262 – Environmental triage

Environmental triage is an important but sometimes-controversial concept in environmental management.

Triage is routinely used in medical emergency situations to determine who out of a group of sick or injured patients should receive treatment and who should not. The idea is to identify those patients who will survive and recover without treatment, and those patients who are too injured or sick to respond to treatment. Having excluded these two groups, resources can be concentrated on those patients who are most likely to benefit from treatment. A key aim of the system is to avoid tying up large amounts of treatment effort on patients who ultimately cannot be helped, in order to help a larger number of patients who can really benefit.

It is not hard to see how triage could be relevant to environmental problems. Just like medical patients, some environmental assets don’t really need help, some are beyond helping, and some could benefit from help. By targeting environmental funds to the last group, we could achieve greater environmental benefits than if we tried to help all three groups. Just like in medicine, the most intractable cases tend to use up very large amounts of resources for little or no ultimate benefit.

plantsCriticisms of environmental triage seem to focus mainly around the idea that it is defeatist. People argue that it implicitly gives governments an excuse for under-funding environmental programs. By providing a formal process for dealing with poorly resourced programs, it gives under-funding a cloak of respectability, and so it lets governments off the hook. Rather than picking winners, the argument goes, we should increase the environmental budget so that all environmental assets can be protected.

Many of us would agree that funding for environmental programs should be increased. However, ruling out environmental triage in order to try to increase environmental funding is highly self-defeating. The environmental benefits of a triage-like approach can be enormous compared to a more “equitable” approach, especially if resources are tight. (They almost always are tight.)

For example, in 2010 Richard Fuller and his colleagues at the University of Queensland estimated the costs and environmental benefits of 7000 environmental projects (for protection of reserves) around Australia. In their data set, the best 5% of projects, in terms of environmental value for money, are around 330 times better than the median project. In other words, being clever and a bit ruthless when choosing which projects to fund can make a really major difference to the environmental outcomes achieved. Commonly, our environmental programs are not this clever or ruthless, and we miss out on achieving much greater environmental benefits.

Of course, I am not arguing against increasing environmental budgets. I’m just arguing that ruling out triage is not a sensible strategy for seeking such increases.

The practical reality is that environmental funds are generally so tight that we always leave a large number of environmental assets unprotected, or so poorly protected that we may as well not bother. In a sense, we are already applying a sort of triage, without calling it that. The question, then, is not whether to apply triage – it is whether to apply it in a systematic, well informed way or in an ad hoc, uninformed way. The answer is obvious, because the alternative is so environmentally costly.

Strictly speaking, the medical triage analogy is not actually a completely snug fit in the environment sector. For example, in the medical world, the focus is on helping patients recover, whereas for the environment, the main aim in some cases is to stop an asset from degrading further. In medicine, we assume that all patients are of equal intrinsic worth, whereas environmental assets vary greatly in their significance or importance. Medical triage is typically short-term in nature, whereas environmental decision making needs to consider issues over a much longer time frame. Techniques have been developed to deal with these additional complexities, such as the Investment Framework for Environmental Resources (www.inffer.org).

Overall, the key point is that targeting resources to those cases that offer the best environmental outcomes for the available resources is good for the environment. It requires organisations to be willing to say what they will not do, which can be politically challenging, but we should be applying tough love where possible. This is increasingly being recognised by environmental managers around the world.

Further reading

Bottril, M.C., Joseph, L.N., Carwardine, J., Bode, M., Cook, C., Game, E.T., Grantham, H., Kark, S., Linke, S., McDonald-Madden, E., Pressey, R.L. Walker, S., Wilson, K.A., and Possingham, H.P. (2009). Finite conservation funds mean triage is unavoidable, Trends in Ecology and Evolution 24, 183-184. Journal web page

Fuller, R.A., McDonald-Madden, E., Wilson, K.A., Carwardine, J., Grantham, H.S., Watson, J.E.M., Klein, C.J., Green, D.C. and Possingham, H.P. (2010). Replacing underperforming protected areas achieves better conservation outcomes, Nature 466, 365-367. Journal web page

Joseph, L.N., Maloney, R.F. and Possingham, H.P. (2009). Optimal allocation of resources among threatened species: a project prioritisation protocol, Conservation Biology 23, 328-338. Journal web page

Pannell, D.J. (2013). Ranking environmental projects, Working Paper 1312, School of Agricultural and Resource Economics, University of Western Australia. IDEAS page ◊ Blog series

9 Comments

  • Hugh Possingham
    19 March, 2014 - 12:32 am | link

    Your paragraph is the key: “In a sense, we are already applying a sort of triage, without calling it that. The question, then, is not whether to apply triage – it is whether to apply it in a systematic, well informed way or in an ad hoc, uninformed way. The answer is obvious, because the alternative is so environmentally costly.” I keep saying this but nobody will listen – they just say “we cant do triage”, ignoring the fact they already do.

