Source of published guidance | Key points | Theoretical paradigm underpinning guidance |
---|---|---|
Kelly et al. (2005) [3] | Limited evidence of what interventions will work to reduce inequalities in health; evaluating single initiatives may fail to capture effects that rely on multiple interventions; behaviour needs to be changed in order to secure uptake of the intervention; difficult to isolate cause and effect due to multi-faceted nature of public health interventions; biological variation in clinical trials are much narrower than social variation in which public health interventions take place; public health interventions can change during their implementation; at what point is an intervention judged to have succeeded? | As they advocate the use of cost-benefit analysis it could be said that the authors come from a theoretical base of welfarism. |
Weatherly et al. (2009) [4] | Attribution of effects: likely to be fewer controlled trials of public health programmes–other approaches will be necessary; measuring and valuing outcomes: other outcomes, apart from QALYs, may be relevant e.g. external outcomes not confined to the health sector alone; identifying inter-sectoral costs and consequences: costs and benefits may fall on many parts of the public sector; incorporating equity considerations: in many cases the main objective of the intervention is to reduce health inequalities. | An extra-welfarist theoretical paradigm is used here in terms of concentrating on measuring benefits not adequately captured by QALYs. |
Payne et al. (2012) [5] | Valuation and Evaluation Research Theme (VERT) demonstrates that complex public health interventions have broader objectives than just health gain; maximising health gain is not a sufficient objective to achieve once cost and benefits outside the healthcare sector are recognised; public health guidance is more pragmatic than for clinical interventions and includes using alternative outcome measures (e.g. life years gained, cases averted) as well as QALYs; the authors suggest a move away from defining health benefits in terms of utility or QALY maximisation to consider non-health benefits and a measure of capability (or empowerment). | A strong theoretical basis to this guidance is the capability approach. This is coupled with an extra-welfarist perspective where wider costs and benefits are considered. |
Marsh et al. (2012) [34] | Reviews methods that could be employed to capture wider range of benefits generated by public health interventions; economists need to embrace a wider set of modelling techniques to capture the effects of public health interventions the selection of which should be facilitated by the production of better data on behavioural outcomes; more valuation paradigms should be explored such as the capabilities and subjective well-being approach. | The authors take an extra-welfarist perspective whereby wider costs and benefits are considered along with a wider range of modelling techniques. Behavioural economics is also a key theoretical underpinning where modelling of behavioural outcomes is considered. |