Developing a wellbeing measure for public health evaluations: integrating capabilities and happiness

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

Public health programmes are considered to be complex because they often require people to change their behaviour and involve interventions that cut across multiple sectors. For this reason, public health programmes are more likely to generate a wide range of benefits, including health gains. This makes the evaluation of such programmes a challenge, particularly when compared to clinical interventions that are focused on testing a spcific drug, for example. Conventional measures used in economic evaluations focus on one dimension of wellbeing (health) and there are concerns that assessing public health programmes with such measures may be too narrow. Important benefits of the programme could be missed which could result in a failure to capture the full value of the intervention.

To respond to this challenge, there are calls to develop new methods to measure wellbeing. Two main approaches to the measurement of wellbeing have thus far gained traction: the capability approach and happiness research. Despite their promising features for the assessment of wellbeing, the use and interpretation of these approaches face significant challenges, especially in a low-income settings. This study aims to tackle these challenges and to answer the following questions:

1) Do materially deprived people report high or low level of happiness? Are happiness measures developed for high-income countries suitable in a low-income context?
2) Do these two concepts of wellbeing (capabilities and happiness) complement each other, or are they the same thing?
3) Can we combine capabilities and happiness into a unique measure of wellbeing?
4) Can we use this wellbeing measure for evaluating public health programmes in a low income setting?

The wellbeing measure developed during the fellowship will be able to provide a broader picture of the effects of complex public health interventions, such as mental health programmes, which are not easily captured with standard evaluation methods. While the measure is intended to support evaluators in low-income countries, the methodology developed in this study will also be of interest for researchers and policy makers in middle-and high-income countries. It will contribute to the global debate on how to measure progress in society.

Technical Summary

The nature of public health interventions raises methodological challenges for their evaluators. One of the challenges is how to measure and value outcomes 'beyond health'. The aim of this fellowship is to develop a broad outcome measure based on two wellbeing approaches (capabilities and happiness) for the evaluation of public health interventions in a low-income setting. The research is structured in four sections.

1. To explore the determinants of happiness in Malawi. A microeconometric model will be built using happiness as outcome and with a number of explanatory variables. A series of multivariate regression analyses will be performed to explore the association between happiness and health status, material wealth and socio-economic background.
2. To examine the conceptual and empirical relationship between the capability approach and happiness. The methods will draw on latent variable structural models to explore whether and which capabilities have an impact on happiness. The model will specify a system of equations for jointly explaining happiness and capabilities. It will also allow for latent personality traits affecting both, to take account of any unobservable heterogeneity.
3. To develop a multidimensional measure that combines both approaches to wellbeing. Building on methods developed during my PhD, a series of focus groups with women of reproductive age will be organised with the Public Health Foundation of India to explore the concept of wellbeing.
4. To explore the feasibility of using the wellbeing measure in the evaluation of a community based maternal depression programme in India. One of the methodological challenges will include how to aggregate the changes in wellbeing for people whose initial wellbeing is low with the changes for those whose initial wellbeing is high.

The wellbeing measure developed during the fellowship will be ready to be used for the evaluation of public interventions targeting women of reproductive age.

Planned Impact

The research carried out during the fellowship is anticipated to benefit to a large audience beyond the academic community, including international organisations and decision-makers and through these, the wider public. The research will benefit the following people and institutions:
a) Myself: through the knowledge and skills acquired during the training that this fellowship will provide I will be able to continue developing to become an independent researcher leader in health economics. It will also help me to develop and reinforce networks with other researchers with the same interests, and this will lead to future collaborations and joint projects.
b) LSHTM. It will benefit from this research through a more diversified research portfolio, and high-quality research outputs. I will also attend the health economics monthly meeting in order to share the methods and the results.
c) Academia. The measurement of wellbeing is of strong interest to health economists, but also to a wider audience including political scientists, welfare economists, and statisticians. This research will contribute to knowledge producing new insights into the measurement of wellbeing and deprivation. It will offer new methodological approaches and will contribute to the wider debate on how to measure progress in society. as detailed in the Communication Plan, I intend to present the findings at several UK and international workshops and conferences.
d) Policy makers. The findings of the research will address the shortcomings of standard evaluation tools in the identification, measurement and valuation of non-health outcomes in public health. The final output of the research will be an instrument capable of capturing the broader effects of complex programmes that can be used by policy makers to aid decision over value-for-money. The instrument will be designed to capture multi-sector effects thus interested policy makers are not only in the health sectors, but also in education, labour, economy etc.
e) UNDP and OECD. The Human Development report is willing to include happiness measures alongside the standard human development indicators (health, education, GDP) although there is little evidence on the validity of these measures in low-income countries. The OECD has developed guidelines on how to measure happiness, but so far these have been used only by high-income countries. This research will bring new evidence of the suitability of happiness measures in low-income settings, and their relationships with human development indicators.

