8 - 12 juin 2020
Brocher Summer Academy in Global Population Health, 2020: Healthy, Wealthy, and Wise -- The Ethics of Health Valuation
- Eyal Nir, Rutgers University
- Hurst Samia, University of Geneva
- Robinson Lisa, Harvard University
- Wikler Dan, Harvard University
Government agencies and donors face significant challenges in determining how best to allocate available resources to improve population health, whether through regulations, new programs, or existing programs. Conventional methods of economic assessment, such as benefit-cost analysis (BCA) and cost-effectiveness analysis (CEA), often inform these decisions. Several innovative approaches are now being proposed to replace or supplement these conventional methods, and their ethical implications have not been thoroughly investigated and compared. Any method of economic assessment selected will have significant, complex, and nonobvious ethical implications.
This Summer Academy will explore the ethical dimensions of approaches for economic assessment of health policy, both innovative and conventional, paying special attention to approaches that measure improvements and harms using the same metric ‒ similar to conventional BCA, which uses money metrics for both benefits and costs. Examples of such innovation include the application of social welfare functions, subjective well-being (“happiness”) units, and equivalent income or healthy life-year measures. We will also explore variants that assign extra weight to benefiting the poor, the unhealthy, or the otherwise disadvantaged.
Preliminary list of confirmed speakers (additional speakers to be announced soon):
- Matthew Adler (Duke Law School and London School of Economics)
- John Broome (University of Oxford)
- David Canning (Harvard T.H. Chan School of Public Health)
- Nir Eyal (Rutgers University)
- Marc Fleurbaey (Princeton University and Institute for Global Studies)
- Daniel Hausman (University of Wisconsin–Madison)
- Samia Hurst (University of Geneva)
- Dean Jamison (University of California, San Francisco)
- Ole Frithjof Norheim (Harvard T.H. Chan School of Public Health and University of Bergen)
- Lisa A. Robinson (Harvard T.H. Chan School of Public Health)
- Daniel Wikler (Harvard T.H. Chan School of Public Health)
Schedule (tentative):Monday to Thursday, 8:30 am to 5:00 pm; Friday, 8:30 am to 2:00 pm.
Registration:Participants will be selected by the organizers based on submission of related materials. Detailed application instructions and submission deadline will be announced soon.
The Brocher Summer Academy in Global Population Health is a 5-day invitation-only working conference held biannually at the Brocher Foundation villa in Hermance, Switzerland, on the shore of Lake Geneva. The 2020 Academy, “Healthy, Wealthy, and Wise: The Ethics of Health Valuation,” will address ethical issues arising when choosing among metrics for evaluating the benefits and costs of interventions that substantially affect public health. Participants will consider both conventional and innovative approaches that estimate costs and benefits using the same metric, including monetary or nonmonetary measures. Our goal is to achieve an understanding of the ethical trade-offs that accompany the choice among these alternatives.
When assessing the allocation of resources within the health care system, CEA is commonly used to set priorities. For example, it is often applied to determine which health conditions to target and which medical care options to select. CEA typically measures effects on health and longevity using nonmonetary metrics (often quality-adjusted life year (QALY) or disability-adjusted life year (DALY) estimates) and compares them to costs measured in money terms.
But many interventions implemented outside of the health care system profoundly affect public health, often addressing the root causes of conditions that would otherwise ultimately require medical treatment. Examples include interventions that aim to control pollution, promote transportation or food safety, or provide education or other social services. For such interventions, BCA is more commonly used. In its conventional form, it measures changes in health and longevity as well as costs in money terms.
The use of money metrics in conventional BCA is often challenged on ethical grounds. One set of questions relates to how welfare is defined. For example, should we focus on satisfying individual preferences? On maximizing other measures of wellbeing? Give priority to health over other attributes of welfare? In addition, there are worries that BCA underweights benefits that accrue to the poor, ignores distributional impacts, relies on self-regarding rather than other-regarding (e.g., altruistic) values, and does not adequately distinguish between morally-desirable and undesirable preferences. Outcomes that are difficult to quantify or to value in monetary terms, such as respect for human dignity, also cannot be easily accommodated within this framework.
Innovative approaches that translate both costs and benefits into a common nonmonetary metric may, for example, rely on subjective wellbeing (“happiness”) units, social welfare functions, or equivalent incomes or healthy life years. Variants may give extra weight to outcomes for the worse off. One or more of these innovative approaches may ultimately avoid some of the (real or imagined) concerns about conventional BCA or raise other concerns. They may also led to other ethical or practical complications, such as the availability of the data needed and the fit with common usage. Exploring these advantages and disadvantages, whether real or imagined, will help determine the desirability of the innovative approaches.
This Summer Academy will bring together distinguished scholars in philosophy, public health, economics, and biomedical sciences, as well as practitioners and professionals in these fields. It will explore these issues and train a new generation of scholars in these topics and in population-level bioethics in general.