Eliciting Public Preferences Across Health and Wellbeing Dimensions: An Equivalent Income Value Set for SIPHER-7, 2020-2021

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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 7 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.

THE PROBLEM There is strong evidence that the social and economic conditions in which we grow, live, work and age determine our health to a much larger degree than lifestyle choices. These social determinants of health, such as income, good quality homes, education or work, are not distributed equally in society, which leads to health inequalities. However, we know very little about how specific policies influence the social conditions to prevent ill health and reduce health inequalities. Also, most social determinants of health are the responsibility of policy sectors other than "health", which means policymakers need to promote health in ALL their policies if they are to have a big impact on health. SIPHER will provide new scientific evidence and methods to support such a shift from "health policy" to "healthy public policy". OUR POLICY FOCUS We will work with three policy partners at local, regional and national level to tackle their above-average chronic disease burden and persistent health inequalities: Sheffield City Council, Greater Manchester Combined Authority and Scottish Government. We will focus on four jointly agreed policy priorities for good health: - Creating a fairer economy - Promoting mental wellbeing - Providing affordable, good quality housing - Preventing long-term effects of difficult childhoods. OUR COMPLEX SYSTEMS SCIENCE APPROACH Each of the above policy areas is a complex political system with many competing priorities, where policy choices in one sector (e.g. housing) can have large unintended effects in others (e.g. poverty). There is often no "correct" solution because compromises between different outcomes require value judgements. This means that to assess the true benefits and costs of a policy in relation to health, policy effects and their interdependencies need to be assessed across a wide range of possible outcomes. However, no policymaker has knowledge of the whole system and future economic and political developments are uncertain. Ongoing monitoring of expected and unexpected effects of policies and other system changes is crucial so failing policies can be revised or dropped. We propose to use complex systems modelling, which has been developed to understand and make projections of what might happen in complex systems given different plausible assumptions about future developments. Our models will be underpinned by the best available data and prior research in each policy area. Our new evidence about likely policy effects across a wide range of outcomes will help policy partners decide between alternative policies, depending on how important different outcomes are to them (e.g. improving health or economic growth). We will develop support tools that can visualise the forecasts, identify policies that achieve the desired balance between competing outcomes and update recommendations when new information emerges. Whilst new to public health policy, these methods are well-established in engineering and climate science. We will 1. Work with policy partners to understand the policy systems and evidence needs 2. Bring together existing data and evidence on each policy system (e.g. links between policies and outcomes, interdependencies between outcomes) 3. Explore citizens' preferences for prioritising when not all outcomes can be achieved 4. Link policies and their health and non-health effects in computer models to analyse benefits and costs over time 5. Build an interactive tool to help policy decision-making, inform advocacy action and support political debate. SIPHER's MAIN OUTCOME We will provide policymakers with a new methodology that allows them to estimate the health-related costs and benefits of policies that are implemented outside the health sector. This will be useful to our partners, and others, who want to assess how scarce public sector resources can be spent to maximise the health and wellbeing benefits from all their activities.