(p. 303) Priority setting, social values, and public health 

Setting priorities is required in all healthcare systems. Around the world policymakers face the dilemma of how to allocate resources to healthcare in ways that are both effective and that can be justified to their citizens. Setting priorities inevitably raises the question of whether the money spent on public health programmes provides better value than the alternative uses to which it could be put. Decisions about priority setting cannot be made simply by appealing to technical tests of ‘what works’ because measuring what works inevitably involves a set of value judgements. Even explicit and seemingly ‘scientific’ criteria such as effectiveness and cost-effectiveness are embedded in views about, for example, the value of different health states. So, in addition to technical processes, broader social value judgements are inevitably brought to bear on decisions. This chapter describes how these issues are played out in different countries and it introduces a new international research programme which addresses the ethical and practical challenges of social values in health priority setting.