(1) The document describes two experimental studies that investigated how people express preferences about health inequality.
(2) The first study tested whether different questionnaire formats and administration methods influenced responses about inequality aversion. It found some evidence that concrete scenarios and online administration led to less egalitarian views.
(3) The second study examined whether "slow thinking" interventions during the questionnaire affected expressed inequality aversion.
The Burden of Disease: Data analysis, interpretation and linear regressionAmanDesai8
Decades of data about the global burden of disease (measured in disability-adjusted life years) were cleaned, interpreted and visualised. After this, a linear regression was done to create a model that can predict (up to an accuracy of 85.7%) the burden of disease in the future, adjustable to changes in demographics, health systems, diet, education, and so on.
This presentation was created as a group project during the Business Analytics course at London Business School.
GHME 2013 Conference
Session: Global and national Burden of Disease IV
Date: June 18 2013
Presenter: Theo Vos
Institute:
Institute for Health Metrics and Evaluation (IHME)
University of Washington
The Burden of Disease: Data analysis, interpretation and linear regressionAmanDesai8
Decades of data about the global burden of disease (measured in disability-adjusted life years) were cleaned, interpreted and visualised. After this, a linear regression was done to create a model that can predict (up to an accuracy of 85.7%) the burden of disease in the future, adjustable to changes in demographics, health systems, diet, education, and so on.
This presentation was created as a group project during the Business Analytics course at London Business School.
GHME 2013 Conference
Session: Global and national Burden of Disease IV
Date: June 18 2013
Presenter: Theo Vos
Institute:
Institute for Health Metrics and Evaluation (IHME)
University of Washington
2014 National Healthcare Quality and Disparities Report Chartbook on Women's ...Ernest Moy
This Chartbook on Women's Health Care is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). This chartbook includes a summary of trends in access to and quality of health care care received by women from the QDR and figures illustrating select measures of women's health care.
Prioritisation in Public Health: Overview of Health Economics ApproachesOlena Nizalova
Overview of Health Economics Approaches Towards Prioritization based on the developments from the NIHR School of Public Health Research project led by Professor David Hunter.
De las intervenciones breves a los farmacos. malaga 2015 Antoni Gual
Conferencia sobre los problemas derivados del alcoholismo y su tratamiento, impartida el 6 de marzo del 2015 en la reunión de la Red de Trastornos Adictivos, realizada el Hospital Universitario de Málaga
Evaluation of the Mother and Infant Health ProjectOlena Nizalova
This presentation is on the paper which exploits a unique opportunity to evaluate the impact of the quality change in the labor and delivery services brought about by the Mother and Infant Health Project in Ukraine. Employing program evaluation methods, we find that the administrative units participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control ones. Among the infant health characteristics, the MIHP impact is most pronounced for infant mortality resulting from deviations in perinatal period. As for the maternal health, the MIHP is the most effective at combating anemia, blood circulation and urinary-genital system complications, and late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 97 taking into account both maternal and infant lives saved as well as cost savings due to the changes in labor and delivery practices.
The Burden of Disease ( BOD) analysis describes in details the uses and effects of BOD. How to measure it. Special emphasis has been given in understanding HALY, DALY and QALY.
N.B: 1. Please download the ppt first, as the animations will act better then
2. There are few hidden slides in the presentation, which you may explore too.
Exploring empowerment transitions of women and men in BangladeshCGIAR
This presentation was given by Audrey Pereira (International Food Policy Research Institute), as part of the Annual Scientific Conference hosted by the University of Canberra and co-sponsored by the University of Canberra, the Australian Centre for International Agricultural Research (ACIAR) and CGIAR Collaborative Platform for Gender Research. The event took place on April 2-4, 2019 in Canberra, Australia.
Read more: https://www.canberra.edu.au/research/faculty-research-centres/aisc/seeds-of-change and https://gender.cgiar.org/annual-conference-2019/
2014 National Healthcare Quality and Disparities Report Chartbook on Women's ...Ernest Moy
This Chartbook on Women's Health Care is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). This chartbook includes a summary of trends in access to and quality of health care care received by women from the QDR and figures illustrating select measures of women's health care.
Prioritisation in Public Health: Overview of Health Economics ApproachesOlena Nizalova
Overview of Health Economics Approaches Towards Prioritization based on the developments from the NIHR School of Public Health Research project led by Professor David Hunter.
