Strengthening methods and international evidence on health inequality aversion

Objectives: This article summarizes areas of methodological agreement about health inequality aversion and proposes a research agenda to strengthen methods and international evidence to inform priority setting. Methods: This article arises from a workshop in November 2024 that brought together methodologists and applied researchers fr12 countries, including ethicists, physicians, epidemiologists, and health economists. The workshop comprised methods and research application presentations culminating in a guided discussion to gain consensus on methods and research agenda. Results: Participants agreed that (1) the magnitude of health inequality aversion may depend on the concept of inequality used; (2) both the concept and magnitude of aversion may vary by decision-making context; (3) pre-existing preferences are often incomplete or internally inconsistent; (4) comparisons across broad ordinal categories of inequality aversion are more robust than point estimates; (5) underlying social value judgments should be clearly communicated to decision makers and the public; (6) health inequality aversion is relevant across a wide range of social decisions; and (7) an international database of estimates would facilitate data sharing and comparability. The proposed research agenda prioritizes investigation into (1) the nature and shape of inequality aversion; (2) how the choice of health measure influences responses; (3) interactions among multiple dimensions of social disadvantage; (4) cultural variation in the understanding of health inequality; (5) reasons underpinning quantitative responses; (6) framing effects; and (7) the validity and representativeness of elicited preferences. Conclusions: There are substantial opportunities to advance methods so that estimates of health inequality aversion can routinely inform decision making. Progress will require interdisciplinary collaboration beyond health economics, medicine, and ethics, drawing on disciplines such as political science, psychology, and sociology, and application across a wider range of settings.