Citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income

Lisanne S Mulderij,José Ignacio Hernández,Niek Mouter,Kirsten T Verkooijen,Annemarie Wagemakers

doi:10.1016/j.socscimed.2021.114015

Lisanne S Mulderij, José Ignacio Hernández + Show 3 more

Open Access

https://doi.org/10.1016/j.socscimed.2021.114015

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Abstract

Overweight and obesity are a growing problem, especially among people with a low income. Policymakers aspire to alleviate this problem by implementing publicly funded projects. This study has three aims: 1) to explore citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income, 2) to identify whether such preferences differ between citizens with a low income and those with a higher income, and 3) to identify the reasons underlying these preferences. We conducted a Participatory Value Evaluation (PVE) among 1053 Dutch citizens to achieve these aims. In an online choice experiment, respondents were asked to advise on the implementation of eight different projects that encourage a healthy body weight among citizens with a low income, with a total resource constraint of 100,000 euros. The projects were 1) lifestyle coaching including sports, 2) lifestyle coaching without sports, 3) local sports coach, 4) fruit and vegetable boxes, 5) bariatric surgery, 6) improving the living environment, 7) courses on healthy lifestyles, and 8) sports vouchers. We used the “Multiple Discrete-Continuous Extreme Value” model to estimate the preferences of respondents towards these eight projects. Fruit and vegetable boxes and sports vouchers were the most popular projects, while bariatric surgery was least popular. Respondents with a low income tended to spend less of the budget than respondents with a higher income. Respondent arguments for the choices they made were qualitatively analysed using inductive content analysis. They often mentioned the value judgements ‘importance’, ‘healthiness’ and ‘usefulness’, as well as project costs and efficacy, as reasons for their decisions. Policymakers could use the results to ensure their decisions on the allocation of public funding to projects that encourage a healthy weight among people with a low income are aligned with citizen preferences.

Highlights

The number of overweight and obese people is increasing, particu larly for people with a low socioeconomic status, who often have a low income (RIVM, 2018; Mackenbach et al, 2008)
This study has three aims: 1) to explore citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income, 2) to identify whether such preferences differ between citizens with a low income and those with a higher income, and 3) to identify the reasons underlying these preferences
Hold different views about the projects compared with people with higher incomes (Pfarr and Schmid, 2016; Xesfingi et al, 2016; Herens et al, 2015); our second research question is: to what extent do citizen preferences regarding the public funding of those projects differ between people with different incomes? to understand which aspects of projects shape citizen motives to prefer some projects over others, our third research question is: why do citizens prefer certain projects that promote a healthy body weight among people with a low income over others?

Summary

Introduction

The number of overweight and obese people is increasing, particu larly for people with a low socioeconomic status, who often have a low income (RIVM, 2018; Mackenbach et al, 2008). To decide which health-promoting projects should be funded, the current body of literature has largely focussed on their (cost-)effectiveness (Bukman et al, 2017; Lindstrom et al, 2006; Schutte et al, 2015; Lin et al, 2014; Horodyska et al, 2015; Mulderij et al, 2020; Morgan et al, 2016; Frew et al, 2014); to improve public support for the funding of health-promoting projects, it is important to take into account the preferences of the general public, including people with a low income, since the public eventually pays for the projects through taxes and premiums Policymakers could use this information to align their decisions on the allocation of public funding with citizen preferences. Our main research question is: what are cit izen preferences regarding the public funding of projects that promote a healthy body weight among people with a low income? People with a low income are the proposed beneficiaries of these projects, and may hold different views about the projects compared with people with higher incomes (Pfarr and Schmid, 2016; Xesfingi et al, 2016; Herens et al, 2015); our second research question is: to what extent do citizen preferences regarding the public funding of those projects differ between people with different incomes? to understand which aspects of projects shape citizen motives to prefer some projects over others, our third research question is: why do citizens prefer certain projects that promote a healthy body weight among people with a low income over others?

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