De las intervenciones breves a los farmacos. malaga 2015 Antoni Gual
Conferencia sobre los problemas derivados del alcoholismo y su tratamiento, impartida el 6 de marzo del 2015 en la reunión de la Red de Trastornos Adictivos, realizada el Hospital Universitario de Málaga
Evaluation of the Mother and Infant Health ProjectOlena Nizalova
This presentation is on the paper which exploits a unique opportunity to evaluate the impact of the quality change in the labor and delivery services brought about by the Mother and Infant Health Project in Ukraine. Employing program evaluation methods, we find that the administrative units participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control ones. Among the infant health characteristics, the MIHP impact is most pronounced for infant mortality resulting from deviations in perinatal period. As for the maternal health, the MIHP is the most effective at combating anemia, blood circulation and urinary-genital system complications, and late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 97 taking into account both maternal and infant lives saved as well as cost savings due to the changes in labor and delivery practices.
The Burden of Disease ( BOD) analysis describes in details the uses and effects of BOD. How to measure it. Special emphasis has been given in understanding HALY, DALY and QALY.
N.B: 1. Please download the ppt first, as the animations will act better then
2. There are few hidden slides in the presentation, which you may explore too.
Exploring empowerment transitions of women and men in BangladeshCGIAR
This presentation was given by Audrey Pereira (International Food Policy Research Institute), as part of the Annual Scientific Conference hosted by the University of Canberra and co-sponsored by the University of Canberra, the Australian Centre for International Agricultural Research (ACIAR) and CGIAR Collaborative Platform for Gender Research. The event took place on April 2-4, 2019 in Canberra, Australia.
Read more: https://www.canberra.edu.au/research/faculty-research-centres/aisc/seeds-of-change and https://gender.cgiar.org/annual-conference-2019/
This presentation offers insight on how to build health equity.
Dr. Cory Neudorf
CMHO, Saskatoon Health Region
Assistant Professor at the University of Saskatoon
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
How can tools like the Internet support changing complicated and complex behaviours like cigarette smoking? This presentation outlines the way an eHealth promotion strategy can help people quit smoking and prevent others from starting using illustrations from the Smoking Zine program developed by the Youth Voices Research Group at the University of Toronto
Overview of tackling non-communicable diseases in EnglandDr Justin Varney
A presentation I gave in 2014 to a senior delegation of officials from Iraq on our approach in England to addressing the challenge of non-communicable disease
Overweight/obesity prevention, treatment, and maintenance from childhood to a...Health Evidence™
Health Evidence hosted a 90 minute webinar on a series of five recent reviews examining overweight and obesity prevention, treatment, and weight maintenance strategies among children, youth, and adult populations.
Dr. Leslea Peirson, Review Coordinator, McMaster Evidence Review and Synthesis Centre, presented key messages from the following five reviews:
Peirson, L., Fitzpatrick-Lewis, D., Morrison, K., Ciliska, D., Kenny, M., Ali, M. U., et al. (2015).Prevention of overweight and obesity in children and youth: A systematic review and meta-analysis.. CMAJ Open, 3(1), E23-E33.(2)
Key findings: Behavioural prevention interventions are associated with improvements in weight outcomes in mixed weight child/youth populations
Peirson L., Fitzpatrick-Lewis D., Morrison K., Warren R., Ali M.U., & Raina P. (2015). Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis.. CMAJ Open, 3(1), E35-E46.(2)
Key findings: Behavioural treatment interventions for overweight and obese children and youth are associated with a significant reduction in BMI compared control groups
Peirson, L., Douketis, J., Ciliska, D., Fitzpatrick-Lewis, D., Ali, M. U., & Raina, P. (2014). Prevention of overweight and obesity in adult populations: A systematic review.. CMAJ Open, 2(4), E268-E272.(2)
Key findings: No clear conclusions were found to determine whether behavioural interventions lead to weight-gain prevention and improved health outcomes in normal-weight adults
Peirson, L., Douketis, J., Ciliska, D., Fitzpatrick-Lewis, D., Ali, M. U., & Raina, P. (2014). Treatment for overweight and obesity in adult populations: a systematic review and meta-analysis.. CMAJ Open, 2(4), E306-E317.(2)
