Pandemics require the whole community to act
The COVID-19 pandemic raises pressing questions about the way we think about the public health preferences of citizens. An effective response to this crisis relies on the cooperation of every member of the community, which is why it is important that health preference research focuses on citizens’ preferences towards communal goods and collective action.
This means that we need to think about how well the tools in our methodological toolbox are up to this task. Can economic preference evaluation methods shed light on people’s concerns about the well-being of others? Can they capture preferences relating to the well-being of vulnerable groups? What do they tell us about people’s ethical principles, such as the refusal to accept preventable deaths even in the face of massive economic costs?
What is a health good and how do we measure it?
In stated preference research, we ask study participants different type of questions to discover which aspects of a particular good they value the most. This good can be a specific health intervention or product, a feature of the healthcare system itself, or even aspects of pandemic response policies, such as the severity of lockdown measures.
Asking the right questions
However, depending on how we ask the question, we might get different kinds of answers. Imagine we wanted to find out what kind of lockdown measures young people would find acceptable. If we asked them to only consider the risk to themselves, many of them might be comfortable with the risk associated with lighter lockdown measures in exchange for greater freedoms. However, the answers might be very different if we ask them to also take the risk to their grandparents or to other vulnerable people in their community into account.
Some methods we use to evaluate health preferences are designed to focus primarily on people’s self-interested preferences, others are better suited to take concerns for other people into account. It is important to know which kind of method can capture which kind of answer so that we do not miss any important concerns people might have.
The right tool for the job
In a PhD project I recently completed in HERU, I looked at different preference evaluation methods and compared how well they were able to evaluate different types of participant concerns. The features I looked at were how well these methods evaluated concerns about other people, concerns about groups of vulnerable people, and concerns that rely on ethical principles on which participants do not want to compromise (such as not wanting to sacrifice lives, for example). I also investigated how well different methods are able to recognize that a participant has changed his or her mind during the exercise. All of this is important to know because researchers need to be confident that they are using the right tool for the job and are passing on accurate information to policy makers. Whilst I found that some health economic valuation methods have limited application to consider these types of factors, I also found that many of the valuation methods in the health economists’ toolbox are capable of taking such a perspective.
Deliberation – a promising new approach
One particularly promising method that is relatively new to health preference research is an approach called deliberation. Its main feature is that it brings groups of participants together to discuss an issue - rather than ask single participants about their preferences in isolation. As participants explain their preferences to each other and also explain the reasons for their preferences, we can find out a lot about why people prefer certain aspects of health goods over others. Furthermore, because participants interact with each other, deliberative approaches can also tell us much about how people evaluate health goods when they make decisions collectively.
One problem of deliberative methods is that they are very expensive because researchers have to invite participants to speak to each other face-to-face. They typically also involve fewer participants than other methods, which means that it can become hard to figure out if the views of the participants are representative of the larger population. This is why researchers at HERU are now looking at ways to combine survey-based evaluation methods with internet-based deliberation. If we can successfully combine deliberative methods with survey-based methods, we might gain greater insight into what people want from their health care system and services, making it possible for political decision makers to better serve our communities.
How our research can help identify more effective pandemic response measures
This has great implications for issues that impact the whole community, such as disease outbreaks. By developing methods that take the communal concerns of citizens into account, we can help identify those response measures that have the best chance of being accepted by the community. This in turn might increase compliance and would hence result in more effective policies that cause as little disruption for citizens as possible.
Many thanks to Dr Ruben Sakowsky for his work developing this Blog post. Ben was a Research Fellow in HERU, and in 2019 completed his PhD in the Unit with a thesis on 'Our values or mine? A philosophical and empirical critique of deliberative and stated preference elicitation techniques in health economics'.
HERU is supported by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates (SGHSC). The views expressed here are those of the Unit and not necessarily those of the CSO.