Diversity across the life-course: variation observed in valued capability indexes developed using similar methods for those at different times of life
Coast, Joanna (2016). 'Diversity across the life-course: variation observed in valued capability indexes developed using similar methods for those at different times of life' Paper presented at the annual conference of the HDCA, Tokyo 2016.
The assessment of capability provides an alternative approach to the evaluation of policies or interventions (Sen, 1993). This paper considers the possibilities for the application of capability measures within a life course framework (Elder, 1994). The life course concept generally focuses on the interlinking between generation and age, such that influences on development are related both to the context and circumstances in which a person is born (their birth cohort) and the age of that person. This may be a particularly useful way to think about measures within a capability framework, given the importance of context within the approach and the potential for diversity in considering capability to different groups.
Capability indices for use in evaluation are growing in number, particularly in the health and social care context. Whilst some of these capability indices focus on those with particular ailments such as pain or mental health conditions, others are more generic, focusing on whole populations. Even with the latter measures, however, they are not truly generic, in that they are always focused on a particular part of the life-course, in practice, often adults. One suite of measures, the ICECAP measures, more explicitly concentrate on different parts of the life-course, with the existing measures focusing on adulthood (ICECAP-A) (Al-Janabi et al, 2012), older people (ICECAP-O) (Grewal et al, 2006) and end of life (ICECAP-Supportive Care Measure or ICECAP-SCM) (Sutton & Coast, 2014). All of these measures were generated using similar methods, comprising in-depth interviews with the populations of interest (adults, older people aged 65+, people at various stages along the trajectory towards death), with interviews focusing on what aspects of life are important to people (what they have ‘reason to value’) and continuing until saturation was reached in terms of the generation of attributes. Each of the measures was then valued using best-worst scaling/discrete choice techniques.
Given the similar methods through which the ICECAP measures were developed, it is possible to examine these measures in combination, to explore the extent to which ‘what people have reason to value’ differs at different points in the life course. This comparison is undertaken in the paper, and suggests that, whilst values differ only slightly in old age from the rest of adulthood, the values in relation to end of life and dying are much more diverse. ICECAP-O and ICECAP-A are broadly similar in terms of the values that seem to be important to people but there are some important differences that may reflect these life course issues, particularly in relation to differences between Achievement (ICECAP-A) and Role (ICECAP-O), and differences between Stability (ICECAP-A) and Security (ICECAP-O). Differences become very much larger, however, once attention shifts from those stages of life that are primarily concerned with a good life, towards those that concentrate on the opportunity for a good death. The ICECAP-SCM has much greater variation within its attributes, with these relating to general wellbeing (Choice, Love and affection, Preparation) as in the other two ICECAP measures, but also directly to health (freedom from Physical suffering and freedom from Emotional suffering) and to care (Support and Dignity), reflecting the concern that people have with anticipated lack of capacity at end of life. The paper fully explores the differences between indices both in the attributes they include and the values accorded those attributes.
The paper concludes by considering some of the issues that would arise in fully exploiting a life-course approach to the generation and use of capability indices. These include issues around delineating particular points on the life course at which values changes, integrating measures across different stages of life and generating appropriate measures for children. Such measures for children would need to capture the desire for wellbeing and ‘wellbecoming’ in children, their rapid changes in development, the lack of capacity of infants and very small children, and the need for imaginative approaches to engage (small) children in the sort of participatory approaches that have characterised the development of the ICECAP measures to date. Despite the many challenges, it is concluded that a life-course approach to capability measurement may well offer an approach that accounts for much of the diversity in values without requiring new capability indices for every situation, and that pursuing such an approach would be a worthwhile endeavour.