Key findings: Behavioural and pharmacologic + behavioural treatments for overweight and obesity in adults lead to clinically important reductions in weight and incidence of type II diabetes in pre-diabetic populations
Peirson, L., Fitzpatrick-Lewis,D., Ciliska, D., Ali, M. U., Raina, P., & Sherifali, D. (2015). Strategies for weight maintenance in adult populations treated for overweight and obesity: a systematic review and meta-analysis.. CMAJ Open, 3(1), E47-E54.(2)
Key findings: Overweight and obese adults can benefit from interventions for weight maintenance following weight loss
Do height and BMI affect human capital formation? Natural experimental evidence from DNA. CHE seminar presentation by Neil Davies, University of Bristol 12 June 2020
Healthy Minds: A Randomised Controlled Trial to Evaluate PHSE Curriculum Deve...cheweb1
CHE Seminar presentation 16 January 2020, Alistair McGuire, Department of Health Policy, LSE. Evaluating the Healthy Minds program: The impact on adolescent’s health related quality of life of a change in a school curriculum
Baker what to do when people disagree che york seminar jan 2019 v2cheweb1
Public values, plurality and health care resource allocation: What should we do when people disagree? (..and should economists care about reasons as well as choices?) CHE Seminar 21 January 2019
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Top 10 Best Ayurvedic Kidney Stone Syrups in India
How reliable are value judgements about health inequality aversion? Results of two experimental studies
1. Shehzad Ali
Centre for Health Economics
University of York
Value judgements about health
inequality aversion: results of
two experimental studies
1
2. Research Team: Richard Cookson (York); Shehzad Ali (York);
Miqdad Asaria (York); Aki Tsuchiya (Sheffield)
With thanks to: Ruth Helstrip, James Koh, Matthew Robson,
Paul Toner and participants of the piloting session
Conference papers:
Ali, Cookson, Tsuchiya and Asaria (2014). Eliciting value
judgements about health inequality aversion: testing for framing
effects. Paper presented in HESG Sheffield in Jan 2014.
Cookson, Ali, Tsuchiya and Asaria (2015). Value judging, fast
and slow: an experimental study of the effects of slow thinking
interventions on expressed health inequality aversion. Paper to
be presented in HESG Leeds in Jan 2015.
3. Equity vs efficiency
• Value judgements are important for making
policy decisions
• Equity relates to fairness in the the
distribution of health and health care as
opposed to maximising the total sum
(efficiency)
• Potential trade-offs between efficiency and
equity
4. Public concern for equity, beyond “a
QALY is a QALY”
1. Severity of illness
2. Children vs. adults
3. Socioeconomic inequality in health
• Evidence suggests public concern for all three
issues
Dolan, P, Shaw, R, Tsuchiya, A and Williams, A. (2005). QALY
maximisation and people's preferences: a methodological
review of the literature Health Economics 14(2): 197-208.
5. Empirical social choice
• In recent years, the inter-
disciplinary field of
“empirical social choice”
has emerged to investigate
social norms about fairness
(Gaertner and Schokkaert,
2012; Konow, 2003)
• Not economic lab
experiments but
psychological experiments
to investigate people’s
views about fairness
6. Quantifying equity concerns
• Typically use questionnaire methods to quantify
the magnitude of inequality aversion in different
contexts (Shaw et al 2001, Abásolo, Tsuchiya,
2004, 2013; Dolan, Tsuchiya, 2011)
• The concern for inequality can be explicitly
incorporated in decision analysis using
methods such as Distributional Cost-
effectiveness Analysis (Asaria et al 2014) or
other approaches (Johri and Norheim 2012) in
the literature
7. Potential cognitive biases
• Estimates of inequality aversion are likely to be
influenced by cognitive biases
• We conducted two experimental studies to
assess reliability of value judgements about
health inequality aversion obtained from a
standard questionnaire instrument
9. Questionnaires
• A standard questionnaire is presented in four
formats
Large gains (in years): Individual level TO1
Small gains (in hours): Individual level TO2
Small gains ABSTRACT (in years): population level TO3
Small gains CONCRETE (in years): population level TO4
10. 0 10 20 30 40 50 60 70 80
Richest Fifth
2nd Richest
Middle Fifth
2nd Poorest
Poorest Fifth
Expected Years of Life in Full Health
England and Wales
Quality adjusted life expectancy at birth
74
62 12
Source: Asaria, M, Griffin, S, Cookson, R, Whyte, S, Tappenden, P. (2012). Cost-equality analysis of
health care programmes – a methodological case study of the UK Bowel Cancer Screening Programme.
