Social Choice: What is the best way to determine the “social good” for decision making in healthcare. Given these conclusions are the current methods used for economic evaluations appropriate for decision making in child health?
In budget constrained systems not all clinically effective health interventions can be offered as treatments. Therefore a decision must be made to determine how society’s finite resources can be distributed to achieve the greatest benefit. In answer to this allocation problem economic evaluations were developed; they provide a mechanisms for logically ranking the costs and benefits from competing healthcare interventions.
There has been much debate surrounding the theory behind economic evaluations. This debate stems from the choice of economic evaluation. In the UK cost benefit analysis, with philosophical roots in welfare economics and utility theory has been rejected in the mainstream in favour of the cost utility analysis consistent with extra-welfarism where “extra” capabilities (as discussed by Sen and Nussbaum) are included alongside utility as the social objective to maximise. The objective of cost utility analysis is to maximise a measure of health, making it more pragmatic that Cost Benefit Analysis given the exogenous healthcare budget in the UK.
Research in this field has focused on general health, and not considered whether methods are appropriate for sub populations, for instance in children. Evidence from the development literature indicates children are most vulnerable early in life. Developmental insults can negatively affect the formation of capabilities. As a child develops deprivation in a single capability has an impact on the development of many other capabilities. For example a child with a health complaint must contend with not only their illness but the effect that missing school has on the development of their cognitive capabilities.
For evaluations conducted in the field of child health economists must consider the implications of development and whether the current framework is acceptable. Expanding the evaluation from a healthcare specific focus to include sectors such as education, crime etc. remains loyal to extra welfarism and might be a prudent response.
Who do wildlife belong to?
One of the features of the capitalist economic system is ownership since without it, trade is impossible. However, to be owner or to be property carries serious moral implications. For many developing countries, wildlife is a vital resource owned publicly or privately. Recently, there have been a number of scholars and organisations such as the World Bank that have advocated for private ownership of protected wildlife areas. Wildlife is seen as a resource for both consumptive and non-consumptive economic benefits of those who legally own it. This view, however, appears to be inconsistent with the view that wild animals possess moral rights. Animals are, on this view, self-owners with moral value over and above the economic value that leads to their commodification. This paper critically examines competing claims of wildlife moral (as contrasted with legal) ownership. These include views that wildlife is owned by God, by humanity, by traditional or modern political institutions such as chiefs, monarchs, or the state, by private individuals who have acquired the wild animals through procedures stipulated by state or international instruments, or that wild animals are owned by no one but themselves. The paper challenges the status quo regarding the property status of wildlife, defends the view of animal self-ownership. The paper thus attempts to show that it is a false dichotomy that depicts the choice as either (private) ownership of wildlife or the perishing of wildlife. The paper offers a third choice, one that is radical but morally sound and practicable. Based on the conclusion that wild animals own themselves, the paper proposes what other things might belong to these animals and what changes this calls for in wildlife policy, and management strategies.