Assessing the health costs of arsenic-contaminated drinking water in Bihar, India: A bivariate probit analysis

Arsenic, classified as a group I carcinogen, is naturally present in groundwater. Exposure to arsenic-contaminated groundwater poses severe health and socioeconomic challenges, such as increased healthcare costs, reduced productivity, and loss of wages and income. Hence, estimating health costs is crucial for research and policy analysis. In this context, by collecting primary data from 300 households in 12 villages consisting of three sampled blocks of Buxar district, Bihar, the present study aims to assess the incidence of illness for affected households caused by arsenic exposure, highlighting averting strategies adopted by them, and to measure the associated health costs incurred. It employs a seemingly unrelated bivariate probit model (SUBP) to estimate the health costs of arsenic-contaminated drinking water. Following the Household Production Function framework, this study jointly estimates the likelihood of sickness from arsenic-related diseases and averting behaviour. It is estimated that 72.19 persons per thousand are experiencing arsenic-related issues. Moreover, preventive strategies are followed by almost 63% of households, whereas remedial strategies which involve direct monetary cost are only followed by 23% of households. It also finds that sickness from drinking arsenic-contaminated water is positively associated with arsenic exposure, getting water from low-layer tube wells and work loss. Additionally, a positive relationship exists between work loss due to illness and averting behaviour, whereas a negative relationship exists between sickness and averting behaviour. The monthly health cost for affected households, including medical expenses (₹244.3 or USD3.28) and wage loss to illness (₹218.34 or USD2.93), is ₹462.64 (USD6.21). These findings underscore the substantial economic burden of arsenic contamination on affected households and highlight the need for targeted policy interventions. Specifically, interventions could include subsidising the cost of technology-based equipment like arsenic filters to targeted income groups, installing community-based arsenic removal units, providing health insurance, enforcing groundwater regulations and creating mass awareness.