Is more health always better?
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Is more health always better?
Aki Tsuchiya
Dept of Economics and
School of Health and Related Research
Inaugural lecture 13 June 2012
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outline
• Microeconomics for non-economists
• Application to health
• How I got here
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PART ONE
Microeconomics
• The relationship between consumption goods and their effects on welfare
– Individual utility– Social welfare
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0 Food
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• Abstraction
• Quantification.
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0 Food
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Water
0 Food
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• More food and more water is better than less food and less water
• Everything else is fixed.
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Water
0 Food
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Water
0 Food
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• Collection of points that are equally good
A “contour” of utility or welfare
• Suppose there is less food
How much water would you need to make up for it?.
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Water
0 Food
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Water
0 Food
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• The gradient of the contour along it
• “Substitutes”?.
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Water
0 Food
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Water
0 Food
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• The contour is curved towards the origin
• The more of one good you already have, the less valuable is the next unit, relative to the other good.
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Water
0 Food
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Water
0 Food
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“Pareto improvement”
If there is more of one good
and everything else is unchanged
then overall that is an improvement
The contour cannot be upward sloping.
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Water
0 Food
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Water
0 Food
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• Too much of a “good” can be bad for you
• But rational individuals would not choose such a point
So the contour will not be upward sloping.
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• The same analytical tool can be used for
– individual utility or social welfare,
– based on goods or services.
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HC2
0 HC1
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– or, social welfare, based on wellbeing of different people.
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PART TWO
Health economics
• Application of microeconomics to health.
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Health2
0 Health1
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• Abstraction
• Quantification
• The grouping of people..
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Health2
0 Health1
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• Substitutes
• Suppose 1’s health declines
the same improvement in 2’s health would make up for it
…?
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• More health is good
• Equality in health is also good– Why?.
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Health2 Health1 = Health2
0 Health1
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• The relationship between
efficiency and equality
“Inequality averse contour”.
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Health2 H1=H2
0 Health1
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Health2 H1=H2
0 Health1
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Health2 H1=H2
0 Health1
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Health2 H1=H2
0 Health1
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• Equality is important
• Willingness to forego overall good• Quantification of the importance of equality.
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Health2 H1=H2
0 Health1
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• Pareto improvement
If there is more of one good
and everything else is unchanged,
then overall that is an improvement
The contour cannot be upward sloping.
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• Pareto improvement
If the already healthy get even more healthy
and everything else is unchanged,
then overall that is an improvement
The contour cannot be upward sloping
….?.
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Health2 H1=H2
0 Health1
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Health2
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Health2
Health2
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Health2
Health2 Health2
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Health2 H1=H2
0 Health1
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• Shouldn’t social welfare be higher when both parties are better off?
• Can social welfare improve when both parties are worse off?
• Maybe, if inequalities are high enough.
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Health2 H1=H2
0 Health1
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Do people think
more health is always better?
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Study country sample mode Sample size
% support upward slop.cont.
ESRC1 UK Public Interview 66 20%
IEF1 Spain Public Interview 973 57%
ESRC2 UK Public Postal 271 10%
HTA UK Public Groups 25 16%
Kaiser USA Policy holders Postal 784 14%
SDO UK NHS staff Postal 626 13%
IEF2-1 Spain Public Interview 327 51%
IEF2-2 Spain Public Interview 341 61%
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Microeconomics, health economics, and health inequalities
• Quantification of the good• Conceptualisation of the contour• Quantification of the efficiency equality
trade off• How serious are we about inequalities?.
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PART THREE
Me.
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How I got here• BA in law & politics (Kyoto)• BA in ethics & philosophy (Kyoto)• MA in ethics & philosophy (Kyoto)• MA in economics (Kyoto)• PhD in health economics (Kyoto)• Post-doc in health economics (York)• ScHARR since 2000 (Sheffield)• ScHARR + Economics since 2005.
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Joint appointment
• Faculty of Medicine Dentistry and Health– School of Health and Related Research
(ScHARR) • Health Economics and Decision Science (HEDS)
– Health Economics group
– March to August
• Faculty of Social Sciences– Department of Economics – September to February.
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What I have being doing
• Valuation of health• Societal value of health• Quantification of aversion to inequalities in
health.
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What I want to do
• Valuation of health • Societal value of health • Quantification of aversion to inequalities in
health
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What I want to do
• Valuation of health and well-being• Societal value of health and well-being• Quantification of aversion to inequalities in
health and well-being
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What I want to do
• Valuation of health and well-being• Societal value of health and well-being• Quantification of aversion to inequalities in
health and well-being• Contrasting aversion to inequality and risk.
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A few thanks
• Colleagues at ScHARR - SHEG, HEDS• Colleagues at Dept Economics
• Professor Soshichi Uchii• Professor Shuzo Nishimura• Professor Alan Williams
• My parents and partner.
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• And thanks to you.