    Bottom line, triage is just choosing, and who doesn’t choose? I do it every 5 minutes. I can only eat one lunch otherwise i get fat, I can only use the next 5 minutes in one way, I am only allowed one wife … . Life is like a box of chocolates, and boxes are the ultimate constraint.

    There will be a discussion soon on ABC Lateline about threatened species triage, plus tomorrow I am doing a BBC Natural History unit interview on triage in Bristol

    – Hugh Possingham. (I think logic is slowly winning).

  • mike bode
    19 March, 2014 - 7:49 am | link

    Fredrick the Great said of military triage: “S/he who defends everything, defends nothing.”

    I liked your discussions about how the medical analogy for environmental triage is limited. However, I’m not sure I agree 100% with the statement that: “In medicine, we assume that all patients are of equal intrinsic worth, whereas environmental assets vary greatly in their significance or importance.” Aren’t controversial metrics like QALY’s an attempt to differentially value patient’s, as well as the outcomes of intervention?

    • 19 March, 2014 - 5:32 pm | link

      Thanks Mike. Great quote. As I understand it, QALY (Quality-Adjusted Life Expectancy) has been used at times to influence resource allocations, although it looks to me that it may not have been used in codified medical triage approaches, which are generally meant for use in emergencies. Perhaps I’ve missed examples where they have used QALY.

  • 20 March, 2014 - 5:58 am | link

    A version of this article is posted as a discussion starter on the ABC Environment page (http://www.abc.net.au/environment/articles/2014/03/19/3967102.htm), associated with its item on triage on ABC Lateline on March 19 (http://www.abc.net.au/news/2014-03-19/australian-species-facing-extinction-living-dead-triage/5331908).

  • David Pritchard
    20 March, 2014 - 5:35 pm | link

    Its a sad day in the life of a ecological restoration worker like myself when I hear my scientific overlords, and valued colleagues, advocate the exacerbation of the sixth extinction by formalizing and bureacratizing the extinction of species by way of handing government and their crony capitalist overseers a potentially handy tool such as Environmental triage policy to wage war on biodiversity. You only need to witness the disaster of Offsetting policy to see how we have been scammed. Any management tool that threatens the relentless onslaught on our biodiversity by urbanisation, resource aquisition and numerous other profitable activities will always be co-opted by those with power. Having said that if we are considering Environmental triage how could it be kept within the control of the environmental domain so that this management tool wont be captured and distorted by government and industry to be turned against the environment as has happened with offsetting policy. A water tight tool must be developed and kept at arms length of government or industry control and manipulation and any input so they cannot capture it within their sphere of influence and so we don’t end up being scammed again. Are we giving any forthought to the politics of this policy. The politics of such a policy must be considered so that we are on the front foot and able to head off any dilution. Too often we end up with compromises that dont achieve or fall well short of the outcomes that the management tool was originally designed for. Such a situation would be a complete defeat for the fight to stem the tide of biodiversity collapse and the policy (Environmental triage) of last resort and lets be quite clear, this type of policy is a last resort.

    • 20 March, 2014 - 8:04 pm | link

      In a comment on the ABC site, someone says that “prioritisation” is a better word than “triage” for what we’re really talking about. I agree, so I’m going to use it instead.

      With these comments you’ve introduced a political and government agency dimension to the discussion, which is a very helpful contribution. You are quite right that these issues should not be considered only in a theoretical way, but should take account of political and administrative factors as well. Your suspicion of governments’ motives is not unreasonable, especially in the current political environment. Your lack of confidence in governments’ capability to deliver hoped-for outcomes is also very understandable. But my reading of the politics is quite different from yours. We are already not protecting most threatened species. Governments know this. This knowledge is not changing their decisions about funding. Clearly, there is not enough concern being expressed by voters to change this. I don’t see any reason to expect that prioritising our investments in species (or other environmental assets) would have an adverse impact on decisions about funding levels. Indeed, it seems more likely to have a positive effect on funding. Being honest and open about which species will be let go seems likely to cause more community outrage and pressure for increased funding than the current strategy of pretending we are trying to protect everything. (There should be outrage about the dishonesty of the current approach, but people outside the environment sector don’t know about it.) Also, departments of treasury are sceptical about environmental programs because they generally have a poor track record of being able to demonstrate outcomes for the investment. If we approach decision making in a more business-like way, it seems more likely that we would be able to convince treasury people that the environment is worth funding. To me, considering the politics just strengthens the argument for prioritisation.

      Even if we did see a substantial increase in funding for threatened species, it’s very unlikely that there would be enough to protect all species, so the need to prioritise would not go away. To me, the thing that is quite clear is that the probability of getting so much funding for threatened species that we wouldn’t need to prioritise is zero.

