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Author: Neil McHugh

Background:

There is a widening health divide in the UK despite health inequalities being a longstanding subject of policy and research. New types of evidence are needed.

Key points for discussion:

Knowledge of public values for non-health policies and their associated (non-)health outcomes is currently missing from decision-making processes. Eliciting public values using stated preference techniques can provide insights on what the general public would be willing to give up for different distributions of (non-)health outcomes and the policies that can achieve them. To understand the role this evidence could have in decision-making processes, Kingdon’s multiple streams analysis (MSA) is used as a policy lens to explore how evidence of public values could affect policy processes for ways to tackle health inequalities.

Conclusions and implications:

This paper outlines how evidence of public values could be elicited through the use of stated preference techniques and suggests this could facilitate the creation of policy windows for tackling health inequalities. Additionally, Kingdon’s MSA helps make explicit six crosscutting issues when generating this new form of evidence. This suggests the need to explore reasons for public values and how decision makers would use such evidence. With an awareness of these issues, evidence on public values has the potential to support upstream policies to tackle health inequalities.

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Chapter Seven focuses on efficiency of administration and the mixing of morals and mathematics in the context of the financialisation of everyday life. They examine the development and scope of Social Impact Bonds (SIBs), a policy instrument designed to extend the role of private finance in welfare provision and delivery, following in the wake of previous efforts to outsource public services and expand the mechanisms for ‘payments by results’. As the authors demonstrate in the UK SIBs represent more than just an expansion of existing privatisation measures; they are part of the financialisation of service provision and delivery, bringing venture capital and the risk calculations and hedging of welfare outcomes to the financial market in an effort to shake up the assumed public sector inertia. As the authors discuss, the assumptions of risk, cost-saving attributes and the measurability of outcomes are all problematic in the financialised framework.

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This article provides a rounded critique of social impact bonds (SIBs): a newly developed and innovative financial investment model, developed in the UK and starting to spread internationally that could transform the provision of social services. Although SIBs have the potential to influence delivery by all providers, this article raises three concerns about their possible effects – in relation to their potential outcomes, unintended consequences for the UK third sector, and governance – and then reflects on SIBs as the latest manifestation of the ideological shift which the UK third sector is undergoing.

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