backup power generation since it only takes into account firms’ expenditures, leaving aside the households’ response –such as indoor generation or traditional cooking using coal and firewood, which have strong impact on indoor air quality.

Further, health care provision can be disrupted if electricity access is not reliable, and there is evidence that the mortality rate increases during power outages. Many essential devices used in health care require significant electricity supply. According to Kishore et al. (2018), difficulty to access health care was one of the main causes of indirect deaths after the hurricane Maria in Puerto Rico. A review of electricity access in health facilities in 11 Sub-Saharan African countries finds that 26% of health facilities have no access to electricity and that only 28% of health care facilities have reliable access (Adair-Rohani et al., 2013). Power outages impact health during extreme weather events by, for example, making it more difficult to access health care for people with chronic diseases and disaster related affections, maintain front line service and cause indirect health impacts due to loss of refrigeration (e.g. food-borne diseases and vaccine spoilage) and heat-related deaths (Beatty et al, 2006; Klinger, Landeg, & Murray, 2014). An assessment of the 2003 power outage in New York City finds that mortality rates for accidental deaths increased by 12% and non-accidental deaths by 25% (Anderson & Bell, 2012).

Power outages have repercussions on other infrastructure all the more so as networks are connected. Water systems in particular tend to rely on power supply and only the parts which are gravity fed can function during blackouts. Transport systems in dense urban areas are also highly reliable on electricity due to increasing complexity of traffic management and signals. While impacts of the lack of telecommunication on households is rarely documented in the literature, some studies put in evidence consequences on emergency systems and public health structure. In the aftermath of hurricane Maria in Puerto Rico, Kishore et al. (2018) report that 8.8% of the surveyed population in the most remote areas of the island were not able to reach emergency services. Beatty et al. (2006) point out the need of improvement of communication during an electricity outage in a hospital setting. Kile et al. (2005) reach the same conclusion after conducting semi-structured interviews on the impact of a power outage in 2003 in the Midwest and Northeast of the US. Respondents underlined the fact that communication was limited, and that public health surveillance was affected along with emergency responses.

# 1.2. The economic cost of electricity outages to households is high

The cost of electricity outages depends on length and timing. Carlsson & Martinsson (2008) provide evidence that the willingness to pay (WTP) to avoid unplanned power outages varies depending on the time of the week and the season. The 2,400 households who responded to their choice experiment survey in Sweden reported being more affected by outages occurring during a weekend and during the winter. Households also place more value on the reduction of long electricity service interruptions. Equivalent studies based on survey methods in other developed countries reach the same conclusion about the nonlinear impact of outage durations on WTP and costs, and therefore on well-being.

Estimates of the WTP to avoid power outage yield very different results across countries and methodologies (Figure 4)<sup>3</sup> . According to the referenced studies, the average cost revealed by contingent valuation and choice experiments surveys are USD 11.9 and USD 0.74 per unserved hour respectively. This difference is coherent with theory: in contingent valuations, people tend to overstate their WTP as they think it will have an impact on the problem while not being directly charged to them. There is no clear

> 3 Detailed figures on WTP for a reliable electricity network can be found in the Appendix section (Table 5).

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