Environmental Sustainability and Health in Pakistan: A Long-term Evaluation of Policy Effectiveness

Abstract

Environmental degradation continues to be a significant public health issue in Pakistan. However, evidence linking the overall environmental policy performance with measurable health outcomes over time is still limited. Using annual time-series data covering the years 1995-2022, this study highlighted the long-run relationship between environmental conditions, selected policy-related indicators, and health outcomes in Pakistan. Four health outcomes variables comprising life expectancy, maternal mortality ratio, out-of-pocket health expenditure, and current health expenditure as percent of Gross Domestic Product (GDP) were analyzed. Key explanatory variables included (Particulate Matter) PM2.5 exposure, water productivity, unsafe drinking water, EPI (Environmental Performance Index), GDP per capita, government expenditure on education, and urbanization. The empirical strategy itself included descriptive statistics, correlation analysis, unit root testing using Augmented Dickey-Fuller (ADF) and Phillips-Perron (PP) tests; multivariate estimation was based on Fully Modified Ordinary Least Squares (FMOLS), which was checked for robustness using Robust Least Squares (RLS). The stationarity results indicated that the variables were mostly integrated of order one. This justified employing long-run modelling approaches. However, formal cointegration evidence is mixed; therefore, the coefficients are interpreted as long-run associations rather than causal effects. Environmental stressors, especially air pollution and unsafe drinking water, were found to be still closely associated with negative maternal health effects as well as long-term financial burden on households. Whereas, better environmental performance was also correlated with improvements in the socioeconomic conditions affecting health expenditure trends. Some coefficients were found to be counterintuitive, notably for unsafe drinking water and life expectancy. This indicated issues related to measurement constraints, multicollinearity, and the limits of small-sample national time-series studies. The study determined that there is a need of more stringent enforcement, monitoring, as well as greater integration of environmental policy with public health financing, urban planning, and water governance in Pakistan. These findings introduced nuance to the policy debate, by providing a more conservative and policy-relevant perspective on environment–health linkages in Pakistan.