Good health comes at a cost: measuring and valuing health and quality of life
Professor Aki Tsuchiya is a Health Economist working between the School of Health and Related Research and the Department of Economics, and her work looks at how we value good health.
How important is good health? Most people are likely to think their health, and the health of their community, is of paramount importance to living a good life. But what health economics tells us is that health has a finite value, and there are always trade-offs and sacrifices to be made.
Professor Aki Tsuchiya is a Health Economist working between the School of Health and Related Research and the Department of Economics. She said: ‘I’ve always liked the idea of putting numbers on things that you’re not supposed to put numbers on, and one way I started to do that was to try and value different types of health.’
Let’s start with an example. ‘If I asked if you would like a headache or to feel sick, you’d probably choose neither,’ Professor Tsuchiya said, ‘but if you had a splitting headache that was causing you pain, would you choose to take painkillers that would help stop that pain, but might make you feel nauseous? Alternatively, if you were suffering from car sickness, would you take a pill to remove the nausea, even if it might give you a headache?’
Professor Tsuchiya uses this concept of comparing different types of health or pain across her work, giving each example a value in order to understand how bad and how much worse one is than the other.
‘The purpose of giving numbers to elements of health is important because it brings in economic logic which says that you can’t do everything. You have to make choices and trade offs,’ said Professor Tsuchiya.
‘For example, suppose there is a drug that could take care of severe pain but is extremely costly, then the NHS would have to decide what to sacrifice in order to fund that drug, or they’d have to choose not to fund it. So the key question policy makers and organisations have to make is whether a drug is worth our while and worth whatever it is that we have to give up instead?’
Another area of research that Professor Tsuchiya specialises in is health inequality, whether in the prevalence of diseases or expected age of death. Major inequalities can be caused by socio-economic class, ethnicity, geography or a range of other factors.
‘Ask a Public Health expert about health inequalities and of course, they will say that inequality is a problem and it’s important to reduce them. But as an economist, I say ‘how important is it to reduce them? What will you sacrifice in order to do that?’
On average, people in the UK live to 81. Wealthier people are more likely to live to approximately 85years old and poorer, more disadvantaged people are more likely to die younger, around 75 years old, causing a ten year gap in life expectancy based on socio-economic status.
‘If we remove that inequality, how much average life expectancy would we be willing to give up?’ Professor Tsuchiya asks. ‘Suppose we could reduce inequalities, but that meant life expectancy would be down by two years to 79. Would that life expectancy be worth giving up in exchange for improving equality?
‘So that’s the type of trade off I like to explore, because depending on how much average you’re willing to forego in exchange for equality, that would tell me how important you think that equality is and by putting numbers on them, policy makers can say whether big decisions in healthcare are worth taking or not.’
As part of her research, Professor Tsuchiya conducts empirical work to evoke the preferences of members of the public and policy makers. Some of them are large scale quantitative on-line surveys, and others are smaller scale qualitative discussion groups. The quantitative data are analysed to arrive at the trade-offs explained above, and the qualitative data helps understand why people make the kinds of trade-offs they make.
‘As part of this work, it’s important for us to understand how policies are formed and how policy makers work with data and evidence. The team looks at what type of evidence gets the best reception and how much technical information is appropriate for the audience, in order for them to be able to make effective decisions,’ she said.
Professor Tsuchiya has been working on her current project, on System-science Informed Public Health and Economic Research for Non-communicable Disease prevention, or a year with a further four years’ development before completion. The team consists of academics and researchers based at the Universities of Glasgow, Leeds, Manchester, Sheffield and Strathclyde; and policy partners from Sheffield City Council, Greater Manchester Combined Authority and the Scottish Government. The core team splits the work across eight project streams and aims to deliver novel evidence of the costs and benefits of the complex, interlinked and long-term consequences of policy decisions. This will help policy partner organisations identify opportunities for the strategic alignment of policies across relevant sectors and give the confidence to change the way major investment decisions are made.
Professor Tsuchiya said: ‘The research we conduct is based on the concept that ‘the conditions in which we are born, grow, live, work and age are key drivers of health and health inequalities. Preventing ill health related to these “social determinants of health” requires well-coordinated policies across many sectors, such as the economy, welfare, housing, education and employment’(SIPHER.ac.uk).’