In Search of Social Value: Insights from (Health) Economics

Alan Shiell

Power to Persuade SymposiumMelbourne

5 September 2012

Start with an assertion

We do not have enough resources (time, space etc.) to do everything we would wish to do

to promote health and social well being

It follows that we need to choose between the things we should do now and the things

we should do later (or not at all)

SCARCITY = CHOICE

Intervention Cost to buy one year in full health

Vaccination (pneumonia > 65 years) Cost saving

GP advice to stop smoking $ 270

Hip replacement $1 180

Treatment of depression in primary care $15 500

Hospital haemodialysis $21 970

EPT for anaemia in dialysis $54 380

Ban on cell phone use by drivers (UK) $70 000

Neurosurgery for some malignancies $197 780

Universal statins (vs targeted statins) $530 000

Promoting Health: A Price List

Intervention Cost to buy one year in full health

Vaccination (pneumonia > 65 years) Cost saving

GP advice to stop smoking $ 270

Hip replacement $1 180

Treatment of depression in primary care $15 500

Hospital haemodialysis $21 970

EPT for anaemia in dialysis $54 380

Ban on cell phone use by drivers (UK) $70 000

Neurosurgery for some malignancies $197 780

Universal statins (vs targeted statins) $530 000

Walking School Bus $750 000

Promoting Health: A Price List

• Change in obesity

• Safer school environment• Social networking• Awareness of neighbourhood• Enhanced pedestrian skills• Good exercise habits• Sustainable changes in family

travel

Benefits of the Walking School Bus

• Non-BMI related health gains

• Spin-off benefits from investments to improve the built environment (walkability

• Local engagement and capacity building … and the benefits these bring

Moral

Try and make sure one measures all that is valued

Lest someone elsevalues ONLY what is measured

Perry Pre-School Project at age 40

SOURCE: Schweinhart LJ et al. The High/Scope Perry Preschool Study through 40. High/Scope® Educational Research Foundation

Perry Pre-School Project at age 40

SOURCE: Schweinhart LJ et al. The High/Scope Perry Preschool Study through 40. High/Scope® Educational Research Foundation

Multiplier Effects of Community Participation

- Reduction in intimate partner violence- Reduction in HIV risk behaviours

Through group-based micro-finance schemes

Multiplier Effects of Community Participation

Newly empowered women’s groups …

• Lobbied local police station leading to changes in the way that women reporting rape and other sexual assaults were treated

• Organised a sit-in at the local hospital leading to improvements in quality of care and an increase in number of community members volunteering to help

• Facilitated improvements in referrals to local child-care agency

• Strengthened the enforcement of licensing laws forbidding sale of alcohol to minors and organised a curfew on all sales

SOURCE: Pronyk et al., Social Science and Medicine 2008; 67: 1559-70

The Power to Persuade?

• Economic evidence is not always necessary

• Economic evidence is seldom sufficient

• And yet, neither the public nor politicians are always as aware of the ECONOMIC COST of political decisions …

The Power to Persuade?

• Economic evidence is not always necessary

• Economic evidence is seldom sufficient:– Distributional concerns– Vested interests

• And yet, neither the public nor politicians are always as aware of the ECONOMIC COST of political decisions as perhaps they should be …

My final word• Costs of social interventions are often greater than we think … but the investment

can enable (large) leverage of additional resources

• Benefits are multiple (spreading beyond health gain) and multiplied (as resources circulate in social networks adding value each time)

• We lack data on these broader social benefits … and the methods to incorporate them adequately in economic evaluation

• Existing economic methods for valuing benefits are OK in limited circumstances but better ways of capturing social benefit are needed

• Need also to look to political economy for methods for dealing with vested interests and how best to use economic evidence for advocacy