Paper presented to Health Economists Study Group in Exeter, January 2013.
13. Shaw, Dolan, Tsuchiya, Williams, Smith and Burrows, 2001.
"Development of a questionnaire to elicit public preferences
regarding health inequalities," Working Papers 040cheop,
Centre for Health Economics, University of York
14.
15. Final choice
Programme A “dominates” Programme B:
more health for the rich and same health for the poor.
... But Programme B reduces health inequality.
16. Five views about health inequality
1. Pro-rich (AAAAA)
2. Health maximisers (EAAAA)
3. Weighted prioritarians (BXXXA)
4. Maximin (BBBBA)
5. Strict egalitarians (BBBBB)
19. Scenario for small population-level
“concrete” question
19
-0.001
0.000
0.001
0.002
0.003
0.004
0.005
Most Deprived IMD 4 IMD 3 IMD 2 Least Deprived
IncrementalPerPersonQALYsComparedtoNoIntervention
targeted universal
Bowel Cancer screening: Impact of Redesign on Health
21. (1) Small versus
unrealistically large health
inequality reductions
(2) Population-level versus
individual-level descriptions
of health inequality
reductions
(3) Concrete versus
abstract intervention
scenarios
(4) Online versus face-to-
face mode of administration
(5) “Academic versus non-
academic” background
Large Individual
Questions TO1
Small Individual
Questions TO2
Small Population
Questions TO3
(abstract)
Small Population
Questions TO4
(concrete)
22. (1) Small versus
unrealistically large health
inequality reductions
(2) Population-level versus
individual-level descriptions
of health inequality
reductions
(3) Concrete versus
abstract intervention
scenarios
(4) Online versus face-to-
face mode of administration
(5) “Academic versus non-
academic” background
Large Individual
Questions TO1
Small Individual
Questions TO2
Small Population
Questions TO3
(abstract)
Small Population
Questions TO4
(concrete)
23. (1) Small versus
unrealistically large health
inequality reductions
(2) Population-level versus
individual-level descriptions
of health inequality
reductions
(3) Concrete versus
abstract intervention
scenarios
(4) Online versus face-to-
face mode of administration
(5) “Academic versus non-
academic” background
Large Individual
Questions TO1
Small Individual
Questions TO2
Small Population
Questions TO3
(abstract)
Small Population
Questions TO4
(concrete)
24. (1) Small versus
unrealistically large health
inequality reductions
(2) Population-level versus
individual-level descriptions
of health inequality
reductions
(3) Concrete versus
abstract intervention
scenarios
(4) Online versus face-to-
face mode of administration
(5) “Academic versus non-
academic” background
Large Individual
Questions TO1
Small Individual
Questions TO2
Small Population
Questions
(abstract) TO3
Small Population
Questions TO4
(concrete)
25. (1) Small versus
unrealistically large health
inequality reductions
(2) Population-level versus
individual-level descriptions
of health inequality
reductions
(3) Concrete versus
abstract intervention
scenarios
(4) Online versus face-to-
face mode of administration
(5) “Academic versus non-
academic” background
Large Individual
Questions TO1
Small Individual
Questions TO2
Small Population
Questions TO3
(abstract)
Small Population
Questions TO4
(concrete)
26. Pro-rich >7
Health maximiser 7
Weighted prioritarian 6.5
Weighted prioritarian 6
Weighted prioritarian 5.5
Weighted prioritarian 5
Weighted prioritarian 4.5
Weighted prioritarian 4
Weighted prioritarian 3.5
Maximin 3
Strict egalitarian <3
AAAAA
=AAAA
BAAAA
B=AAA
BBAAA
BB=AA
BBBAA
BBB=A
BBBBA
BBBB=
BBBBB
Non-
Egalitarian
Strong
Egalitarian
{
{
Response classification
B
A
A
A
A
27. Recruitment and Administration
Administration:
5-hour Saturday session in York city centre
•facilitated discussions in groups of five or six;
•individual completion of the questionnaire
Recruitment of face-to-face sample:
Advertisements in a monthly Your Local Link and 810 leaflets distributed
door-to-door in 10 of the most deprived streets in York.
