New Appointments,Presentations andOther News

1ContentsEHI WelcomeNewsflash

Health andDeprivation inScotland andEnglandEffectiveness ofIncome SupportPoliciesAnalysis of HealthMeasures Availablein Large SecondaryData Sets

Future ResearchPlans

2

3

H E A L T H E C O N O M I C S R E S E A R C H U N I T

Welcome

Welcome to issue5 of HERU NEWS.

This edition focuses on theEvaluation of Health

Improvement (EHI) Programme.Examples of EHI projects arepresented on pages two andthree. Other HERU NEWS andevents are discussed onthe back page.

July 2003 issue 5

EHI TEAMThe EHI team currently comprises Anne Ludbrook, MacDonaldMwale and Kathy Porter.

This edition of HERU news turnsthe spotlight on the Evaluationof Health Improvement (EHI)Programme, the most recentlyestablished of HERU’s fourprogrammes of research.

The programme addresses the efficient allocation ofresources to improve health through interventions affectinglifestyles (smoking, alcohol, diet etc.) and life circumstances(income, housing, employment etc.). Our research focuseson evaluating specific health improvement interventionsand the health impacts of public policy. As such, the focusis very much on health as opposed to health care. Thishas been a relatively neglected area in health economicsbut is of growing importance, reflecting increased policyinterest in the wider determinants of health and healthimprovement.

The immediate methodological challenge for the programmearises from the question of how to apply economicevaluation in situations where standard methods ofevaluation may not be applicable. In the area of policyinterventions, this may arise from e.g. lack of controlgroups, long time scales, macroeconomic effects. Oneprominent feature of the research programme is theanalysis of large secondary data sets as a potential solutionto some of these problems. We will also be working onthe estimation of long term benefits from short termoutcome indicators. For further information about ourresearch visit www.abdn.ac.uk/heru.

Information is provided in this Newsletter on a number ofrecent and ongoing projects, as well as some future plans.If you require more information on these projects, orindeed any issues related to the work of EHI, please emailme at a.ludbrook@abdn.ac.uk

I hope you enjoy this Newsletter, and look forward tohearing from you.

Anne LudbrookProgramme Director

4

Newsflash:Valuation and Implementation Programme (VIP)will be holding a three day workshop on the application ofdiscrete choice experiments (DCEs) to health care. The coursewill cover issues in the design and analysis of DCEs, and willinclude group work and computer based exercises. No experiencewith DCEs will be required. The course is scheduled for Novemberof this year.

Please contact Professor Mandy Ryan (tel: 01224 554965;m.ryan@abdn.ac.uk) for more information.

The aim of this analysis is to examine the extent to whichlifestyle and life circumstances impact on current healthstatus and to identify differences between Scotland andEngland. Scotland has an unenviable record as the ‘sickman of (Western) Europe’, with high mortality rates formost major diseases. The Scottish way of life, poornutrition, smoking, alcohol consumption and lack of exerciseare seen to contribute to this image. Other factors interms of life circumstances, such as income, education,and employment status, are seen as contributing to poorhealth, particularly for lower socio-economic groups. Todate, most of the research concerning health status andits determinants has been carried out in terms of mortality.This limits the analysis to negative outcomes and tooutcomes that affect a minority of the population. Thisproject explores the contribution that can be made byusing data from the British Household Panel Survey (BHPS)and the extended Scottish sample. The inclusion of theSF-36 health status measure in the BHPS offers scope toexplore the relationship between this measure of currenthealth status and factors that have previously beendemonstrated to be related to excess mortality.

Comparing mean SF-36 scores for Scotland and Englandidentifies no significant differences. This finding is consistentwith the similarities in self-reported health status foundin other surveys. The impact on health of factors such assmoking, income, education and employment status, allof which have been well-investigated with respect tomortality, are confirmed by the data analysed here. Theresults also appear to reveal that lifestyle and lifecircumstances may have a differential impact on health inScotland and England. The findings suggest that theexamination of health differences between Scotland andEngland has to consider both the different frequency ofhealth damaging or enhancing factors and the differentialimpact of those factors.