  • Mike Young
    21 March, 2014 - 12:33 am | link

    An important issue.. Some time ago, the late Jim McColl and I wrote a droplet on this important prioritisation issue.

    A related issue, which deserves much more work, is the question of who should be empowered to make such decisions and what processes should they follow as they do this.

    Our droplet asked posed the proposition that you might get more environmental benefit from a smaller river.

    See Droplet 16 at http://www.myoung.net.au/water/droplets.php

    Wish Jim was still around. He had a great mind

  • Matt Giraudo
    31 March, 2014 - 10:41 am | link

    The concept of using a triage approach into determining investment priorities within the strategy is not new. Triage approach to investment in natural resource management is not currently employed by MRM regions, although there has been some discussion regarding the Triage approach to resource allocation within Natural Resource Management.
    Triage refers to a specific process for deciding where to expend limited resources essentially by grouping presenting individuals in a range of categories ahead of treatment. The presenting individuals are entirely unconnected, and therefore each decision regarding priority for treatment is made completely independently. This is not the case in resource allocation in NRM, where outcomes are typically reliant on multiple streams of coordinated investment, including supporting existing and related programs. In other words, each investment decision cannot be made in isolation as they are not independent of other decisions.
    Triage requires that individuals are assessed on the basis of their need and likelihood to respond to urgent treatment. It is not applied within the context of diagnosis, nor in context of deciding what treatment each patient requires, merely his/her need for urgent attention.
    As the triage approach assesses individuals for priority treatment, it could only be effectively applied within the context of an asset / threat model. In an asset / threat approach it is common to use a resource allocation model. These models, including INFER, decision theory, bayesian logic etc, are typically more sophisticated and better suited to NRM resource allocation than a simple triage approach.
    Triage also lacks the capacity to manage future and impending stressors, nor embrace the complex interactions that impact socio-economic and environmental systems. Triage does not have the multifaceted capacity to deal with the complex issues impacting NRM, nor the flexibility required to manage the range of divers impacting investment decisions.
    Investment analysis in NRM demands a much more sophisticated resource allocation model, based on an inclusive and adaptive approach that seeks to embrace the complexity of the systems being managed.
    A reductionist triage approach to investment allocation simply does not fit with modern NRM systems based analysis and does not provide a robust and effective means for making current or future investment decisions. This approach has not been adopted in the NRM community (in fact it has been widely rejected), is not recommended by government.
    A key issue here is that the natural environment does not actually consist of a range of discrete assets. Instead, natural environments are complex, inter-related, self-organising systems governed by multiple internal feedback loops, and respond to a variety of overlapping external stressors and shocks. Effective management requires effective systems based approaches. Application of linear, reductionist models simply highlights a lack of understanding of the underlying systems being managed.
    The problem with the asset – threat model is that it tends to lead you to believe that you can buy environmental outcomes, by undertaking discrete projects in isolation to one another. Generally this is not the case in natural systems. I would argue that a lack of investment is greatly exacerbated by a lack of understanding of the systems being managed – or rather not being managed.

    • 8 April, 2014 - 9:41 pm | link

      Lots of issues there. Here are comments on some of them.

      “Triage approach to investment in natural resource management is not currently employed by NRM regions”
      Response: well, not strictly speaking, but my point is that they all have to choose to do some things and not others. The quality of these decisions can be good, bad or indifferent.

      “Triage refers to a specific process …”
      Response: As I’ve said in other replies, I agree that medical-style triage is not the best way to approach decision making about the environment. But the general idea of prioritising and focussing effort is highly relevant.

      “A key issue here is that the natural environment does not actually consist of a range of discrete assets.”
      Response: I think your comments on this aspect go too far and misrepresent what an asset-based approach is doing. It is, of course, important to recognise the connections and interconnections between environmental elements. And I’m the first person to say that decisions need to be well-informed with knowledge of the underlying systems. But it doesn’t follow that you can’t break the investment decision down into a set of sub-investments, each focusing on some assets but not others. In fact, you could not practically proceed without doing that.
      The level of aggregation when defining the scale of projects is something that has to be judged, considering factors such as: the importance of the interconnections, the quality of information about them that’s available, the cost and complexity of accounting for them, the capacity of the people doing the analysis and making the decisions, and the availability of resources (cash and time) to undertake the process.
      I’d also observe that it’s important not to focus on interconnections to the exclusion of other issues. In cases where people do try to consider investments in a way that is holistic in an ecological sense, they often fall down in other respects, such as considering behaviour change, economic aspects, getting the maths right, etc. In my view, this often has much greater adverse impacts than the failure to account for all ecological connections.

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