Payment = £70
On-Line
Recruitment:
1) Website of the Centre for Health Economics at the University of York,
2) Social media,
3)York Local Link magazine
4) Jiscmail mailing list for health economists,
Payment = £0
Respondents divided into Non-academic (n = 83) & Academic (n = 46)
(n=129)
Face-to-face (n=52)
28. Results
Table 1: Descriptive statistics of the discussion group and on-line survey respond
Discussion group
(N = 52)
Online group:
non-academic
(N = 83)
Online group:
academic
(N = 46)
Baseline Statistic n Statistic n Statistic n
Male (%) 40.4% 21 32.5% 27 32.6% 15
Age (%)
Under 18 0.0% 0 0.0% 0 2.2% 1
18-34 21.2% 11 18.1% 15 39.1% 18
35-49 13.5% 7 15.7% 13 39.1% 18
50-64 38.5% 20 42.2% 35 17.4% 8
65+ 26.9% 14 24.1% 20 2.2% 1
Mean deprivation quintile (mean)
(1 = most deprived; 5 = most affluent)
3.71 51 3.17 83 3.39 33
Social attitude statements* (mean)
(1= strongly agree; 5= strongly disagree)
The creation of the welfare state is one
of Britain's proudest achievements.
1.42 52 1.36 82 1.37 46
Government should redistribute income
from the better-off to those who are less
well off.
2.86 51 2.05 82 2.07 46
*1 suggests most egalitarian and 5 suggests most non-egalitarian
Descriptive statistics of the discussion group and on-line survey respondents
29. Pro-rich (AAAAA);
Health maximiser (=AAAA);
Weighted prioritarian (BXXXA);
Maximiner (BBBB=);
Strict egalitarian (BBBBB)
** The vertical line indicates the
location of the median
respondent
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
O3: Small-
population…
O2: Small-average
question
O1: Large-average
question
Percentage of respondents
Online mode: academic
Pro-rich
Health maximiser
Weighted
prioritarian
Maximiner
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
D4: Concrete
question
D3: Small-
population…
D2: Small-average
question
D1: Large-average
question
Percentage of respondents
Discussion mode
Pro-rich
Health maximiser
Weighted
prioritarian
Maximiner
Strict egalitarian
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
O3: Small-
population…
O2: Small-average
question
O1: Large-average
question
Percentage of respondents
Online mode: non-academic
Pro-rich
Health maximiser
Weighted
prioritarian
Maximiner
Distribution of responses across principles of health justice
Results (cont.)
30. Table: Statistical tests (D = Discussion group; O = Online group)
First hypothesis Difference in % that are
strong egalitarian*
Difference in % that are
non-egalitarians*
Wilcoxon signed-rank equality test
on matched dataǁ
Large-average vs small-population question (D1 – D3) -0.8% (p = 0.937) -0.2% (p = 0.937) z = 0.458; p = 0.647
Large-average vs small-average question (D1 – D2) +9.2% (p = 0.377) -5.4% (p = 0.225) z = 1.964; p = 0.050
Large-average vs small-population question (O1 – O3) +2.6% (p =0.765) -3.8% (p =0.281) z = 0.979; p = 0.328
Large-average vs small-average question (O1 – O2) +2.46% (p =0.773) -5.1% (p =0.167) z = 1.915; p = 0.056
Second hypothesis Difference in % that are
strong egalitarian*
Difference in % that are
non-egalitarians*
Wilcoxon signed-rank equality test
on matched dataǁ
Small-average vs small-population question (D2 – D3) -9.9% (p = 0.350) +5.2% (p = 0.271) z = -1.313; p = 0.189
Small-average vs small-population question (O2 – O3) +0.1% (p =0.991) +1.4% (p =0.767) z = 0.311; p = 0.756
Third hypothesis Difference in % that are
strong egalitarian*
Difference in % that are
non-egalitarians*
Wilcoxon rank-sum equality test
on unmatched dataǂ
Small-population vs concrete question (D3 – D4) +18.6% (p = 0.080) -11.6% (p = 0.049) z = 3.244; p = 0.001
Fourth hypothesis Difference in % that are
strong egalitarian*
Difference in % that are
non-egalitarians*
Wilcoxon rank-sum equality test
on unmatched dataǂ
Large-average question (D1 – O1) +17.3% (p =0.059) -0.6% (p = 0.838) z =1.338; p = 0.181
Small-average question (D2 – O2) +10.6% (p =0.292) -0.3% (p = 0.954) z = 0.987; p = 0.324
Small-population question (D3 – O3) +20.7% (p =0.036) -4.1% (p = 0.329) z = 2.022; p = 0.043
Fifth hypothesis Difference in % that are
strong egalitarian*
Difference in % that are
non-egalitarians*
Wilcoxon rank-sum equality test
on unmatched dataǂ
Large-average question (Na1 – A1) +23.8% (p = 0.012) -6.6% (p = 0.114) z = 2.930; p = 0.003
Small-average question (Na2 – A2) +29.2% (p = 0.004) -6.9% (p = 0.283) z = 2.506; p = 0.012
Small-population question (Na3 – A3) +26.8% (p = 0.006) -1.05% (p = 0.838) z = 2.489; p = 0.013
Results (cont.)
