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      Advancing the social return on investment framework to capture the social value of public health interventions: semistructured interviews and a review of scoping reviews

      , , , ,
      Public Health
      Elsevier BV

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          Beyond Money: Toward an Economy of Well-Being.

          Policy decisions at the organizational, corporate, and governmental levels should be more heavily influenced by issues related to well-being-people's evaluations and feelings about their lives. Domestic policy currently focuses heavily on economic outcomes, although economic indicators omit, and even mislead about, much of what society values. We show that economic indicators have many shortcomings, and that measures of well-being point to important conclusions that are not apparent from economic indicators alone. For example, although economic output has risen steeply over the past decades, there has been no rise in life satisfaction during this period, and there has been a substantial increase in depression and distrust. We argue that economic indicators were extremely important in the early stages of economic development, when the fulfillment of basic needs was the main issue. As societies grow wealthy, however, differences in well-being are less frequently due to income, and are more frequently due to factors such as social relationships and enjoyment at work. Important noneconomic predictors of the average levels of well-being of societies include social capital, democratic governance, and human rights. In the workplace, noneconomic factors influence work satisfaction and profitability. It is therefore important that organizations, as well as nations, monitor the well-being of workers, and take steps to improve it. Assessing the well-being of individuals with mental disorders casts light on policy problems that do not emerge from economic indicators. Mental disorders cause widespread suffering, and their impact is growing, especially in relation to the influence of medical disorders, which is declining. Although many studies now show that the suffering due to mental disorders can be alleviated by treatment, a large proportion of persons with mental disorders go untreated. Thus, a policy imperative is to offer treatment to more people with mental disorders, and more assistance to their caregivers. Supportive, positive social relationships are necessary for well-being. There are data suggesting that well-being leads to good social relationships and does not merely follow from them. In addition, experimental evidence indicates that people suffer when they are ostracized from groups or have poor relationships in groups. The fact that strong social relationships are critical to well-being has many policy implications. For instance, corporations should carefully consider relocating employees because doing so can sever friendships and therefore be detrimental to well-being. Desirable outcomes, even economic ones, are often caused by well-being rather than the other way around. People high in well-being later earn higher incomes and perform better at work than people who report low well-being. Happy workers are better organizational citizens, meaning that they help other people at work in various ways. Furthermore, people high in well-being seem to have better social relationships than people low in well-being. For example, they are more likely to get married, stay married, and have rewarding marriages. Finally, well-being is related to health and longevity, although the pathways linking these variables are far from fully understood. Thus, well-being not only is valuable because it feels good, but also is valuable because it has beneficial consequences. This fact makes national and corporate monitoring of well-being imperative. In order to facilitate the use of well-being outcomes in shaping policy, we propose creating a national well-being index that systematically assesses key well-being variables for representative samples of the population. Variables measured should include positive and negative emotions, engagement, purpose and meaning, optimism and trust, and the broad construct of life satisfaction. A major problem with using current findings on well-being to guide policy is that they derive from diverse and incommensurable measures of different concepts, in a haphazard mix of respondents. Thus, current findings provide an interesting sample of policy-related findings, but are not strong enough to serve as the basis of policy. Periodic, systematic assessment of well-being will offer policymakers a much stronger set of findings to use in making policy decisions.
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            The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows

            This year marks the 30th anniversary of the Dahlgren and Whitehead model of the main determinants of health, sometimes known as 'The Rainbow Model'. In this article, we reflect on developments over those thirty years before going on to look to the future. We start by telling the story of our model's idiosyncratic journey from initial rejection to worldwide acclaim. We reflect on the many ways in which the model has been used over the years and why it has proved illuminating for people in so many different positions. It is equally important to understand what it does not do and what it was never intended to do, as sometimes the conceptual debate gets side-tracked by mistaken assumptions. We take some space to outline how we ourselves use the model with the complementary Diderichsen Framework to explain the pathways and mechanisms by which the known determinants of health bring about the social gradients in health that are observed within countries. We conclude by looking to the future and what further needs to be done to capture insights for action on the determinants and drivers of health and of growing inequalities in the post-pandemic world.
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              Social Return on Investment (SROI) methodology to account for value for money of public health interventions: a systematic review

              Background Increased scarcity of public resources has led to a concomitant drive to account for value-for-money of interventions. Traditionally, cost-effectiveness, cost-utility and cost-benefit analyses have been used to assess value-for-money of public health interventions. The social return on investment (SROI) methodology has capacity to measure broader socio-economic outcomes, analysing and computing views of multiple stakeholders in a singular monetary ratio. This review provides an overview of SROI application in public health, explores lessons learnt from previous studies and makes recommendations for future SROI application in public health. Methods A systematic review of peer-reviewed and grey literature to identify SROI studies published between January 1996 and December 2014 was conducted. All articles describing conduct of public health SROI studies and which reported a SROI ratio were included. An existing 12-point framework was used to assess study quality. Data were extracted using pre-developed codes: SROI type, type of commissioning organisation, study country, public health area in which SROI was conducted, stakeholders included in study, discount rate used, SROI ratio obtained, time horizon of analysis and reported lessons learnt. Results 40 SROI studies, of varying quality, including 33 from high-income countries and 7 from low middle-income countries, met the inclusion criteria. SROI application increased since its first use in 2005 until 2011, declining afterwards. SROI has been applied across different public health areas including health promotion (12 studies), mental health (11), sexual and reproductive health (6), child health (4), nutrition (3), healthcare management (2), health education and environmental health (1 each). Qualitative and quantitative methods have been used to gather information for public health SROI studies. However, there remains a lack of consensus on who to include as beneficiaries, how to account for counterfactual and appropriate study-time horizon. Reported SROI ratios vary widely (1.1:1 to 65:1). Conclusions SROI can be applied across healthcare settings. Best practices such as analysis involving only beneficiaries (not all stakeholders), providing justification for discount rates used in models, using purchasing power parity equivalents for monetary valuations and incorporating objective designs such as case–control or before-and-after designs for accounting for outcomes will improve robustness of public health SROI studies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1935-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                (View ORCID Profile)
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                Journal
                Public Health
                Public Health
                Elsevier BV
                00333506
                January 2024
                January 2024
                : 226
                : 122-127
                Article
                10.1016/j.puhe.2023.11.004
                6d84158f-b165-4d45-9ab5-2786aed4cb6c
                © 2024

                https://www.elsevier.com/tdm/userlicense/1.0/

                http://creativecommons.org/licenses/by-nc-nd/4.0/

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