Aki Tsuchiya

Background: Economic evaluations in health typically assume a nonwelfarist framework, arguably better served by preferences elicited from a social perspective than a personal one. However, most health state valuation studies elicit personal preferences, leading to a methodological inconsistency. No studies have directly compared social and personal preferences for outcomes using otherwise identical scenarios, leaving their empirical relationship unclear. Aim: This unique study examines whether the choice of eliciting preferences from a social or personal perspective influences valuations of health and well-being outcomes. Methods: Using discrete choice experiments, social and personal preferences for health and well-being attributes were elicited from the UK general public recruited from an internet panel ( n = 1,020 personal, n = 3,009 social surveys). Mixed logit models were estimated, and willingness-to-pay (WTP) values for each attribute were calculated to compare differences between the 2 perspectives. Results: While no significant differences were observed in the effects of physical and mental health, loneliness, and neighborhood safety across the 2 perspectives, significant differences emerged in WTP values for employment and housing quality. For instance, other things being the same, personal preferences rate being retired as more preferable than being an informal caregiver, but the social preferences rate them in the reverse order. Conclusion: Our findings demonstrate that the perspective matters, particularly for valuing outcomes such as employment and housing. These findings indicate that the exclusive use of personal preferences to value states such as employment and housing quality may potentially lead to suboptimal resource allocation, given that such valuations reflect individual rather than societal benefit. This highlights the importance of considering perspective especially in the resource allocation of public health interventions. Highlights: Personal preferences were not aligned with social preferences for employment and housing quality outcomes. Respondents valued health outcomes the same in both social and personal perspectives. Using personal preferences in public health resource allocation decisions may not reflect societal priorities.

This paper presents a large scale cross-section survey of health and wellbeing that allows econometric mapping between different outcome measures. The Systems science In Public Health and Health Economics Research - Health and Wellbeing Multi-Instrument Comparison (SIPHER-HWMIC) is a cross-sectional individual-level survey conducted in the United Kingdom, of over 12,000 members of the general public aged 18 + . It includes a wide range of self-reported questions in health and wellbeing taken from established outcome instruments such as the EQ-5D-5L, Health Utilities Index Mark 3 (HUI3), ICECAP-A, EQ Health and Wellbeing Short (EQ-HWB-S), etc., alongside work-related and housing-related questions, and socioeconomic covariates including age, gender, education, personal income, etc. The data were collected through three separate commercial internet panels in November 2022, and oversampled respondents from Scotland. To demonstrate the potential uses of the dataset, the paper also reports on the results of an econometric mapping analysis between Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) and the 12-Item Short Form Health Survey (SF-12v2) Mental Component Summary. The SIPHER-HWMIC dataset is available from the UK Data Service (SN9458).

The Equality of Opportunity framework assumes that a given distribution of outcomes is a function of factors for which the individuals should be held accountable (referred to as effort) and factors that are beyond the individuals’ responsibility (referred to as circumstances). Circumstances can influence effort by shaping: i) the return to effort (interaction effect) or ii) the distribution of effort (indirect effect). The theoretical literature has mainly focused on the former. This study explores different allocation strategies to mitigate health inequalities due to the unfair indirect effects of circumstances and their alignment with principles of fair allocation. A questionnaire-experimental study is conducted, adapting these concepts to explore public attitudes toward health inequalities resulting from the intergenerational transmission of smoking habits.

The call for “health and wellbeing in all policies” requires a preference‐based measure that collapses multi‐dimensional health and wellbeing into a single index, such as equivalent income. We aim to elicit preferences of the UK general public to estimate a value set for a suite of seven commonly used wellbeing indicators including health, income, and other dimensions, in terms of equivalent income. Secondly, we examine heterogeneous preferences by gender, by age, and by income. Thirdly, we explore the stability of preferences, since the survey took place amid the pandemic, possibly affecting preferences over health and wellbeing. Effects of attrition and of time are distinguished. Data were collected online across two waves using Discrete Choice Experiments through an internet panel (N1 = 3362; and N2 = 3357). The regression coefficients for all the ordered attribute levels have the expected sign, are significant, and ordered. Equivalent income was found to vary up to 10% by gender and by age (both significant) and 4% by income (not significant), while the effect of time was up to 16% (significant). The study facilitates the calculation of overall wellbeing in terms of equivalent income based on the preferences of the UK public, where the relevant wellbeing indicators are available.

Objectives: Quantifying area-level inequalities in population health can help to inform policy responses. We describe an approach for estimating quality-adjusted life expectancy (QALE), a comprehensive health expectancy measure, for local authorities (LAs) in Great Britain (GB). To identify potential factors accounting for LA-level QALE inequalities, we examined the association between inclusive economy indicators and QALE. Setting: 361/363 LAs in GB (lower tier/district level) within the period 2018–2020. Data and methods: We estimated life tables for LAs using official statistics and utility scores from an area-level linkage of the Understanding Society survey. Using the Sullivan method, we estimated QALE at birth in years with corresponding 80% CIs. To examine the association between inclusive economy indicators and QALE, we used an open access data set operationalising the inclusive economy, created by the System Science in Public Health and Health Economics Research consortium. Results: Population-weighted QALE estimates across LAs in GB were lowest in Scotland (females/males: 65.1 years/64.9 years) and Wales (65.0 years/65.2 years), while they were highest in England (67.5 years/67.6 years). The range across LAs for females was from 56.3 years (80% CI 45.6 to 67.1) in Mansfield to 77.7 years (80% CI 65.11 to 90.2) in Runnymede. QALE for males ranged from 57.5 years (80% CI 40.2 to 74.7) in Merthyr Tydfil to 77.2 years (80% CI 65.4 to 89.1) in Runnymede. Indicators of the inclusive economy accounted for more than half of the variation in QALE at the LA level (adjusted R ² females/males: 50%/57%). Although more inclusivity was generally associated with higher levels of QALE at the LA level, this association was not consistent across all 13 inclusive economy indicators. Conclusions: QALE can be estimated for LAs in GB, enabling further research into area-level health inequalities. The associations we identified between inclusive economy indicators and QALE highlight potential policy priorities for improving population health and reducing health inequalities.

Wind turbines play an important role in the worldwide mission of producing renewable energy. The development toward integrating large-scale wind turbines in the urban environment has raised concerns over the noise impacts on urban residents. While most of the existing studies on wind turbine noise (WTN) have focused on rural settings, this paper investigates the relationship between WTN, noise perception and self-reported health of people, and controlling for background characteristics of the residents in urbanized areas. Questionnaire surveys were carried out around three suburban wind farms in the UK with 359 respondents. A-weighted sound pressure levels of WTN were predicted using noise mapping, for the most exposed façade of each dwelling of the respondent. The dose-response relationship was found between WTN and annoyance, moderated by age and degree of education. WTN was associated with some aspects of self-reported health, including raised health concerns, having headaches, nausea, and ear discomfort, but was not related to sleep disturbance directly. Noise sensitivity, attitudes to wind energy, and visibility of the wind turbines were found to significantly influence self-reported health. By employing a second variant of the questionnaire with the research aim masked, this study also addressed the focusing effects induced by the questionnaire design. The significant differences in the reported adverse health between questionnaire variants implied focusing bias among the sample who knew the research purpose. This elicited a methodological finding that should be noted in future research.