Public values and plurality in health priority setting

Symposium Monday 21st October
GCU London, Fashion St, Spitalfields.

On a wet and blustery day this October, Glasgow Caledonian’s London campus welcomed a flock of health economists, bioethicists, political scientists, sociologists, philosophers, public health and policy experts, gathered together to debate a particularly intractable problem: how to make health policy that takes account of people’s values when people often disagree – especially on questions of value.

The symposium was made possible with support from The Wellcome Trust.  Four papers were pre-circulated and discussants presented their thoughts. Authors were given some time to respond before discussion was opened out to the room.  The format was complemented with short talks by early career researchers. Reflections from some more experienced voices closed the day.

In the first session, Benedict Rumbold (Nottingham) discussed Lucy Frith’s (Liverpool) paper: ‘The limits of democracy in priority setting: critical reflections’. In the paper, Lucy analysed the various ways in which democracy has been used to defend and inform public input in health decision making.  The paper set out various justifications for involving the public in priority setting decisions and various democratic models that might be employed, focusing in particular on forms of ‘deliberative democracy’. It finished with five key questions: What do we mean by priority setting?  What levels of decision making are we addressing?  What types of decisions should seek public values? What are the aims of soliciting public values?  And who do we want to engage?  In response, Benedict suggested that truly democratic decision-making may be rarer than we normally think: one necessary condition being that decisions are made collectively, as a group. In Benedict’s view, therefore, not every effort to solicit public input could really classified as part of a democratic decision-making process. But this had advantages as well as disadvantages: non-democratic decision-making might lack the cache of being democratic but it also doesn’t need to reach the same standards of equality between participants.

From the purely theory to the resolutely empirical, next up was a paper by Kat Smith (Strathclyde): ‘How do public, researcher and policymaker perspectives on health inequalities compare?  A mixed methods study involving interviews, a survey and citizens’ juries’.  Vickie Charlton (Kings College London) led the discussion, posing questions about plurality in relation to health inequalities – perhaps there is more disagreement over health care priority setting and more agreement in relation to social determinants of health?  In relation to NICE appraisal committees, the consideration of facts is appropriately served by expert committees but it is less clear why they would be a legitimate body to judge or represent public values.   It would be interesting to compare judgements made by a lay committee with an appraisal committee, and whether the same views would emerge in different contexts.

The ‘lightning talks’ session, chaired by Job van Exel (Erasmus, Rotterdam) opened with developing ideas from Neil McHugh (GCU) who has a discretionary award from the Wellcome Trust and is using that time to explore questions about policy, politics and windows of opportunity for upstream policies addressing the social determinants of health.   Katie Hirono (Edinburgh) followed with a presentation of doctoral work in progress comparing the possibilities for community participation within citizens’ juries and Health Impact Assessment in Australia and the UK.

In a second mixed methods empirical paper, Jennifer Whitty (UEA) provided much material for discussion in a comparison of a discrete choice survey and two citizens’ juries in Australia, considering provision of bariatric surgery and prioritisation criteria.  Helen Mason (GCU) discussed the paper, which focussed on whether information and deliberation changed preferences, beginning with some welfare economics principles about preferences (i.e. that preferences are informed and stable) and raising questions about the concept of conviction in the paper.  Overall the paper found information and deliberation made little impact on prioritisation criteria in this context, leading to a provocative suggestion that discrete choice surveys, being a more efficient means of garnering preferences, might be sufficient – on instrumental reasoning.  The authors conclude by recommending a mixed methods, sequential approach involving a citizens’ jury (refining the prioritisation and attribute selection) followed by discrete choice survey, followed by further deliberation, reconvening the jury – although this is a resource intensive proposal.

The final paper session was led by Ellen Stewart (Edinburgh) discussing a paper by Rachel Baker and GCU colleagues that proposed an empirical framework that might be used to bring together aggregative and deliberative approaches and to better understand the patterns in public values such that policymakers might be better informed about areas of consensus or disagreement, and consistency between public values expressed at the level of principles policies or choices.  Ellen asked whether we should seek to deliver consensus within research and posed key questions about the role of the researcher in all of this.  If public values are plural is it our role to do the political work – and resolve plurality into policy recommendation – or should that work be done by people with clear lines of accountability?  Turning to the elicitation of public values we debated whether people can and should be required to give reasons for their values or choices; how the paper sets up the ‘who’ in terms of publics, patients or simply ‘people’; and what a citizens’ perspective means.   What are the political implications of asking people to set aside personal experiences and make reasoned judgements behind a ‘veil of ignorance’?

