Breaking out of the health bubble

28 October, 2022

Dear colleagues,

I've just read a short but thoughtful article that might be of interest to members for weekend reflection. It's by Richard Lilford, Director of NIHR West Midlands ARC on p4 of arc_wm_newsblog_2022-10-28.pdf (warwick.ac.uk) [ https://warwick.ac.uk/fac/sci/med/about/centres/arc-wm/news-events/blog/... ] entitled 'Looking Around Corners: Emerging Trends in Health Research' but really about why we should look beyond health - substantial excerpt below:

Interventions implemented in a health setting and/or with a health-related objective often have effects beyond health.

Interventions implemented in a non-health setting and/or with a non-health objective often have effects on health.

In both of the above scenarios, the unintended effect may be more important than the health effect. For example, broadening access to Medicaid in the US state of Oregon had a strong

effect on financial status and wellbeing, but nugatory effects on health.[2] On the other hand, arguably the most important effect of educational interventions (especially those targeted at girls) .[3]

While most people accept the overlap in effects across ‘health’ and ‘non-health’ interventions, there is still a tendency to examine outcomes rather myopically. This is understandable because health workers exist in different cultural ‘bubbles’ from economists and other disciplines.

Even health economists tend to take a focus on health in my experience. Health researchers more naturally collaborate with health researchers in other universities than with non-health workers in their own universities. But the barriers are breaking down...

For example, a recent, fascinating article in JAMA examined the financial effect of chronic disease.[4] Likewise, outcomes like ICECAP-A (ICEpop CAPability measure for Adults) [5] are

also being used alongside traditional health related quality of life. This is a very welcome trend that ARC WM is pioneering, for example, in studies of wellbeing and social care, and collaborating on evaluation of micro-finance interventions in Asia and Africa.[6]

References:

2. Baicker K, et al. The Oregon Experiment ? Effects of Medicaid on Clinical Outcomes. N Engl J Med. 2013; 368: 1713-22.

3. Evans DK, Yuan F. What We Learn about Girls’ Education from Interventions That Do Not Focus on Girls. The World Bank Economic Review. 2022; 36(1): 244–67.

4. Becker NV, Scott JW, Moniz MH, Carlton EF, Ayanian JZ. Association of Chronic Disease

With Patient Financial Outcomes Among Commercially Insured Adults. JAMA Intern Med. 2022; 182(10): 1044?51.

5. Al-Janabi H, Flynn T, Coast J. Deevelopment of a self-report measure of capability wellbeing for adults: the ICECAP-A. Qual Life Res. 2012; 21(1): 167-76.

6. Shrestha D, et al. Evaluation of a self-help intervention to promote the health and wellbeing of marginalised people including those living with leprosy in Nepal: a prospective, observational, cluster-based, cohort study with controls. BMC Public Health. 2021; 21: 873.

Patrick Wilson

Head of Global Health Communications & Stakeholder Engagement | Communications | National Institute for Health Research (NIHR)

t. +44 7487 268167 | e. patrick.wilson@nihr.ac.uk

a. Minerva House, London

w. https://www.nihr.ac.uk/explore-nihr/funding-programmes/global-health/

HIFA profile: Patrick Wilson is Head of Global Health Communications & Stakeholder Engagement at the National Institute for Health and Care Research (NIHR), UK . Professional interest: Global health research. @NIHRglobal patrick.wilson AT nihr.ac.uk