Operationalising Sen's Capability Approach: An application in public health - PowerPoint PPT Presentation

Loading...

PPT – Operationalising Sen's Capability Approach: An application in public health PowerPoint presentation | free to view - id: 77a0cb-YmFlO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Operationalising Sen's Capability Approach: An application in public health

Description:

Operationalising Sen's Capability Approach: An application in public health Dr Paula Lorgelly Health Economics Appraisal Team (HEAT) Public Health and Health Policy – PowerPoint PPT presentation

Number of Views:214
Avg rating:3.0/5.0
Slides: 65
Provided by: Author421
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Operationalising Sen's Capability Approach: An application in public health


1
Operationalising Sen's Capability Approach An
application in public health
  • Dr Paula Lorgelly
  • Health Economics Appraisal Team (HEAT)
  • Public Health and Health Policy

2
Outline of seminar
  • Economic evaluations of public health
    interventions
  • An example
  • Sens Capability Approach
  • Operationalising the approach as a means of
    measuring outcome
  • Remaining challenges and future research

3
Cost effective public health
  • UK background, Wanless (2004) recommended using
    a consistent framework to evaluated the cost
    effectiveness of interventions initiatives across
    health care and public health
  • 2005 NICEs remit expanded, now considers public
    health interventions

4
Amended NICE reference case
  • Their approach to methods states
  • resources available in the health service and
    other available public funds
  • Cost consequence analysis to supplement cost
    utility analysis where appropriate

5
Challenges of producing NICE PH guidance
  • Measuring benefit
  • Population based interventions
  • Equity vs. efficiency
  • Economic perspective
  • Time horizons
  • Quality of evidence
  • Cost effectiveness threshold
  • Chalkidou et al (2008) Health Economics

6
Challenges of applying standard approaches
  • Methodological challenges of
  • Attributing outcomes to interventions
  • Measuring and valuing outcomes
  • Incorporating equity considerations
  • Identifying intersectoral costs and consequences
  • Public Health Research Consortium, York

7
Measuring and valuing outcomes
  • QALYs are the reference case
  • Preference for using the EQ5D
  • No adjustment for equity
  • QALYs have their benefits
  • Public health vs health care interventions
  • But does the QALY framework (or descriptive
    system) capture all relevant outcomes

8
My (HEATs) involvement
  • Section of Public Health and Health Policy
  • Strong collaborations with the Medical Research
    Council Social and Public Health Sciences Unit
    (MRC SPHSU)
  • Including a joint appointment (Liz Fenwick)
  • Involved in evaluating a range of social and
    public health interventions
  • Majority of which are complex

9
Complex Public Health Interventions
  • Complex interventions
  • developing overtime
  • heterogeneous
  • made up of various interconnecting parts
  • Complex outcomes
  • Complex evaluation
  • Comparator group
  • Randomisation
  • Perspectives
  • Timescales

10
An Example GoWell
  • Glasgow Community Health and Well-being Research
    and Learning Programme
  • Multi-site, prospective study
  • Multi-intervention
  • Core stock refurbishment
  • Area transformation
  • Special areas
  • Peripheral estates
  • Baseline survey follow-ups till 2013

11
(No Transcript)
12
GoWell outcomes
  • Individuals health and well-being
  • Physical health
  • Mental health
  • Health behaviours
  • Use of health services
  • Sense of control and self-esteem
  • Neighbourhoods and communities
  • social participation, personal social networks
  • neighbourhood outcomes

13
GoWell economic evaluation
  • Cost-effectiveness (utility)
  • Which outcome?
  • Cost consequences
  • Implicit decision making

14
Key question
  • How best to measure and value the outcomes of
    social and public health interventions?

15
Capability Approach
  • Amartya Sen (1979, 1985)
  • Rejects normative evaluations based exclusively
    on commodities, income, or material resources
  • Resources are the means to enhance peoples
    well-being
  • Resource-based theories do not acknowledge that
    people differ in their abilities to convert
    resources into capabilities

16
  • Wellbeing should be measured not according to
    what individuals actually do (functioning) but
    what they can do (capability)

17
Benefits of using the CA
  • Evaluative space
  • Richer set of dimensions
  • QALYs have one dimension health
  • Focus of evaluation
  • Equality of capability
  • Equity, rather than health maximisation

18
Challenges of using the CA
  • How to operationalise a highly theoretical
    approach?
  • What is the set of capabilities?
  • How to estimate an index of capability?
  • How to value this index?

