Economic Analysis of Cost-Effectiveness of Community Engagement to Improve Health

Liberty of association is one of the building blocks of a democratic society, and presumes that community engagement in a democratic society is universally a good thing. This presumption is not subject to economic analysis, but the issue considered here is whether community engagement is a better vehicle for improving the community’s health than another approach. The problems of applying the standard framework of economic evaluation to consider this issue include: multiple perspectives and time frames; identifying and costing activities and specifically the costs of volunteer time; identifying and measuring benefits; identifying comparator communities; how the intervention interacts with the community and therefore identifying end gainers and losers and eventually how the former might compensate the latter; attribution of any changes in community (health) to the approaches and methods of community engagement (CE); quantification across the whole range of community engagement. We consider three possible ways to apply the tools of economic appraisal to assess community engagement, these being: developing a typology; relying just on effectiveness data from the literature and guesstimating costs; and developing a scenario based on partial information about both costs and benefits. We assess the impact of community engagement on health and health behaviour; the contribution of community engagement to supporting social networks and social capital formation; and other impacts specific to a particular situation, including collective and ideological outcomes (whether of citizenship, obedience or political literacy). We conclude with a set of questions to ask of any CE intervention.