Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment

Public health policy has two primary aims: promoting population health and reducing health inequalities. When these aims conflict, policy-makers must determine the relative importance to place on each in decision-making. We conducted a computer-based, face-to-face, choice-experiment to explore how the UK-public think government should act in these situations; and to explore how “inequality-aversion” may differ depending on the groups between which a health inequality exists and type of health an intervention provides. We tested three hypotheses: (1) the UK-public are more averse to inequalities in health between socioeconomic groups than they are to inequalities in health between neutrally labelled groups; (2) this difference is, at least in part, driven by the role non-health information plays in determining aversion to inequalities in health between socioeconomic groups; and (3) the UK-public are more willing to prioritise groups with lower lifetime health over groups with higher lifetime health if an intervention improves life-expectancy than if it improves quality-of-life. Eighty people participated in Sheffield and Hull in May/June 2019. Each participant completed three Person-Trade-Off exercises between interventions that would improve population health and reduce health inequalities, or improve population health by a larger amount but increase health inequalities. Participants were randomised to exercises involving scenarios with socioeconomic groups or neutrally-labelled groups, and each answered questions about three health-benefit types: increased life-expectancy; pain-relief; and mobility-improvement. Following the exercises, participants provided rationales for their selections. Respondents were (1) more averse to inequalities in health between socioeconomic groups than neutrally labelled groups. Participant rationales suggest (2) this divergence is partly motivated by factors other than health: for example, financial inequality between socioeconomic groups. The sample was also (3) more willing to prioritise neutrally labelled groups with lower lifetime health if an intervention improves life-expectancy rather than if it improves quality-of-life.