Evaluating childhood policy impacts on lifetime health, wellbeing and inequality: lifecourse distributional economic evaluation

We introduce and illustrate a new framework for distributional economic evaluation of childhood policies that takes a broad and long view of the impacts on health, wellbeing and inequality from a cross-sectoral whole-lifetime perspective. Total lifetime benefits and public cost savings are estimated using lifecourse microsimulation of diverse health, social and economic outcomes for each individual in a general population birth cohort from birth to death. Cost-effectiveness analysis, policy targeting analysis and distributional analysis of inequality impacts are then conducted using an index of lifetime wellbeing that allow comparisons of both value-for-money (efficiency) and distributional impact (equity) from a cross-sectoral lifetime perspective. We illustrate how this framework can be applied in practice by re-evaluating a training programme in England for parents of children at risk of conduct disorder. Our illustration uses a simple index of lifetime wellbeing based on health-related quality of life and consumption, but other indices could be used based on other kinds of outcomes data such as life satisfaction or multidimensional quality of life. We create the detailed underpinning data needed to apply the framework by using a previously published meta-analysis of randomised controlled trials to estimate the short-term effects and a previously published lifecourse microsimulation model to extrapolate the long-term effects.