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 representative samples of adult Canadians to elicit value judgements about reducing socioeconomic-related health inequality (i.e. the gap in healthy life expectancy between the highest and lowest household income quintiles) vs. improving overall population health. Each experiment compared two programs: (i) universal and tailored vaccination; (ii) non-specific prevention programs (universal prevention vs. tailored prevention interventions); (iii) generic health care programs (program A vs. program B). Tailored programs and program B had a more equitable distribution of additional life years, while universal programs and program A were more efficient. We used benefit trade-off analysis to estimate the Atkinson health inequality aversion index.

RESULTS: We recruited 3,000 adult Canadians (1,000/experiment). Preferences for the vaccination, prevention, and generic interventions were distributed as follows: minimizing inequalities (i.e., egalitarians; Atkinson Index undefined): 54%, 55%, and 57%, respectively; maximizing the health of the population with the highest income (i.e., pro rich; Atkinson Index<0): 31%, 22%, and 16% respectively; willingness to trade some health to reduce inequalities (i.e., weighted prioritarians; Atkinson Index>0): 13%, 19%, and 22% respectively; improving the health of the individuals with the lowest income (i.e., maximins; Atkinson Index=∞): 0%, 1%, and 3%, respectively; and maximizing total health (i.e., health maximizers; Atkinson Index=0): 2%, 3%, and 2%, respectively. The median response reflected a preference for minimizing health inequalities across the three experiments. A stronger aversion to health inequality was observed among females, younger respondents (18-40 years old), and respondents with lower income (<$50,000 household income per year).

CONCLUSIONS: Our findings suggest a strong aversion to health inequality among Canadians with over half of respondents consistently willing to minimize health inequalities regardless of the cost to efficiency.