Publications

10 25 50

publication icon
Greco G (2018) Power, Social Exclusion and the "Good Life": the Importance of Measuring What Really Counts in Journal of Human Development and Capabilities

publication icon
Greco G (2018) Setting the Weights: The Women's Capabilities Index for Malawi. in Social indicators research

publication icon
Greco G (2018) Development, Validity, and Reliability of the Women's Capabilities Index. in Journal of human development and capabilities

 
Description Techincal advisor for the 2019 Global Happiness and Well-Being Policy Report produced by the Global Happiness Council (GHC), chapter "Priority Setting in Healthcare Through the Lens of Happiness"
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
URL http://www.happinesscouncil.org
 
Description Honorary Social Scientist 
Organisation MRC/UVRI Uganda Research Unit on AIDS
Country Uganda 
Sector Public 
PI Contribution Teaching at Makerere School of Economics and School of Public Health.
Collaborator Contribution Data collection with MRC/UVRI
Impact Teaching at Makerere School of Economics and School of Public Health. Data collection with MRC/UVRI
Start Year 2016
 
Description Honorary Social Scientist 
Organisation Makerere University
Department School of Public Health
Country Uganda 
Sector Academic/University 
PI Contribution Teaching at Makerere School of Economics and School of Public Health.
Collaborator Contribution Data collection with MRC/UVRI
Impact Teaching at Makerere School of Economics and School of Public Health. Data collection with MRC/UVRI
Start Year 2016
 
Description Visiting Lecturer 
Organisation Makerere University
Country Uganda 
Sector Academic/University 
PI Contribution I am a visiting lecturer at Makerere Univesiry School of Economics. I participate at seminars at the School of Economics and School fo Public Health, and I engage in the Academic life of both faculties. I also teach and supervise MSc and PhD students.
Collaborator Contribution n/a
Impact Teaching Health Economics
Start Year 2016
 
Description Convener for the Early Career Researchers Interest Group for the International Health Economics Association (IHEA) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact The ECR Special Interest Group (SIG) is a platform for ECRs in health economics, enabling them to draw on the knowledge and experience of their peers from around the globe and providing access to information, advice and support from more experienced health economists through activities organized by the SIG. We hope that the ECR SIG will also help young researchers to make international connections with others who are focusing on similar topics.

Currently, 30% of iHEA's members have registered within the student and ECR category.
Year(s) Of Engagement Activity 2017,2018,2019
URL https://www.healtheconomics.org/page/ECRSIG
 
Description Coordinator of the Thematic Working Group on Health & Disability for the Human Development and Capabilities Association 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This thematic group is a network of social scientists, physicians, public health practitioners, and philosophers interested in health and disability issues from a capability perspective. Through the past several conferences on the capability approach and now through our growing network of participants worldwide, group participants have begun to examine a number of issues at the nexus of health, disability and capability including, but not exclusive to, questions of social justice; resource allocation; HIV/AIDS and antiretroviral therapy; reproductive health; impairment, disability and special needs; health system financing and access; capabilities and functionings; responsibility; disability and poverty; aging; disability and income conversion; genetics; gender disparities and health; social determinants of health; and micro-credit participation and health.
Year(s) Of Engagement Activity 2017,2018,2019
URL https://hd-ca.org/thematic_group/health-and-disability