For more information on this project contact AnneLudbrook, (a.ludbrook@abdn.ac.uk) or MacDonald Mwale,(m.mwale@abdn.ac.uk)

Future Research PlansOther projects being developed within the EHI

programme include:

• Modelling the long term benefits of interventionsfrom short term outcomesThis methodological project will address a fundamental problemin the evaluation of health promotion interventions; namelythat projects rarely, if ever, have sufficiently long follow upto enable changes in health outcomes to be measured. In orderto provide comparisons with health care interventions, robustestimates of health gains based on short-term outcomes wouldbe useful. This work will provide a unifying theme across anumber of topic specific areas.

•An evaluation of the cost-effectiveness of housingimprovementsThis project will combine a review of costs and benefits ofhousing improvements with primary costing of specificinterventions for which effectiveness data are available. Itprovides an example of the contribution that economics canmake to the evidence base on public policy interventions bymodelling cost-effectiveness data.

•Valuing the benefits of housing improvementsand housing attributesFollowing on from the previous study, the aim of this projectis to value both the health benefits and other benefits ofhousing improvements. Attributes will be identified from thehousing literature and from focus groups and these will bevalued by means of a discrete choice experiment. Data onmarket values will also be sought to test the external validityof the discrete choice results.

Health and Deprivation inScotland and England

Anne Ludbrook & MacDonald Mwale, HERUIoannis Theodossiou & Vanya Gerova,Department of Economics, University of Aberdeen.

Anne Ludbrook &Kathy Porter

Although the associationbetween low income and poorhealth is widely accepted, thereis little evidence to support the effectiveness of interventions.Evidence reviewed for the Acheson Report identified onlyone trial relating to income support and the health outcomeemployed was relatively short-term; effect on low birthweight. However, the review adopted fairly restrictive criteria,in terms of study design. Case-control studies, observationalstudies and modelling of secondary data offer alternativeapproaches that may provide sufficiently robust evidence forpolicy purposes. This project is undertaking a less restrictivesystematic search of the literature to identify studies relatingincome change to health, regardless of design. At this stage,studies that simply relate income and health and the literatureon the separate role of income inequality are not beingconsidered.

Since the interventions being evaluated could cover a widerange of welfare policies, the search terms used had toencapsulate this. The search terms included health status,health disparities, social class, income, poverty, incomesupport, public policy and social support.

These search terms have enabled identification of a widerange of studies. These include: prospective observationalstudies of Citizens Advice Bureau users that had receivedincreased benefits, longitudinal surveys examining welfareto work and food stamp programmes and the impact thatchanges to retirement pension policy can have.

For more information on this project contact AnneLudbrook,(a.ludbrook@abdn.ac.uk) or Kathy Porter,(k.porter@abdn.ac.uk)

How effective are income support policies in improving health

Anne Ludbrook &MacDonald Mwale

It is unlikely that large scaleintervention studies will beundertaken to provide evidenceabout the health effects of policy interventions. Therefore,the careful analysis of secondary data sets may be the mostfeasible approach to identifying such evidence. These datasets contain an array of different health measures and theirsuitability for specific analytical purposes varies. This projectis exploring the appropriateness of different measures, initiallyin the context of income and health.

Health measures from the British Household Panel Survey(BHPS) have been examined first. Data have been used fromwave 9 of the BHPS, which includes SF-36, GHQ 12, thenumber of health problems and self assessed health. Thedistributions were divided into binary categories of good andpoor health, a technique frequently used to simplify thesubsequent analysis. The agreement between the differentmeasures on what constitutes good health is better than theagreement about poor health.

The SF-36 data from wave 9 have been analysed in comparisonwith GHQ-12 scores and self assessed health. The correlationbetween each of the SF-36 components and the 2 forms ofGHQ-12 scores reported in BHPS shows them not to beindependent but the degree of correlation between them isnot particularly high. The comparison of mean SF-36 componentscores by category of self assessed health lends some supportto the grouping used in the binary variable good health / poorhealth, with distinct differences between the groups selfassessed as good and fair. However, it also appears that thecategory of excellent, very good or good may be morehomogeneous than the category of fair or poor. The distributionof SF-36 scores within categories demonstrates this further.Comparing the distributions for those with ‘good’ health and‘poor’ health, as shown in the figure for one component,illustrates the similarity in the 3 categories which comprise‘good’ health and the difference in the distribution betweenfair and poor.