19
Operationalising the CA
  • Literature largely conceptual
  • No gold standard with which to operationalise the
    CA
  • Value in operationalising
  • Issues
  • How can we choose relevant capabilities?
  • How can evaluations be sensitive to cultures?

20
Nussbaums Central Human Capabilities
Life
Practical reason
Bodily health
Affiliation
Bodily integrity
Other species
Senses, imagination and thought
Play
Emotions
Control over ones environment
21
Nussbaums Central Human Capabilities
Being able to live to the end of a human life of
normal length . . . not dying prematurely . . .
Practical reason
Life
Bodily health
Affiliation
Bodily integrity
Other species
Senses, imagination and thought
Play
Emotions
Control over ones environment
22
Nussbaums Central Human Capabilities
Life
Practical reason
Bodily health
Affiliation
Bodily integrity
Other species
Being able to move freely from place to place
being able to be secure against violent assault,
including sexual assault . . . having
opportunities for sexual satisfaction and for
choice in matters of reproduction
Senses, imagination and thought
Play
Emotions
Control over ones environment
23
Nussbaums Central Human Capabilities
Life
Practical reason
Bodily health
Affiliation
Bodily integrity
Other species
Being able to live for and in relation to others,
to recognize and show concern for other human
beings, to engage in various forms of social
interaction being able to imagine the situation
of another and to have compassion for that
situation having the capability for both justice
and friendship. . . . Being able to be treated as
a dignified being whose worth is equal to that of
others.
Senses, imagination and thought
Play
Emotions
Control over ones environment
24
Nussbaums Central Human Capabilities
Life
Practical reason
(A) Political being able to participate
effectively in political choices that govern
ones life having the rights of political
participation, free speech and freedom of
association . . . (B) Material being able to
hold property (both land and movable goods)
having the right to seek employment on an equal
basis with others . . .
Bodily health
Affiliation
Bodily integrity
Other species
Senses, imagination and thought
Play
Emotions
Control over ones environment
25
Anand and colleagues
  • Programme of work operationalising the capability
    approach
  • Sought to exploit secondary collected data,
    specifically the BHPS
  • Addition of further indicators
  • List of some 60 capabilities aligned with
    Nussbaums ten (referred to as the OCAP)
  • Research explores links between life
    satisfaction/ happiness/wellbeing and capability

26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
This Project
  • This project aimed to
  • further develop and refine the survey instrument
    as proposed by Anand et al
  • validate the instrument for use in public health
    evaluations
  • propose how future evaluations might employ the
    capability approach

32
Phases/Stages
  • Phase I, Stage I
  • FG group discussions
  • Analysis of the YouGov questionnaire
  • Phase I, Stage II
  • Semi-structured interviews
  • Pilot postal survey
  • Phase II
  • Interviews and postal survey (for validation)
  • Phase III (now a PhD studentship)
  • Develop an index

33
Phase I, Stage I findings
  • Focus Groups
  • Issues of
  • Question interpretation
  • Ambiguous questions
  • Answer/response options
  • Question ordering
  • Questionnaire refinement

34
Phase I, Stage I findings (cont.)
  • Factor analysis (YouGov questionnaire)
  • Factor loadings onto Nussbaums list
  • Correlations amongst multiple measures
  • Raised issues of measuring this so-called
    capability
  • yes or no, i.e. does or does not have the
    capability
  • or is there a degree of capability
  • Questionnaire reduction

35
Item Reduction/Refinement
  • Key changes included
  • Change option responses
  • Merged questions
  • Removed multiple questions,
  • Used more established questions
  • Refined the wording
  • Changed the ordering of the question
  • 64 specific capability questions to 43 specific
    capability questions

36
Phase I, Stage II findings
  • Semi-structured interviews
  • Further clarification
  • Insight into respondents understanding of
    capabilities
  • Pilot postal survey interview
  • Analysed quantitatively

37
Further reduction/refinement
  • Ordering
  • Understanding and interpretation
  • Face validity for retention
  • Measured capability rather than functioning
  • e.g. I appreciate and value plants, animals and
    the world of nature
  • ? I am able to appreciate and value plants,
    animals and the world of nature

38
Phase II
  • 64 capability questions
  • ? 43 capability questions
  • ? 18 capability questions
  • 27 question questionnaire (24 questions on
    capability and demographics 3 validation
    questions)
  • Sent to 1000 Glaswegian homes 400 invites for
    interviews

39
Final version
  • Postal and interview survey, N198
  • Characteristics of the sample
  • white (97),
  • female (62),
  • employed full-time (50),
  • some form of higher education (45) or no
    qualifications (24),
  • married (30), never married (34),
  • no dependent children (69),
  • no religion (35), Presbyterian (26), Catholic
    (28),
  • household income of under 30,000 per year (61),
  • average age 46 years old (range 19 to 91 years)

40
Deprivation of sample
41
1 Life
  • Until what age do you expect to live, given your
    family history, dietary habits, lifestyle and
    health status?

