim of adapting to a changed environment, to maintain some altered environmental values in the aftermath of, say, climate change.

(e) We might even invest with the specific intention of maintaining the environment in a radically altered state. This doesn’t seem relevant in Australia, but it is the basis of most environmental policy in Europe, for example.

These points highlight that the way to think about it is to compare outcomes with and without the proposed intervention, as in a benefit:cost analysis. We should evaluate the benefits of the intervention relative to what would have happened otherwise. The triage concept does not give us this. It ignores that some currently healthy patients are on the verge of a serious decline, and that even if we cannot fully recover some of the most injured, a partial recovery may still be very worthwhile. The with versus without perspective does pick this up.

2. In the medical emergency, we assume that all the people we could treat are of equal intrinsic merit. This is not true of environmental assets. A nature reserve with only common species would not be as valuable as one containing threatened species, for example. There is a whole range of criteria – ecological, social and economic – that might make one environmental asset intrinsically more valuable than another. This needs to be factored into the decision about which assets get the resources.

3. In the medical analogy, once the decision has been made about which group a patient belongs to, the supply of treatment follows more or less as a matter of course. The medico making the assessment of priority may be the same person who actually provides treatment, or even if they are not, the treating physicians understand the system and are likely to comply with it reasonably tightly. For many environmental problems, successful intervention requires you to alter the behaviour of a range of other people, who may or may not have any interest in the asset. Thus we need to pay attention to the motivations of relevant land and water managers, and the adoptability of the practices we would like them to adopt (Pannell et al., 2006). This too needs to be factored into the prioritisation decision. If there is no prospect of adequate adoption, we should not invest even if saving the asset is technically feasible.

4. The medical analogy operates on a short time scale: treat these people now or they will die. Some environmental problems are like that, but some operate on a much longer time scale. For example, in the case of climate change, one important response is to invest in development of new renewable energy technologies, rather than just in immediate mitigation. We invest in medical R&D as well of course, but this doesn’t feature in the triage approach either. I think the technology change option for environmental management is actually a relatively neglected one that deserves more attention (Pannell 2008).

5. Triage suggests what you should do given a fixed pool of resources, but doesn’t address the question of whether the resources should be increased or reduced.

Certainly the idea of not throwing money at something that cannot be helped is a good one, but overall triage is no substitute for a good investment framework, such as INFFER.

David Pannell, The University of Western Australia

Further Reading

Pannell, D.J. (2008). Public benefits, private benefits and policy mechanism choice for land-use change: technology change, presented at 52nd Annual Conference of the Australian Agricultural and Resource Economics Society, Canberra, 5-8 Feb 2008. here (117K pdf file)

Pannell, D.J., Marshall, G.R., Barr, N., Curtis, A., Vanclay, F. and Wilkinson, R. (2006). Understanding and promoting adoption of conservation practices by rural landholders. Australian Journal of Experimental Agriculture 46(11): 1407-1424.

If you or your organisation subscribes to the Australian Journal of Experimental Agriculture you can access the paper at:http://www.publish.csiro.au/nid/72/paper/EA05037.htm (or you can buy a copy on-line for A$25).

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