This blog post is based on the Evidence & Policy article ‘Eliciting public values on health inequalities: missing evidence for policy windows?’
What would you be willing to sacrifice to reduce health inequalities? What is the most you would be willing to give up for the introduction of a basic income? How does this compare to what you would trade off for an increase in Universal Credit? Does your support depend on the income and health implications of these policies? And on your own income and/or health status? At present, we do not know the answer to these questions. Arguably, providing answers could help create the conditions to improve current policies and/or introduce more radical policies for tackling health inequalities.
There is a health divide in the UK. Individuals who are poorer die earlier and have worse health than those who are better off. We have known this for many years. Yet despite health inequalities being a focus of research and policy, health gaps continue to widen. To tackle socio-economic inequalities in health we need macro policies that will change the socio-economic, cultural and environmental conditions of people’s lives. These policies could include, but are certainly not limited to, taking action to reduce homelessness, increasing the availability and accessibility of good quality and affordable social housing, introducing a basic income that supports a minimum income standard and implementing a more progressive taxation system. However, it is difficult to create the political conditions necessary to implement these types of policy. One form of evidence which could help facilitate policy change is knowledge of a specific type of public value – economic value – for non-health policies and their associated (non-)health outcomes. This evidence is currently missing from decision-making processes.
Economic value is commonly expressed through sacrifice: what is the most you would be willing to give up in order to achieve a particular change in the world? The maximum trade off represents the value placed on that change and provides a measurable indication of the intensity of one’s support for what is being valued. These values are typically elicited through stated preference techniques that are well developed in economic research. These techniques are used when we wish to know the value placed on non-market goods, services or programmes. One method used for measuring trade-offs is willingness to pay (WTP), where payment is sometimes presented as an out of pocket, or tax, payment depending on the context. For example, how much would you be willing to pay in the form of increased income tax for the introduction of Policy X? Importantly, eliciting value in this way helps inform decisions about what policies to fund. However, this approach does not rule out funding policies in other ways, such as through wealth or data taxes or Modern Monetary Theory.
This recently published Evidence & Policy article sets out the case for a new area of research and provokes some key questions. First, there are methodological issues to think through around how to adapt stated preference techniques to this topic. Second, as different moral and ideological reasons exist for supporting these policies, complementary research may need to explore reasons for economic values. Third, in practice, there are also some unanswered questions about how decision makers would use such evidence. However, these issues do not detract from the potential of evidence on public values to support positive policy change for health inequalities. This offers the prospect of new insights on the relative importance the general public attach to different non-health policies and the importance of different kinds of benefits. This evidence could improve the chances of the type of policies needed to tackle health inequalities making it onto the policy agenda.
Dr Neil McHugh is a Reader at the Yunus Centre for Social Business and Health, Glasgow Caledonian University. He is an interdisciplinary researcher working at the interface of health economics, public health and social policy.
You can read the original research in Evidence & Policy:
McHugh, N. (2021) Eliciting public values on health inequalities: missing evidence for policy windows? Evidence & Policy, DOI: 10.1332/174426421X16286783870175.
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