Citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income (2021)

Highlights:

• Citizens mostly prefer projects that increase healthy lifestyle accessibility.
• Citizens least prefer publicly funded bariatric surgery for people with low incomes.
• Citizens with low incomes spent less of the budget than those with higher incomes.
• Citizens deemed preferred projects to be important, healthy, useful and effective.
• Citizen participation can inform policymakers’ choices and increase public support.

Abstract:

Overweight and obesity are a growing problem, especially among people with a low income. Policymakers aspire to alleviate this problem by implementing publicly funded projects. This study has three aims:

1. to explore citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income,
2. to identify whether such preferences differ between citizens with a low income and those with a higher income, and
3. to identify the reasons underlying these preferences.

We conducted a Participatory Value Evaluation (PVE) among 1053 Dutch citizens to achieve these aims. In an online choice experiment, respondents were asked to advise on the implementation of eight different projects that encourage a healthy body weight among citizens with a low income, with a total resource constraint of 100,000 euros.

The projects were

• lifestyle coaching including sports
• lifestyle coaching without sports
• local sports coach
• fruit and vegetable boxes
• bariatric surgery
• improving the living environment
• courses on healthy lifestyles, and
• sports vouchers.

We used the “Multiple Discrete-Continuous Extreme Value” model to estimate the preferences of respondents towards these eight projects. Fruit and vegetable boxes and sports vouchers were the most popular projects, while bariatric surgery was least popular. Respondents with a low income tended to spend less of the budget than respondents with a higher income. Respondent arguments for the choices they made were qualitatively analysed using inductive content analysis. They often mentioned the value judgements ‘importance’, ‘healthiness’ and ‘usefulness’, as well as project costs and efficacy, as reasons for their decisions. Policymakers could use the results to ensure their decisions on the allocation of public funding to projects that encourage a healthy weight among people with a low income are aligned with citizen preferences.