ECONOMIC-EVALUATION OF HEALTH PROMOTION - FRIEND OR FOE

It is commonly believed that economic evaluation is hostile to health promotion and that the requirement for health programs to be cost effe ctive will result in a biased allocation of funds in favour of program s that can demonstrate short-run benefits as defined by inadequate out come measures. The paper is concerned with the validity of this percep tion. It is argued that economic evaluation has the potential for trea ting health promotion activities on an equal basis with other health i nterventions. The major obstacle to this does not arise from the theor y of economic evaluation, which is discussed. but from a lack of infor mation about outcomes. Without this information any evaluation - econo mic or otherwise - is flawed. Three problems relating to the economic evaluation of health promotion activities are considered. These are: t he discounting of future health benefits; the potential for economic e valuation to be counter-productive if applied to 'immature' projects; and the practical problems encountered in the measurement of the outco mes of health promotion programs. A four-fold classification of possib le outcomes is suggested which is based upon a distinction between dis ease cure, individual health promotion, community welfare and systemic change designed to promote either individual health or social well-be ing. The capacity of economics to incorporate these objectives is disc ussed.