Preventing inequalities in health through better policy decisions of preventative and health promoting interventions

Research problem and specific questions
Difficult choices need to be made on which preventative and health promoting policies are to be implemented.
Economic evaluation is often used to assess cost-effectiveness of interventions. A key challenge is to develop
methods that not only consider cost-effectiveness but also inequalities in health. Another challenge is to identify
the impact of preventative interventions on health inequalities. A third challenge is to strengthen institutional
structures to ensure that both cost-effectiveness and equity concerns are considered in the practical decision-
making process.
The overall aim of this program is to develop, design, and implement an improved decision-making process for
prevention and health promotion policies into Swedish policy making institutions that systematically considers
health equity. Specific questions include:
How can the effect of prevention and health promotion interventions on health inequalities be measured
and analysed?
How can inequalities in health be incorporated into cost-effectiveness analyses (Distributional CEA,
DCEA)?
How can DCEA be used to improve existing prevention and health promotion interventions?
How can policy making institutions be enabled and supported to systematically utilise DCEA in practical
decision-making?
We will apply DCEA to important prevention and health promotion interventions.

Data and method
We will utilise the administrative and survey data infrastructure at Lund University, combined with Australian and
Swedish RCT collaborations and natural policy experiments to estimate health inequality impacts. We will
combine this with experiments eliciting preferences for redistribution, and qualitative studies of institutional
structures to provide practical tools for equity informed DCEA that is useful for policy makers.

Relevance and utilisation
The Swedish public health framework has the overarching aim of promoting good and equitable health.
Preventative and health promoting interventions play an important role yet their role in promoting equitable
health is less clear. For example, adherence to Statins that prevent cardiovascular disease is pro-rich, and men
are less likely to take up cancer screening. Furthermore, given limited healthcare budgets, difficult policy choices
need to be made as to which prevention interventions to implement. In this program, we aim to deliver a
prevention focused equity informed DCEA framework that is feasible, helpful, and regularly utilised by
practitioners.

Plan for programme realisation
The research group has the necessary inter-disciplinary skills and established collaborations with both policy
making institutions and representatives of leading prevention projects. The project’s system-wide perspective
from idea to policy decision in collaboration with Swedish policy making institutions will ensure the practical
impact of the developed tools and thus contribute towards the public health goal of good and equal health.