* Strong egalitarians = maximiner or strict egalitarian; Non-egalitarians = pro-rich or health maximisers.
31. Conclusion (study 1)
• No evidence of effects of small versus unrealistically
large health inequality reduction scenarios (1) or
population-level descriptions (2)
• Evidence of an anti-egalitarian concrete scenario
effect (3)
• Weak evidence of an anti-egalitarian online mode of
administration effect (4): “socially desirable” face-to-
face responses?
• Clear evidence of an anti-egalitarian academic
sample selection effect (5): academics may be more
comfortable with cognitively demanding tasks?
32. Conclusion (cont.)
• Reassuring that no clearly significant effects of using
small rather than unrealistically large, or using
population-level rather than individual-level
presentations health gains
• The other effects are potential cause for concern
• Weakness:
– Gain egalitarianism over outcome egalitarianism
(Tsuchiya, Dolan, 2009). However, identical framing with a
fixed ratio of gains has been maintained
– Order of questions was not randomised
34. Thinking, fast and slow
• Questionnaire methods are
vulnerable to “fast thinking”
cognitive biases
• Kahneman defines two
systems:
– System 1: Fast, automatic,
emotional, subconscious
– System 2: Slow, effortful,
calculating, conscious
• Respondents may use simple
“like-dislike” approach rather
than carefully weighing the
competing values
35. “Slow thinking” interventions
• Video animation
– exposing subjects to rival points of view
• Interactive computer-based version of the
questionnaire
– Providing feedback on implied trade-offs between
health inequality and sum total health
36. Study design
Paper questionnaire
Paper group
Video animation
Paper questionnaire
Interactive questionnaire
Video animation
Interactive questionnaire
Interactive group
37.
38.
39.
40.
41. Yearsfortherich
Years for the poor
Indifference curves representing
different views on equity
With thanks to Matthew Robson
44. Recruitment and Administration
Administration:
5-hour Saturday session in Heslington East
Campus
Individual completion of the questionnaire
Recruitment:
N = 60 (two sessions with 30 participants each)
Advertisements in a monthly Your Local Link.
Payment = £50
45. Results
Sample characteristics
Paper group
(N = 29)
Interactive group
(N = 30)
Characteristic Statistic n Statistic n
Male (%) 38% 11 47% 14
Age (%)
18-34 31% 9 20% 6
35-49 7% 2 27% 8
50-64 38% 11 20% 6
65+ 24% 7 33% 10
Deprivation quintile group (mean)
(1 = most deprived; 5 = most affluent)
3.41 29 3.7 30
Social attitude statements(1) (mean)
(1= strongly agree; 5= strongly disagree)
The creation of the welfare state is one of Britain's
proudest achievements.
1.79 29 1.77 30
Government should redistribute income from the
better-off to those who are less well off.
