Designing a generic, adaptive protocol resource for the measurement of health impact in cash transfer pilot and feasibility studies and trials in high-income countries.

INTRODUCTION: In the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. The resource is designed for use in high-income countries (HIC) but draws on examples from a UK context to illustrate means of development and deployment. The resource is capable of further adaptation for use in low- and middle-income countries (LMIC). It has particular application for trials of Universal Basic Income but can be adapted to those covering other kinds of cash transfer and welfare system changes. METHODS: We outline two types of prospective intervention based on pilots and trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model for use in pilot and feasibility studies. RESULTS: We find that, in general, self-reported measures alongside routinely collected linked respondent data may provide a feasible means of producing data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. In addition, accurate self-reported objective income data remains a challenge and requires further development and testing. A process of development and implementation of the resource in pilot and feasibility studies will support assessment of whether or not our proposed health outcome measures are acceptable, feasible and can be used with validity and reliability in the target population. DISCUSSION: We suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.

Designing trials of Universal Basic Income for health impact: identifying interdisciplinary questions to address.

BACKGROUND: A large body of evidence indicates the importance of upstream determinants to health. Universal Basic Income (UBI) has been suggested as an upstream intervention capable of promoting health by affecting material, biopsychosocial and behavioural determinants. Calls are emerging across the political spectrum to introduce an emergency UBI to address socioeconomic insecurity. However, although existing studies indicate effects on health through cash transfers, UBI schemes have not previously been designed specifically to promote health. METHODS: In this article, we scope the existing literature to set out a set of interdisciplinary research challenges to address in designing a trial of the effectiveness of UBI as a population health measure. RESULTS: We present a theoretical model of impact that identifies three pathways to health impact, before identifying open questions related to regularity, size of payment, needs-based supplements, personality and behaviour, conditionality and duration. CONCLUSIONS: These results set, for the first time, a set of research activities required in order to maximize health impact in UBI programmes.

Modelling the size, cost and health impacts of universal basic income: What can be done in advance of a trial?

Opposition to Universal Basic Income (UBI) is encapsulated by Martinelli's claim that 'an affordable basic income would be inadequate, and an adequate basic income would be unaffordable'. In this article, we present a model of health impact that transforms that assumption. We argue that UBI can affect higher level social determinants of health down to individual determinants of health and on to improvements in public health that lead to a number of economic returns on investment. Given that no trial has been designed and deployed with that impact in mind, we present a methodological framework for assessing prospective costs and returns on investment through modelling to make the case for that trial. We begin by outlining the pathways to health in our model of change in order to present criteria for establishing the size of transfer capable of promoting health. We then consider approaches to calculating cost in a UK context to estimate budgetary burdens that need to be met by the state. Next, we suggest means of modelling the prospective impact of UBI on health before asserting means of costing that impact, using a microsimulation approach. We then outline a set of fiscal options for funding any shortfall in returns. Finally, we suggest that fiscal strategy can be designed specifically with health impact in mind by modelling the impact of reform on health and feeding that data cyclically back into tax transfer module of the microsimulation.

Examining the ethical underpinnings of universal basic income as a public health policy: prophylaxis, social engineering and 'good' lives.

At a time of COVID-19 pandemic, universal basic income (UBI) has been presented as a potential public health 'upstream intervention'. Research indicates a possible impact on health by reducing poverty, fostering health-promoting behaviour and ameliorating biopsychosocial pathways to health. This novel case for UBI as a public health measure is starting to receive attention from a range of political positions and organisations. However, discussion of the ethical underpinnings of UBI as a public health policy is sparse. This is depriving policymakers of clear perspectives about the reasons for, restrictions to and potential for the policy's design and implementation. In this article, we note prospective pathways to impact on health in order to assess fit with Rawlsian, capabilities and perfectionist approaches to public health policy. We suggest that Raz' pluralist perfectionist approach may fit most comfortably with the prospective pathways to impact, which has implications for allocation of resources.

Mitigating social and economic sources of trauma: The need for universal basic income during the coronavirus pandemic.

The COVID-19 pandemic is projected to cause an economic shock larger than the global financial crisis of 2007-2008 and a recession as great as anything seen since the Great Depression in 1930s. The social and economic consequences of lockdowns and social distancing measures, such as unemployment, broken relationships and homelessness, create potential for intergenerational trauma extending decades into the future. In this article, we argue that, in the absence of a vaccine, governments need to introduce universal basic income as a means of mitigating this trauma. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Religious circumcision, invasive rites, neutrality and equality: bearing the burdens and consequences of belief.

The decision of the German regional court in Cologne on 26 June 2012 to prohibit the circumcision of minors is important insofar as it recognises the qualitative similarities between the practice and other prohibited invasive rites, such as female genital cutting. However, recognition of similarity poses serious questions with regard to liberal public policy, specifically with regard to the exceptionalist treatment demanded by certain circumcising groups. In this paper, I seek to advance egalitarian means of dealing with invasive rites which take seriously cultural diversity, minimise harm and place responsibility for the burdens and consequences of beliefs upon those who promote practices.