42
1 Life II
  • Deviations in life expectancy

43
2 Bodily Health
  • Does your health in any way limit your daily
    activities compared to most people of your age?

44
3 Bodily integrity
  • Please indicate how likely you believe it to be
    that you will be assaulted in the future
    (including sexual and domestic assault)?

45
4 Senses, imagination thought
  • I am free to express my views, including
    political and religious views

46
5 Emotions
  • In the past 4 weeks, how often have you lost much
    sleep over worry?

47
6 Practical reason
  • I am free to decide for myself how to live my
    life

48
7 Affiliation
  • Outside any employment, in your everyday life,
    how likely do you think it is that you will
    experience discrimination

49
8 Species
  • I am able to appreciate and value plants, animals
    and the world of nature

50
9 Play
  • In the past 4 weeks, how often have you been able
    to enjoy your recreational activities?

51
10 Control over ones environment
  • I am able to influence decisions affecting my
    local area

52
(No Transcript)
53
Aggregation
  • How to develop an index given
  • multi-dimensionality and
  • the incompatible nature of the dimensions?
  • Not uncharted water, Human Development Index has
    its foundations in the capability approach
  • Ideally, should consider the relative importance
    of each domain and preferences/tradeoffs for each
    dimension

54
Preference elicitation
  • Range of techniques available
  • Standard gamble
  • Time trade off (TTO)
  • Rating scale
  • Discrete choice experiments (DCE)
  • Preference weights allow economic evaluations to
    consider technical and allocative efficiency
  • But whos preferences?
  • Issues of adaptation and expert opinion

55
(gross) Estimate of capability
  • Give each capability equal weight (that is each
    question not each domain)
  • Maximum possible score of 18
  • Mean 12.44, range 3 17.75

56
Index of capability
57
Health/Wellbeing vs Capability
58
Inequalities and Capability
Mean Std Dev Minimum Maximum p-value
Gender
Male 12.53 2.41 5.50 17.75
Female 12.40 2.62 3.00 17.25 0.761
Age
Under 40 12.50 2.50 3.00 17.75
40 to 60 12.30 2.65 4.50 17.25
Over 60 12.70 2.42 6.50 16.00 0.772
Deprivation
deciles 1 to 6 13.45 1.79 8.50 16.50
deciles 7 to 9 12.88 2.43 4.50 17.75
decile 10 11.92 2.66 3.00 17.25 0.006
Income
less than 10k 10.73 2.70 4.50 14.75
10k to 19k 11.85 2.66 3.00 17.25
20k to 40k 13.25 1.95 7.50 16.50
more than 40k 13.94 1.54 10.50 17.75 lt0.001
59
(No Transcript)
60
Capability vs Functioning
Interviewee Adequately nourished Expressing views Love, care support Planning of one's own life Influencing decisions affecting local area
1 C C C C F
2 C C F F C
3 C C C F C
4 C C F C C
5 F C F F C
6 C C F C F
7 F C C F C
8 C C C C C
9 C C C C C
10 C C C C C
11 F F F F C
12 F C C C C
13 C C C C C
14 F C C C C
15 C C F C C
16 C C NOT SURE C C
17 C C F BOTH C
18 C F C F F
61
Implementing the approach
  • Questionnaire/instrument appears valid and
    sensitive
  • More appreciative evaluation space (for public
    health interventions)
  • Issues of aggregation
  • Valuation approaches
  • Whose preferences
  • Anchoring
  • Acceptability to decision makers
  • QALYs (EQ5D) are the norm

62
Future research
  • ESRC/TSG studentship
  • More participatory approach
  • Consult with key stakeholders (public, academics
    and govt advisors)
  • Core set of capabilities
  • Test a range of valuation methodologies
  • Validation of instrument in a number of nested
    GoWell studies

63
Discussion points
  • Weighting dimensions, preference or otherwise?
  • More detailed quantitative analysis, latent
    class? further reduction?
  • (in)Compatibility of the dimensions problematic?
  • Super-QALY? Or a WALY?

64
  • Contact details
  • p.lorgelly_at_clinmed.gla.ac.uk
  • Final report available at
  • www.gcph.co.uk
About PowerShow.com