In a final session Annette Rid (NIH), Peter Littlejohns (Kings College London) and Cam Donaldson (GCU) reflected on the issues raised across the day from different perspectives.  Annette, a bioethicist, noted that there had been little discussion of Accountability for Reasonableness and that A4R is not only about process for resolving disagreement but involves more substantive requirements, such as relevance and focussing only on reasonable disagreement.  The symposium papers covered democratic/intrinsic justifications and technocratic/instrumental motivations for public involvement but there is still work to be done on conceptual matters.   Public involvement is resource intensive, so when is deliberation needed?   And when might representative, aggregative approaches be sufficient?

Peter Littlejohns drew on a wealth of experience as a clinician, decision maker and a pragmatist, through his role at NICE and subsequently as part of a Clinical Commissioning Group.  Norman Daniels served as a critical friend to NICE over the years and helped to develop their deliberative processes.  Daniels argued that unless NICE involve patients and public in appraisal then it is not truly public involvement.  Public deliberation might be seen as an end in itself in that there is inherent value in the process, but what impact does it have?   On outcomes?  On processes?  On structures?

Cam Donaldson reflected on his background as a health economist whose work focusses on managing scarcity and not taking the numbers too seriously!  Thinking about why, what, who and how, the key for economists is concern over use of scarce resources.  We returned to questions that Lucy’s paper raised in Session 1: what questions are being asked at what levels in the health system.  Thinking forwards there is a lot of common ground, as well as plurality in the room.  Cam encouraged us to keep the link between academia and decision making as core.   Although many arguments go back several decades, there are changes, and institutionalised ideas (highlighted in Kat Smith’s paper) do change.   We should seek improvement and not perfection (quoting David Cohen).

Co-organisers

Rachel Baker (Glasgow Caledonian University)
Lucy Frith (Liverpool University)
Benedict Rumbold (Nottingham University)
Ellen Stewart (Edinburgh University)
Contacts

Rachel.Baker@gcu.ac.uk 

Social Business Academia Conference 2019

PhD students from the Yunus Centre for Social Business & Health presented papers at the annual Social Business Academia held in Berlin on the 5th and 6th November 2019.

  • Assessing the ‘value’ of ‘ arts-based public health interventions for use in economic evaluation – Katerina Papadopoulou
  • Financial inclusion and refugees’ integration: an exploration using financial diaries – Fatma Ibrahim
  • Exploring the market behaviour of social businesses: a framework for macroeconomic modelling and analysis – Michael Marshall

Conference website: http://socialbusinesspedia.com/sbac/2019

Béatrice Alain delivers the 2019 John Pearce Memorial Lecture

GCU celebrated the history of social enterprise and the future of the sector at the John Pearce Memorial Lecture.

Béatrice Alain, Executive Director of the Chantier de l’économie sociale, in Quebec, delivered the 2019 keynote address in honour of one of the most influential figures in community enterprise in the UK.

This year’s event also featured the exhibition, A History of Social Enterprise in Scotland, which is part of a Scottish Government funded project to develop the Social Enterprise Collection (Scotland) at GCU.

The touring exhibition provides an introduction to the history and showcases the images and documents held within the archives.

Professor Cam Donaldson, Pro Vice-Chancellor Research at GCU, said: “Béatrice Alain is a major leader of thought and action with respect to the development of the social economy, both in Quebec and internationally.

“It was an honour to host Béatrice, and, in particular, hear her views on how to advance this hugely important sector of society.”

John Pearce, who passed away in 2011 aged 69, is viewed as a pioneer of community enterprise. The University houses an extensive archive of his work.

Global social innovation leaders attend ISIRC 2019

Glasgow Caledonian University is hosting one of the world’s biggest conferences on social innovation.

Around 300 delegates from 34 different countries are attending the 11th International Social Innovation Research Conference.

Hosted by the Yunus Centre at GCU, in conjunction with the universities of Oxford, York, and Swinburne, with the support of the Scottish Government, ISIRC 2019 attracted a record number of submissions from all over the world.

The conference, which runs for three days, coincides with Social Enterprise Week and features keynote speeches from social innovation leaders, including Professor Jürgen Howaldt, of Dortmund University, Dr Helen Haugh, of the University of Cambridge, and GCU’s Professor Simon Teasdale.

Professor Pamela Gillies, Principal and Vice-Chancellor of GCU, said: “Hosting ISIRC 2019 further confirms Glasgow Caledonian University’s position as a global leader of social innovation.

“As the University for the Common Good, we strive to empower individuals and groups to make a lasting difference to people’s lives through our pioneering research and outreach work in the communities we serve both at home and abroad.”

Opening the conference, Communities Secretary Aileen Campbell MSP told delegates: “With Brexit and austerity, we need to show leadership in Scotland and look at ways we can innovate to mitigate the challenges we face.

