Monetising Health and Wellbeing outcomes - when is it appropriate?

1. Monetising health and wellbeing
as an outcome of advice?
Nick Abercrombie¹, Peter Cressey¹, Michelle Farr¹, Beth Jaynes¹
and Sue Milner²
Department of Social and Policy Sciences¹,
Politics, Languages & International Studies (PoLIS)²

2. Evidence from CAB clients
Baseline data (151 client responses): on a scale of 1-10,
this problem is affecting me... (average = 8.6)
Interview transcripts:
• Impact of problem
“it was just demoralising, completely demoralising and it
had a big impact on my mood”C004;
• Effects: fatigue, stress, sleeplessness, depression
“yeah, it did make me feel a bit anxious, well it still does.
It’s a bit depressing, hopefully things are progressing a
bit now but it is hard to explain to be honest with you”
C011;
• Physical health deterioration; suicidal thoughts

3. Using standard well-being measurements
Warwick Edinburgh Mental Well Being Scale
Shortened in HEPS (Scotland) project to 7 questions, self-
assessed, scaled 1-5 (none of the time, rarely, some of
the time, often, all of the time):
1. I’m optimistic about the future
2. I’ve been feeling useful
3. I’ve been feeling relaxed
4. I’ve been dealing with problems well
5. I’ve been thinking clearly
6. I’ve been feeling close to people
7. I’ve been able to make up my own mind about things

4. Findings
Modest increases in wellbeing from phase 1 (initial advice
session) to first project interview
Bigger increases over a longer period to second project
interview, esp. ability to deal with problems (Q2 and Q4:
+33%), clarity of thought (Q5: +30%), and relaxation
(Q3: +27%)

5. How to monetise?
State proxy – client going to GP for mental health problem, reported
improvement as result of CAB intervention
Individual proxy - client self-reported feelings of depression, anxiety or
other mental health issues (but not just stress), reported improvement
as a result of CAB intervention.
One year duration, attribution & deadweight both usually calculated at
50%. Attribution was client specific where clients precisely gave this
outcome an attribution score.
Examples: C030 (debt) depression GP treated, without CAB ‘health would
have completely collapsed’, client attributed 100% to CAB,
improvement in WEMWBS score; client 069 treated for depression,
attributed to problem, but CAB advice did not lead to resolution of
(employment) problem no change in WEMWBS score
Proxy values: improved mental health £2,014 saving to state (proxy based
on costs of treatment), £585 to individual (willingness to pay/ utility
value); physical health with depression £1,493 saving to NHS (co-
morbidity); lack of sleep £102 saving to state based on sickness-
related absenteeism (lower final values when deadweight and
attribution applied)

6. Questions
• Did our method capture increases in wellbeing?
• Interview data:
"I’ve stopped drinking, even social drinking. The problem
was controlled and I feel happier and do not dread the post
coming in the morning. The CAB gave me that.”
[Without the CAB] … I would have ended up in the mental
ward because of the stress and loss”
• Could we have done this differently?
• Use of General Health Questionnaire GHQ12 to assess
individual changes rather than population changes
• Shortcomings of WEMWBS - population measurement
tool