We introduce a summary wellbeing measure for economic evaluation of cross‐sectoral public policies with impacts on health and living standards. We show how to calculate period‐specific and lifetime wellbeing using quality‐adjusted life years based on widely available data on health‐related quality of life and consumption and normative assumptions about three parameters—minimal consumption, standard consumption, and the elasticity of the marginal value of consumption. We also illustrate how these three parameters can be tailored to the decision‐making context and varied in sensitivity analysis to provide information about the implications of alternative value judgments. As well as providing a general measure for cost‐effectiveness analysis and cost‐benefit analysis in terms of wellbeing, this approach also facilitates distributional analysis in terms of how many good years different population subgroups can expect to live under different policy scenarios.

We present a novel dynamic microsimulation model that undertakes stochastic transition modelling of a rich set of developmental, economic, social and health outcomes from birth to death for each child in the Millennium Birth Cohort (MCS) in England. The model is implemented in R and draws initial conditions from the MCS by re-sampling a population of 100,000 children born in the year 2000, and simulates long-term outcomes using life-stage specific stochastic equations. Our equations are parameterised using effect estimates from existing studies combined with target outcome levels from up-to-date administrative and survey data. We present our baseline projections and a simple validation check against external data from the British Cohort Study 1970 and Understanding Society survey.

PurposeWe review quantitative methods for analysing the equity impacts of health care and public health interventions: who benefits most and who bears the largest burdens (opportunity costs)? Mainstream health services research focuses on effectiveness and efficiency but decision makers also need information about equity.Design/methodology/approachWe review equity-informative methods of quantitative data analysis in three core areas of health services research: effectiveness analysis, cost-effectiveness analysis and performance measurement. An appendix includes further readings and resources.FindingsResearchers seeking to analyse health equity impacts now have a practical and flexible set of methods at their disposal which builds on the standard health services research toolkit. Some of the more advanced methods require specialised skills, but basic equity-informative methods can be used by any health services researcher with appropriate skills in the three core areas.Originality/valueWe hope that this review will raise awareness of equity-informative methods of health services research and facilitate their entry into the mainstream so that health policymakers are routinely presented with information about who gains and who loses from their decisions.

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This paper presents new evidence that foreign development aid only boosts growth in aid recipient countries with sufficiently low levels of income inequality, with less income inequality associated with better aid effectiveness. This finding holds irrespective of other determinants of aid effectiveness such as institutional quality, trade openness, budget balance, inflation, colonial history, geography and climate. I focus on aid intended to boost growth, by excluding categories of aid with other primary aims and by focusing on aid from OECD countries rather than China, India, Russia and the Gulf states. I use growth regressions using data on 53 countries over the years 1971-2015, controlling for numerous country-level factors previously associated with aid effectiveness. An increase of one standard deviation in the aid-to-GDP ratio is associated with nearly 2 percentage points of higher growth in the least unequal aid recipient countries but has no significant effect on growth in those recipient countries with inequality above the median level. The results are robust to sensitivity analysis using different control variables and specifications, and can be replicated using different estimators to address dynamic panel bias. This new evidence also supports the hypothesis, which I have developed in previous theoretical work, that economic inequality increases the power of rich elites to re-purpose aid expenditure in ways that further their own narrow economic interests. JEL Classification: F35 – O15 – O47 – O1 – O43

Background Early childhood poverty is associated with poorer health and educational outcomes in adolescence. However, there is limited evidence about the clustering of these adverse outcomes by income group. Methods We analysed five outcomes at age 17 known to limit life chances – psychological distress, self–assessed ill health, smoking, obesity, and poor educational achievement – using data from the longitudinal UK Millennium Cohort Study (N=15,245). We compared how single and multiple outcomes were distributed across quintiles of household income in early childhood (0-5 years) and modelled the maximum potential benefit of tackling the income gradient in these outcomes. Findings Children from the poorest households were 12.7(95% CI 6.4-25.1) times more likely than those from the richest to experience four or five adverse adolescent outcomes, with poor educational achievement and smoking showing the largest single risk ratios – 4.6(95% CI: 4.2-5.0) and 3.6(95% CI 3.0-4.2), respectively. We modelled hypothetical absolute and relative poverty elimination scenarios, as well as an income inequality elimination scenario, and found these would yield maximum reductions in multiple adolescent adversity of 5%, 30%, and 80% respectively. Interpretation Early childhood poverty is more strongly correlated with multiple adolescent adversity than any single adverse outcome. Reducing absolute poverty alone is not sufficient to eliminate the life-long burden of multiple adversity, which disproportionately impacts children across the bottom three-fifths of the income distribution. An ambitious levelling up agenda needs co-ordinated multi-agency action to tackle the complex interacting factors generating the steep social gradient in multiple adolescent adversity.

BackgroundMany public policies have potentially important but poorly understood long-run consequences for health, income, public cost and inequality over the lifecourse. We aim to improve understanding by (i) developing a novel discrete time lifecourse microsimulation model of an English birth cohort, and (ii) using it to extrapolate the lifecourse consequences of a training programme (‘Incredible Years’) for parents of young children exhibiting antisocial behaviour.Methods Model: We simulate a cohort of 100,000 English children born in 2000–1, using data from the Millennium Cohort Study (MCS) to describe their characteristics and family circumstances. We model the year-by-year evolution of lifecourse outcomes using difference equations parameterised using quasi-experimental evidence and calibrated against longitudinal survey data. Difference equations vary across four key life stages (0–4, 5–24, 25–69 and 70+) to represent the causal pathways linking family circumstances, cognitive and socio-behavioural skills formation, conduct disorder and educational attainment in childhood to diverse later life outcomes including poverty, imprisonment, social security benefits, residential care, unhealthy behaviour, physical illness, mental illness and mortality. Intervention: We assume training is offered to parents of all children at high-risk of conduct disorder at age 5. Effects on the parent-reported Strengths and Difficulties Questionnaire Conduct Subscale are drawn from a participant-level meta-analysis, with effect size differentiated by child gender, baseline behaviour problems and parental mental health. Primary outcomes: We summarise lifetime benefits using ‘good life-years’ which go beyond conventional quality-adjusted life-years to adjust for income as well as illness. We examine differential benefits by parental income, mental health and baseline behavioural problems.ResultsWe estimate that parent training increases the lifetime wellbeing of a child at risk of conduct disorder by an average of 2.43 [95% CI 1.03 to 3.83] good years. On average, children with parents suffering mental health problems gain 8.04 [95% CI 6.75 to 9.34] good years; children with severe baseline behavioural problems gain 5.37 [95% CI 3.97 to 6.77] good years; children that are poorest 20% at birth gain on average 3.58 [95% CI 2.63 to 4.54] years and children that are richest 20% at birth gain on average 1.73 [95% CI 0.77 to 2.69] years.ConclusionParent training can yield substantial long-run benefits in years of good life gained, especially for children from disadvantaged families, though uncertainty remains about effectiveness for parents who do not seek help.

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