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Unformatted text preview: 1 Economic Evaluation of the Social Determinants of Health: An Overview of Conceptual and Practical Issues Don Kenkel , PhD Department of Policy Analysis and Management Cornell University Ithaca NY USA And Marc Suhrcke , PhD University of East Anglia Norwich UK January 2011 Draft prepared for the World Health Organization. Chris Brown of the WHO has provided useful guidance and comments. J. Catherine Maclean and Kerri Lavelle have provided excellent research assistance. We are also most grateful to the extensive comments received by Richard Cookson, Guillermo Paraje and Gran Dahlgren. The authors are solely responsible for all views contained in this Report, and for its remaining gaps and limitations. 2 1. Introduction Policy makers, on behalf of the public they represent, face difficult choices about allocating scarce societal resources to investments that address the social determinants of health (SDH). The WHOs Commission on the Social Determinants of Health (CSDH) describes the SDH as including the conditions of daily life in which people are born, grow, live, work and age, including the health system. Specific interventions to improve the conditions of daily life include for instance investments in early childhood education, environmental quality, health care, housing, nutrition, schooling, and work conditions. This Report reviews and discusses a number of conceptual and practical issues around the economic evaluation of SDH interventions. In light of the truly vast and heterogeneous domain of what SDH comprise, as laid out by the CSDH, we cannot, however, claim to provide sufficient detail on the intricacies involved in the economic evaluation of all possible SDH interventions. The use of economic arguments, in particular regarding the value for money of suggested interventions, has so far been a low priority in recent major SDH initiatives, such as in the WHOs CSDH (Epstein et al, 2009). 1 At the same time, the need to add an economic perspective to the analysis of SDH and of health inequalities has been increasingly recognized in the public health community (Lavin & Metcalfe 2009). Because any economic evaluation hinges on the evidence of effectiveness in the first place, a considerable share of our discussion focuses on the challenge of assessing, whether a given intervention works (and if so, for whom it does). It is well known that compared to 1 There was some consideration of certain economic aspects in the recent England-specific Strategic Review of Health Inequalities in England post-2010 (The Marmot Review, Marmot 2010), in that there was an attempt to estimate the expected economic benefits of reducing health inequalities (Mazzuco, Meggiolari & Suhrcke 2010)....
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This note was uploaded on 04/28/2011 for the course PAM 4380 taught by Professor Kenkel during the Spring '08 term at Cornell University (Engineering School).
- Spring '08