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In Search of Social Value: Insights from (Health) Economics Alan Shiell Power to Persuade Symposium Melbourne 5 September 2012.

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Presentation on theme: "In Search of Social Value: Insights from (Health) Economics Alan Shiell Power to Persuade Symposium Melbourne 5 September 2012."— Presentation transcript:

1 In Search of Social Value: Insights from (Health) Economics Alan Shiell Power to Persuade Symposium Melbourne 5 September 2012

2 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

3 InterventionCost 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 $ Hospital haemodialysis $ EPT for anaemia in dialysis $ Ban on cell phone use by drivers (UK) $ Neurosurgery for some malignancies$ Universal statins (vs targeted statins)$ Promoting Health: A Price List

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5 InterventionCost 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 $ Hospital haemodialysis $ EPT for anaemia in dialysis $ Ban on cell phone use by drivers (UK) $ Neurosurgery for some malignancies$ Universal statins (vs targeted statins)$ Walking School Bus$ Promoting Health: A Price List

6 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

7 Moral Try and make sure one measures all that is valued Lest someone else values ONLY what is measured

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9 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

10 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

11 Multiplier Effects of Community Participation - Reduction in intimate partner violence - Reduction in HIV risk behaviours Through group-based micro-finance schemes

12 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:

13 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 …

14 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 …

15 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


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