Image from: http://www.jokeroo.com/pictures/funny/975890.html. The impact of ... Image from: http://merciagroup.files.wordpress.com/2012/08/bg.jpg?w=300 ...
Priority Setting & the Capabilities Approach
{
Emma Tumilty, PhD Candidate, Bioethics Centre, University of Otago Supervisors: Dr Simon Walker and Prof. John McMillan, Bioethics Centre, University of Otago
Priority Setting ‐ Elements Description of current limitations Capabilities Approach
Outline How it addresses limitations Benefits Issues?
Questions
Overview
Priority Setting involves making decisions towards a specified end within a certain context given a certain relevant set of information Information
Priority Setting: Goals
Identification Analysis Decision‐making
Constraints
Priority Setting
Values
Scope: Do I have all the kinds of information I need?
Accuracy: Is the information correct?
Relevance: Is it applicable to the problem being addressed?
Data
Research
Expert Opinion
a) Limitations of Current Information
Values influence our information gathering and evaluation, which in turn influences phases of priority setting
Justice framework implicitly makes us think about problems in a certain way
material/instrumental goods rather than intrinsic goods (problem of conversion)
b) Limitations of current value system
Image from: http://www.jokeroo.com/pictures/funny/975890.html
The impact of these limitations is likely to increase
Devised by Amartya Sen (Economist) Emphasises intrinsic goods (i.e. capabilities) as the point of evaluation rather than instrumental goods, in order to allow people to achieve their functionings
Recognises heterogeneity – person‐centered Emphasises freedom and deliberative decision making Practically applied by UN in Human Development and other areas through an index.
Capabilities Approach
Using a capabilities approach, we reset the priorities and decision‐making framework, from a parcelling out of goods/services equally with extra consideration for disadvantaged groups to:
A consultative process regarding capabilities A planning structure that allocates based on the achievement of these capabilities to allow freedom to achieve functionings A gap analysis approach rather than a general>specific approach.
a) Values
Image from: http://www.outfront.org/images/equity.jpg
In data collection, this means
Broader base for data collection Expanded scope of what is meaningful
In research, this means:
a new starting point for research design – people‐centred (exception rather than the norm at present) Introduction of a set of capabilities that need to be addressed through research participation
b) Information
Image from: http://merciagroup.files.wordpress.com/2012/08/bg.jpg?w=300
Can it work?
Person‐centered – outcomes directly linked to population, therefore likely to create more “buy‐in” Information base – more useful Socially more just
d) Benefits?
Can it work?
Heavy front‐end workload to change structures/systems Innovation in deliberative methods/processes Innovation/adaptation within service settings and research settings
Already operationalised in certain settings, to a limited extent (in terms of evaluation) Image from: http://media‐cache‐ ec0.pinimg.com/236x/88/e1/a7/88e1a719663260bb9c9bcbe6315631 ad.jpg
d) Issues?
Bonell, C., Oakley, A., Hargreaves, J., Strange, V., & Rees, R. (2006). Assessment of generalisability in trials of health interventions: suggested framework and systematic review. Bmj, 333(7563), 346‐349. Chalmers, I., Bracken, M. B., Djulbegovic, B., Garattini, S., Grant, J., Gülmezoglu, A. M., ... & Oliver, S. (2014). How to increase value and reduce waste when research priorities are set. The Lancet, 383(9912), 156‐165. Chan, A. W., Song, F., Vickers, A., Jefferson, T., Dickersin, K., Gøtzsche, P. C., ... & van der Worp, H. B. (2014). Increasing value and reducing waste: addressing inaccessible research. The Lancet, 383(9913), 257‐266. Daniels, Norman. ʺAccountability for reasonableness: Establishing a fair process for priority setting is easier than agreeing on principles.ʺ BMJ: British Medical Journal 321.7272 (2000): 1300. Dixon, J., & Welch, H. G. (1991). Priority setting: lessons from Oregon. The Lancet, 337(8746), 891‐894. Glasziou, P., Altman, D. G., Bossuyt, P., Boutron, I., Clarke, M., Julious, S., ... & Wager, E. (2014). Reducing waste from incomplete or unusable reports of biomedical research. The Lancet, 383(9913), 267‐ 276. Saaty, T. L. (1983). Priority setting in complex problems. In Essays and Surveys on Multiple Criteria Decision Making (pp. 326‐336). Springer Berlin Heidelberg. Sen, A. (1999). Development as freedom. Oxford University Press. Sen, A. (1992). Inequality reexamined. Oxford University Press. Sharpe, N. (2002). Clinical trials and the real world: selection bias and generalisability of trial results. Cardiovascular drugs and therapy, 16(1), 75‐77. Tumilty, E. & S. Walker, (2014), “Tainting by Numbers: How the Disadvantaged Become Invisible in Evidence‐Based Medicine”, Physical Therapy Reviews, 19(5): 367‐377.
References & Questions