3.03 29 3.10 30
Note: (1) 1 suggests most egalitarian and 5 suggests least egalitarian
46. Results (cont.)
Figure 1: Inferred principles of health justice by question and sample design* ** ***
* Complete case analysis, n = 30 in the interactive group, n = 29 in the paper group
** See table 2 for the response classification system corresponding to the five principles of health justice
*** The vertical line indicates the location of the median respondent
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Post-video interactive
Pre-video interactive
Post-video paper
Pre-video paper
Percentage of respondents
Pro-rich
Health maximiser
Weighted prioritarian
Maximin
Strict egalitarian
47. Figure 2: Cumulative distribution of responses (1), (2)
Notes
(1)
Complete case analysis, n = 30 in the slider group and n=29 in the paper group
(2)
The trade off point represents the point of indifference in terms of the gain to the poorest fifth in programme
A, as shown in the response classification system in table 2.
Wilcoxon rank sum test
[p = 0.000]
0.000.200.400.600.801.00
>8 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 2 <2
Trade off point (number of years)
group = paper group = interactive
Wilcoxon rank sum test
[p = 0.004]
0.000.200.400.600.801.00
>8 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 2 <2
Trade off point (number of years)
group = paper group = interactive
Wilcoxon sign rank test
[p = 0.000]
0.000.200.400.600.801.00
Cumulativeresponseproportion
>8 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 2 <2
Trade off point (number of years)
Pre-video, paper Post-video, paper
Wilcoxon sign rank test
[p = 0.945]
0.000.200.400.600.801.00
Cumulativeresponseproportion
>8 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 2 <2
Trade off point (number of years)
Pre-video, interactive Post-video, interactive
Pre-video vs. post-video (interactive)Paper vs. interactive (post-video)
Pre-video vs. post-video (paper)Paper vs. interactive (pre-video)
Results (cont.)
49. Table 3: Random effects ordered probit models of the five ordered response categories
Variables Without
respondent
covariates
With
respondent
covariates
Interactive ( 𝛽1) -2.32*** -2.18***
(0.417) (0.407)
Post-video ( 𝛽2) -1.49*** -1.50***
(0.344) (0.343)
Interactive*post-video ( 𝛽3) 1.70*** 1.70***
(0.451) (0.451)
Joint test of ( 𝛽2 + 𝛽3):
Video effect on interactive
0.21
(0.28)
0.20
(0.28)
Joint test of ( 𝛽1 + 𝛽3):
Interactive post-video vs. paper post-video
-0.63*
(0.34)
-0.49
(0.34)
Intercept 1 (strict egalitarian) -3.39***
(0.459)
-4.09***
(0.766)
Intercept 2 (maximin) -2.70*** -3.43***
(0.399) 0.727)
Intercept 3 (weighted prioritarian) -0.92*** -1.67**
(0.283) (0.649)
Intercept 4 (health maximiser) -0.23 -0.96
(0.264) (0.631)
Observations 118 118
Number of individuals 59 59
Notes:
(1) A positive coefficient indicates a difference in a more egalitarian direction
(2) Standard errors in parentheses; *** p<0.01, ** p<0.05, * p<0.1
(3) The respondent covariates were four age groups, sex and five deprivation quintile groups; coefficients on
the covariates are suppressed as none were significant.
Results (cont.)
Notes:
(1) A positive coefficient indicates a difference in a more egalitarian direction
(2) Standard errors in parentheses; *** p<0.01, ** p<0.05, * p<0.1
(3) The respondent covariates were four age groups, sex and five deprivation quintile groups; coefficients on
the covariates are suppressed as none were significant.
50. -.4-.3-.2-.1
0
.1.2.3.4
Pro-rich Health max Trader Maximin Strict Egal
Inferred principles of health justice
(post-video paper minus pre-video paper)
Change in predicted probabilities: ordered probit model
Figure: Marginal effects on probabilities, from ordered probit model
Results (cont.)
51. Conclusion (study 2)
• Both “slow thinking” interventions produced
significantly less egalitarian responses
• Paper group (before vs after): strong egalitarian
response reduced from 75% to 21%
– Due to strong egalitarians switching to weighted
prioritarians
• Interactive vs paper: strong egalitarian responses
were 23% vs 75%
• Fast thinking effect: treating equality as a “sacred
value”
• Potential “Social desirability bias”?
52. Conclusion (overall)
• Standard methods of eliciting value
judgements about inequality aversion are
vulnerable to cognitive biases
• “Slow thinking” interventions may reduce pro-
egalitarian bias
• Expressed inequality aversion is vulnerable to
scenario effect, sample selection and, to some
extent, on mode of administration