Why object to inequalities in health and wellbeing? A mixed-methods exploration of inequality aversion with members of the general public

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Field, Becky and Smith, Katherine E. and Wickramasekera, Nyantara and Tsuchiya, Aki (2026) Why object to inequalities in health and wellbeing? A mixed-methods exploration of inequality aversion with members of the general public. Value in Health. ISSN 1524-4733 (https://doi.org/10.1016/j.jval.2026.01.029)

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Abstract

Objectives: To examine whether: (1) reasoning for distributional preferences depends on the domain of inequality; (2) reasoning for distributional preferences is affected by cause of inequality; (3) participants provide and explain responses that violate “monotonicity” (the welfare economics principle that, other things being equal, social welfare improves when at least one person is better-off); and (4) the above vary across the digital divide. Methods: We used mixed-methods to collect qualitative and quantitative data, via online discussion groups with a survey (11 groups, n = 53) and telephone interviews (n = 15) with digital minority individuals. Participants considered scenarios comparing equal and unequal health and wellbeing outcomes for an imaginary island. Well-being was framed as “equivalent income” (described to participants as household spending money, with other life aspects being good). Results: Distributional preferences varied by domain and cause of inequality but not digital status. Health inequality caused by financial inequality was widely unaccepted. Some preferred equal distributions, even when violating “monotonicity,” citing fairness and social cohesion. Conclusions: Recruiting across the digital divide and using mixed-methods enriches inequality aversion research, enhancing the inclusivity and legitimacy of DCEA.

ORCID iDs

Field, Becky, Smith, Katherine E. ORCID logoORCID: https://orcid.org/0000-0002-1060-4102, Wickramasekera, Nyantara and Tsuchiya, Aki;
CORE (COnnecting REpositories)