The efficiency-equity trade-off, self-interest, and moral principles in health and safety valuation

Danae Arroyos Calvera, Judith Covey, Graham Loomes, Rebecca McDonald

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
176 Downloads (Pure)


Policy makers try to take account of public preferences when making trade-offs between policy options. Yet most estimates of the value of health and safety reflect only individuals’ self-interested preferences, neglecting their preferences over the distribution of public resources. We conduct an experiment in which participants choose between policy options that differ in their efficiency (expected number of fatalities or cases of ill health they would prevent) and their equity (defined in terms of the balance of risk reductions for different sections of the population). The policy options were framed as interventions to improve a hypothetical city’s water supply that would reduce the risk of death or ill health for people in different areas of the city to varying degrees. In order to examine whether self-interest would affect the trade-offs, we asked half of the sample about scenarios where they would personally benefit from some options. Our results suggest that efficiency is the most important single factor determining preferences between policy options, but decisions were influenced almost as much by equity as by efficiency. The effect of self-interest was smaller than that of the general concern for efficiency. We also elicited participants’ stated moral principles regarding trade-offs between equity, efficiency and self-interest, and found that their expressed principles were well-aligned with their choices. Our findings contribute to the growing evidence that distributional concerns matter when evaluating health interventions.
Original languageEnglish
Article number112477
Number of pages13
JournalSocial Science and Medicine
Early online date9 Aug 2019
Publication statusPublished - Oct 2019

Bibliographical note

Funding Information:
We are grateful to the Leverhulme Trust for their financial support (Grant Number RP2012-V-022). Graham Loomes also received support from the Economic and Social Research Council's funding of the Network for |Integrated Behavioural Science (Grant Numbers ES/K002201/1 and ES/P008976/1). We should like to thank Michael Jones-Lee, Jose Luis Pinto-Prades, Andrea Isoni, MatteoGalizzi, Tigran Melkonyan, Richard Cookson, and the participants of the 2018 ExperimentalWorkshop on Social Preferences at Birmingham, and the Summer 2018 Health EconomistsStudy Group (particularly Nils Gutacker) for valuable comments.


  • efficiency
  • equity
  • self-interest
  • moral principles

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


Dive into the research topics of 'The efficiency-equity trade-off, self-interest, and moral principles in health and safety valuation'. Together they form a unique fingerprint.

Cite this