Analysis of health measures available in large secondary data sets

For more information on this project contact AnneLudbrook, (a.ludbrook@abdn.ac.uk) or MacDonald Mwale,(m.mwale@abdn.ac.uk)

Economic Evaluation Manualfor Health Improvement

The UK Health Promotion and Health Economics Forum haveproduced an economic evaluation manual. This aims to assistanyone who is interested in evaluating the process or practiceof health promotion or health improvement to understandhow an economic dimension could be added to their plannedevaluation. The manual will initially be available on the website of the Health Promotion Division of the Welsh AssemblyGovernment for consultation and feedback at the end of themonth. http://www.healthewales.org.uk

Further information can also be obtained from AnneLudbrook a.ludbrook@abdn.ac.uk

other issue 5

Appointments And Other Highlights

CONTACT US..HEALTH ECONOMICS RESEARCH UNITInstitute of Applied Health SciencesPolwarth Building,ForesterhillAberdeen AB25 2ZDTel: +44 (0) 1224-553480/553733Fax: +44 (0) 1224-550926Email: heru@abdn.ac.uk

HERU is supported by the ChiefScientist Office (CSO) of the ScottishExecutive Health Department(SEHD) The views expressed hereare those of the authors and notnecessarily those of CSO.

www.abdn.ac.uk/heru

Maria Ana Odejar will take up a five year post within theValuation and Implementation Programme (VIP) in June.This post is funded by the PPP Foundation, and is concernedwith the translation of the theoretical and methodologicalwork to the policy arena.

Shelley Farrar, a member of Behaviour, Performance andOrganisation of Care programme, has been successfullyexamined for a PhD. Shelley’s thesis: ‘Hospital ObjectiveFunctions’ examines what drives decision makers in hospitals.

Developing Economic Evaluation Methods (DEEM)

Prod

uced

by

Xpre

ss P

rint

Tel:

0122

4 87

8799

Applications welcome for Health Economics PostgraduateCertificate – Distance Learning, 2003/4

Applications are now welcome for the next intake of students to our DistanceLearning Course. This course, accredited by the University of Aberdeen andRoyal College of General Practitioners, is modular based.

• Module 1 - Introduction to Economics and Health Economics• Module 2 - Economic Evaluation - Principles and Frameworks• Module 3 - Economic Evaluation - Applications and Policy• Module 4 - Health Care Systems and Policy

The course is designed for health care professionals who want to gain arecognised qualification in health economics.

To find out more about the course visit our website or contact ProfessorMandy Ryan (m.ryan@abdn.ac.uk), Course Director, or Laura Heatherwick(lah@heru.abdn.ac.uk), Course Secretary.

Application forms can be downloaded from our website(http://www.abdn.ac.uk/heru) or obtained from the Postgraduate Registry,University of Aberdeen (Tel +44(0) 1224 273506, email ptgoff@abdn.ac.uk)Closing Date for Applications is 31st July 2003

The Unit hosted the third in this series of two day seminarswhich focus on issues relating to the methods of economicevaluation with the objectives of encouraging betterunderstanding of available methods, improving the guidanceavailable to practitioners and encouraging the use anddevelopment of state of the art methodology. The overalltheme of this seminar was costing methods. A particularhighlight was the presentation by Professor Will Manning fromthe University of Chicago. The Unit was well representedwith presentations by Mary Kilonzo and by Luke Vale.

Presentations…Evidence Policy and Practice:Public health research in Scotland

Anne Ludbrook presented a workshopon Economic evaluation of healthpromotion programmes. Anne alsopresented two papers: Healthy ‘til wedie? Self reported health status inScotland compared with England andEconomic evaluation of communitytreatment for opiate dependence: areview of the evidence

Mandy Ryan presented a paper: Prenataltesting: how women value informationand time to obtain results.

Norwegian Health Economicsconference, Solstrand

John Cairns presented a paper: Evaluationof pharmaceuticals – what can we learnfrom the UK?