“We value our academic partners here at Glasgow Caledonian University, the University for the Common Good, and our vibrant third sector and social economy.”

Dr Artur Steiner, reader in social entrepreneurship at GCU, added: “There is a growing number of people who want to do something good for their communities, they want to do something good for others. 

“Social innovation aims to tackle social challenges in creative ways. Very often it’s about bringing entrepreneurial solutions and empowering local communities.”

For more information visit ISIRC Conference 2019.

– Communities Secretary Aileen Campbell MSP opens ISIRC 2019

MSBM Conference Best Paper Award

Congratulations to Michael Marshall on winning the Best Paper Award at the Mona School of Business & Management Conference, 10th-12th July 2019.

The 4th Conference International Conference on Business and Management held on the 10th-12th July 2019 brings together business practitioners, business scholars, philanthropists, the public sector, and civil society, to share best practices, interrogate theory, concepts and methodologies, and engender new ideas at the intersection of business, philanthropy, capital, innovation and society.

The Mona School of Business & Management is a key plank of the University of the West Indies (UWI) Mona’s value proposition to its constituents in Jamaica and the region. Specifically, its mandate is to be the arm of the University that facilitates effective business education and practices in the private and public sectors in order to advance the economic development agenda of Jamaica and the region.

Summary of Paper:
Author(s): Michael R Marshall; Simon Teasdale; Cam Donaldson; Olga Biosca

The paper proposes a theoretical framework for the macroeconomic analysis of social enterprises. It presents several assumptions about characteristics that are common among groups of social enterprises and are expected to influence their economic behaviour.

The paper considers social enterprises as economic agents that seek to pursue goals related to maximising the utility of their targeted beneficiaries by integrating them into labour and commodities markets. Three (3) broad representative homogeneous groups of social enterprises are proposed that, based on organisational characteristics, are further disaggregated into ten (10) representative groups.

The framework proposed enables further studies into the economic behaviour of social enterprises. Moreover, it enables the evaluation of policy impact on social enterprises as well as the effects of the wider economy on these organisations.

University to host world-leading social innovation conference

Glasgow Caledonian University will host one of the world’s leading social innovation conferences in September.

The International Social Innovation Research Conference, which attracts scholars and policy experts from all over the globe, is being organised by the Yunus Centre for Social Business and Health this year.

More than 300 delegates are expected to attend the three-day event, which runs from September 2-4, at 200 SVS in the city centre.

The 2019 conference coincides with Scotland’s Social Enterprise Week.

Keynote speakers include Professor Jürgen Howaldt, Director of Social Research Centre at TU Dortmund University, Professor Alex Nicholls, of the University of Oxford, and Dr Helen Haugh, Research Director for the Centre for Social Innovation at Cambridge Judge Business School.

A civic reception will be hosted by the Lord Provost at Glasgow City Chambers on the evening of September 2 to welcome the delegates to the city.

For more information about the 11th ISIRC visit the event’s website.

GCU to host conference on labour-market integration of migrants

Researchers exploring migrants, refugees and asylum seekers’ integration into labour markets will head to Glasgow Caledonian University in August for the SIRIUS project’s first academic conference.

Sessions across the two days will be structured around six themes, including the role of the third sector in promoting the integration of migrants, refugees and asylum seekers in European societies and labour markets, biographies of labour-market integration, and labour-market integration policies for migrants.

The Yunus Centre is the coordinator of the EU H2020-funded SIRIUS project, which aims to advance the integration of migrants and refugees in European labour markets. The project involves universities and organisations in Belgium, Czech Republic, Denmark, Finland, Greece, Italy, Switzerland and the UK.

Keynote speakers will include: Professor Christina Boswell from the University of Edinburgh, Professor Barbara Oomen from Utrecht University, GCU’s Dr Ima Jackson and Dr Amparo Gonzalez-Ferrer from the Spanish National Research Council and the Spanish Government.

The free conference will take place on campus on August 29 and 30. All staff and students are welcome to attend and registration is now open on Eventbrite.

Academia Report on Social Business 2019

An exciting Report on 15 selected YSBCs, planned and produced by YY Foundation, is a quick guide to the Academic/university Social Business Programmes and partnerships of the YSBC (Yunus Social Business Centre) Network.   It contains interviews from Nobel Laureate Professor Muhammad Yunus, Former UN Assistant Secretary General Mr Thomas Gass, Dr Ashir Ahmed, Dr Andeas Heinecke, Dr Anita Nowak and others.

For more information and to view the report, please visit the website below:

http://socialbusinesspedia.com/news/details/731