Working across sectors for the good of global health

This horizon scanning article explores the complexities involved in international medical travel, whereby patients travel abroad to receive required health care, and as a consequence, the possibilities for integrated global health policies

Optimising nudges and boosts for financial decisions under uncertainty

Abstract: Behavioural interventions that directly influence decision-making are increasingly popular policy tools. Two prominent interventions used are nudges, which promote an optimal choice without restricting options, and boosts, which promote individual capabilities to make more informed choices. Direct comparison is a critical step toward understanding the populations and contexts where they may be most efficient, or potentially complementary toward improving their effectiveness. Two trials in the US and Serbia (N = 1423) tested a series of choices under uncertainty using both nudge and boost interventions. In a replication setting, hypothetical and consequential decisions are used. Findings indicate that disclosure nudges and boosts, unlike social nudges, promote more advantageous financial decisions. Furthermore, the effects of disclosure nudges and boosts generally differ depending on loss and gain framing—boosts promoted more advantageous decisions under gain frames while disclosure nudges did so under loss frames. Finally, boosts were typically more effective for those who initially made suboptimal choices and sociodemographic factors did not mediate the effectiveness of the interventions. These insights provide clarity to highly nuanced, complex patterns across population behaviours in the context of financial choice under uncertainty and considerable implications for the design of interventions for policies that impact population behaviours

Applying Behavioural Insights to Policy: From Evidence to Practice

Evidence from the behavioural sciences is increasingly used to inform and improve policy around the world across many domains. These behavioural insights can be used for a number of purposes, such as improving communication to the public, encouraging healthier behaviour, and increasing the uptake of social services that improve life outcomes. However, not all evidence can be equally applied to any policy; the strength of the evidence and suitability for the situation at hand should be assessed case by case and ideally more evidence within the new context should be established. This report presents an approach to incorporating behavioural insights into policy using a number of examples while leveraging original work on mental health, trust, and decision-making in Lebanon. The aim is not to present a specific recipe or set of recommendations, but to share general concepts and examples for consideration in establishing a behavioural policy framework.This publication is funded through the UK Research and Innovation GCRF Research for Health in Conflict (R4HCMENA); developing capability, partnerships and research in the Middle and North Africa ES/P010962/1

The Cost-Effectiveness of Lowering Permissible Noise Levels Around U.S. Airports

Aircraft noise increases the risk of cardiovascular diseases and mental illness. The allowable limit for sound in the vicinity of an airport is 65 decibels (dB) averaged over a 24-h ‘day and night’ period (DNL) in the United States. We evaluate the trade-off between the cost and the health benefits of changing the regulatory DNL level from 65 dB to 55 dB using a Markov model. The study used LaGuardia Airport (LGA) as a case study. In compliance with 55 dB allowable limit of aircraft noise, sound insulation would be required for residential homes within the 55 dB to 65 dB DNL. A Markov model was built to assess the cost-effectiveness of installing sound insulation. One-way sensitivity analyses and Monte Carlo simulation were conducted to test uncertainty of the model. The incremental cost-effectiveness ratio of installing sound insulation for residents exposed to airplane noise from LGA was $11,163/QALY gained (95$93,054/QALY gained). Changing the regulatory standard for noise exposure around airports from 65 dB to 55 dB comes at a very good value

Key Considerations for an Economic and Legal Framework Facilitating Medical Travel

Medical travel has the capacity to counter increasing costs of healthcare by creating new markets and increased revenue for health services, potentially benefiting local populations, economies and health care systems. This paper is part of a broad, comprehensive project aimed at developing a Global Health Access Policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations when setting up a GHAP include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those travelling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel

Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries

Background Recent trends on measurement of well-being have elevated the scientific standards and rigor associated with approaches for national and international comparisons of well-being. One major theme in this has been the shift toward multidimensional approaches over reliance on traditional metrics such as single measures (e.g. happiness, life satisfaction) or economic proxies (e.g. GDP). Methods To produce a cohesive, multidimensional measure of well-being useful for providing meaningful insights for policy, we use data from 2006 and 2012 from the European Social Survey (ESS) to analyze well-being for 21 countries, involving approximately 40,000 individuals for each year. We refer collectively to the items used in the survey as multidimensional psychological well-being (MPWB). Results The ten dimensions assessed are used to compute a single value standardized to the population, which supports broad assessment and comparison. It also increases the possibility of exploring individual dimensions of well-being useful for targeting interventions. Insights demonstrate what may be masked when limiting to single dimensions, which can create a failure to identify levers for policy interventions. Conclusions We conclude that both the composite score and individual dimensions from this approach constitute valuable levels of analyses for exploring appropriate policies to protect and improve well-being

Boosting promotes advantageous risk-taking

Abstract: Due to the prevalence and importance of choices with uncertain outcomes, it is essential to establish what interventions improve risky decision-making, how they work, and for whom. Two types of low-intensity behavioural interventions are promising candidates: nudges and boosts. Nudges guide people to better decisions by altering how a choice is presented, without restricting any options or modifying the underlying payoff matrix. Boosts, on the other hand, teach people decision strategies that focus their attention on key aspects of the choice, which allows them to make more informed decisions. A recent study compared these two types of interventions and found that boosts worked better for risky choices aimed at maximising gains, whereas nudges worked best for choices aimed at minimising losses. Though intriguing, these findings could not be easily interpreted because of a limitation in the items used. Here we replicate that study, with an extended item set. We find that boosts work by promoting risk-taking when it is beneficial, whereas nudges have a consistent (lesser) impact, regardless of whether risk-taking is beneficial or not. These results suggest that researchers and policymakers should consider the base rate risk propensity of the target population when designing decision-support systems

Global mental health: an improved measure of well-being in multiple languages

Abstract: Background: An increasing number of international organisations and national governments have committed to well-being promotion. Unfortunately, important questions regarding how to assess well-being are still unresolved, making policy implementation and evaluation difficult. Methods: This research expanded on Huppert and So’s (Soc Indic Res. 110, 837–861 2013) multidimensional subjective well-being framework by investigating the replicability of the model in two non-European regions (South America, represented by Brazil and Colombia, and Eastern Africa, represented by Uganda), and the United Kingdom. Additionally, previous limitations of the framework were also addressed. ESS Round Six items were crucially improved in terms of temporal and response scale consistency. Bayesian approximate measurement invariance was applied on a sample of 381 young adult participants to test for consistency across countries. Results: The Huppert & So (Soc Indic Res. 110, 837–861 2013) model was found to fairly replicate across non-European regions, where meaningful differences in well-being patterns across regions were observed. Additionally, estimated well-being was related with other well-being measures (Five Ways): Learn and Connect were the strongest predictors of general well-being, with Take Notice and Give being associated with specific aspects of it. Conclusions: Based on this narrow sample of young adults, it appears the ten-item measure proposed by Huppert & So (Soc Indic Res. 110, 837–861 2013) is useful for assessing population mental health outside of Europe. This is only an initial attempt to assess qualities, so further testing should be done before applying at scale for identifying policy opportunities to address well-being of populations