OBJECTIVES To estimate the extent to which Canadians are averse to health inequalities, a critical component for equity-informative economic evaluations but lacking in the Canadian context.

METHODS We conducted three experiments among a representative sample of adults living in Canada to elicit value judgements about reducing income-related health inequality vs. improving population health. Each experiment compared two programs: (Experiment 1) universal and tailored vaccination; (Experiment 2) non-specific prevention programs; (Experiment 3) generic health care programs. The programs varied in terms of efficiency (additional life years), and income-related health inequality. Preferences were elicited using benefit-trade off analysis and were classified as: pro-rich (maximizing the health of individuals with the highest income); health maximizer (maximizing total health); weighted prioritarian (willing to trade some health to reduce inequalities); maximin (only improving the health of the individuals with the lowest income); and egalitarian (minimizing health inequalities).

RESULTS We recruited 1,000 participants per experiment. Preferences for the vaccination, prevention, and generic experiments were distributed as follows: pro-rich (Atkinson Index<0): 31%, 22%, and 16% respectively; health maximizers (Atkinson Index=0): 2%, 3%, and 2%, respectively; weighted prioritarians (Atkinson Index>0): 13%, 19%, and 22% respectively; maximins (Atkinson Index=∞): 0%, 1%, and 3%, respectively; egalitarian (Atkinson Index undefined): 54%, 55%, and 57%, respectively. The median responses reflected a preference for minimizing health inequalities across the three experiments.

CONCLUSIONS Our findings suggest a strong aversion to health inequality among people living in Canada with over half of respondents willing to minimize health inequalities regardless of the impact on efficiency.

The authors have declared no competing interest.

NI is supported by a Canada Graduate Scholarship Doctoral, from the Canadian Institutes of Health Research (CFC 213041) SA is supported by a Tier 2 Canada Research Chair in Public Health Economics, from the Canadian Institutes of Health Research SM is supported by a Tier 2 Canada Research Chair in Mathematical Modelling and Program Science, from the Canadian Institutes of Health Research (CRC 950 232643) BS is supported by a Tier 1 Canada Research Chair in Economics of Infectious Diseases, from the Canadian Institutes of Health Research (CRC 2022 00362)

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