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Room: Congress Hall B
Time: Sat 10:15 AM-11:30 AM

Using the capability approach in health care decision making

Chair: Hareth Al-Janabi (University of Birmingham)

Session Description

Capabilities represent individuals’ abilities to ‘do’ and ‘be’ the things that are seen as valuable in life. The architect of the capability approach, Amartya Sen, suggests these ‘valuable things’, can range from basic functionings, such as being well nourished and having shelter to more complex functionings such as an ability to entertain and be close to people. When making social choices, the capability approach advocates evaluating individuals’ ability to achieve key functionings. This contrasts with other evaluative foci for social choices, such as resources, rights, incomes or utility (as with conventional welfare economics).

The focus on QALY maximisation in (health) economic evaluations also represents a departure from conventional welfare economics and this practise has been related to the capability approach. QALYs, however, focus on health, and capabilities can be interpreted more broadly than health alone. This suggests that the capability approach has the potential to consider the broader impacts of health and social care interventions. It is widely recognised that the capability approach is underspecified and work is needed to make it more practical for informing healthcare decision-making. Key questions include: what capabilities are relevant for decision-making? Are capabilities specific to a particular culture or context? How should one value capabilities? And can capability techniques used in human development be applied in healthcare? Each of these issues is covered in the five talks that form the basis of this organised session.

The first paper by Coast and Al-Janabi examines theoretical issues in valuing and anchoring a capability index for economic evaluation, specifically focusing on the potential to use health state valuation techniques to derive capability values. The second paper by Greco et al. is an empirical study to select and rank capabilities to help evaluate the benefits of a community-based maternal intervention in a developing country. The third paper by Kinghorn et al. examines the issue of valuing an index of capability. Focusing on a capability questionnaire for patients with chronic pain, the authors pilot a Multi-Attribute Value (MAV) method to derive values for capabilities that are not based on individuals’ choices. The fourth paper by Ariana and Alkire explores lessons from the development of a multidimensional measure of capability poverty (the Alkire-Foster method) for health economics. The paper compares the development process for the poverty measure with that of the EQ-5D, examining differences in approaches and empirical differences when the measures are applied to the same dataset. The final paper by Lorgelly explores the appropriateness of transferring capability lists from one country to another. The author suggests possible ways of retaining an element of country-specific participation in evaluation exercises, without having to develop new lists or measures for every application.

The papers in this session demonstrate practical applications of the capability approach in healthcare and raise interesting questions about the wholesale adoption of standard health economics approaches, when using the capability approach to inform healthcare policy decisions.

Session Organizer: Hareth Al-Janabi (University of Birmingham)

Presentations

1. Capability approaches in public health: will there be an effect of culture?

   Presenter: Paula Lorgelly (Monash University)

2. Using focus groups to select and rank capabilities. A case study on women’s quality of life in rural Malawi

   Presenter: Giulia Greco (London School of Hygiene and Tropical Medicine)

3. Values, death and anchoring in the capability approach: A theoretical exploration

   Presenter: Joanna Coast (University of Birmingham)

4. Valuing capability: Findings from a pilot study applying a Multi-Attribute Value Method

   Presenter: Phillip Kinghorn (University of East Anglia)