Accessibility statement

Deliberative decision making processes and social value judgements about equity

Social value judgements about equity are complex, context-dependent and contestable.  There is little prospect of consensus on a fully specified and generally applicable formula for quantifying trade-offs between equity concerns and other policy objectives such as health maximisation.  In these circumstances, the most appropriate way to analyse value judgements about equity may be through the use of deliberative decision making processes.  Such processes aim to facilitate consistency and rationality in decision making through a process of deliberation among decision makers and stakeholders that helps to clarify the social value judgements at stake.  Deliberative processes facilitate deliberation not only about the case in hand, but also about future cases by helping to build a useful body of knowledge about the social value judgements made in past decisions – a process known in ethics as “casuistry” and in law as “case law”. 

Research on this topic aims to develop principles and methods to support deliberative decision making processes, including methodological guidance and “equity checklists” for analysts and decision makers and analyses of past social value judgements.  The research methods used include philosophical analysis and social policy analysis of deliberative decision making processes by organisations such as the National Institute of Health and Care Excellence.

  • Publications:
    • A J Culyer, Hic sunt dracones: the future of Health Technology Assessment – one economist’s perspective. Medical Decision Making 2012;32:E25-E32.
    • Culyer AJ, Bombard Y. An equity framework for health technology assessments. Medical Decision Making 2012;32(3):428-441. Download from sagepub
    • Culyer AJ, Lomas J. Deliberative processes and evidence-informed decision-making in health care – do they work and how might we know?  Evidence and Policy. 2006;2:357-371.
    • Shah K, Cookson R, Culyer AJ, Littlejohns P. Nice's social value judgements about equity in health and health care. Centre for Health Economics, University of York;CHE Research Paper 70 (PDF , 419kb)‌ 2011.
  • Contacts: Richard Cookson, Tony Culyer