What policies should we introduce to tackle the UK's worsening population health trends? From an economic perspective, the concern is with achieving the greatest health outcomes from available resources. This reflects economics preoccupation with outcome-based utility. However, evidence from within health economics suggests that how outcomes are achieved matters as well as what outcomes are achieved, reflecting a concern for process utility. This issue has received much less attention in public health perhaps because of the greater complexity. For example, upstream, non-health policies affect both health and non-health outcomes and policy characteristics, such as universality versus targeting, can generate much debate. In this mixed-method exploratory preference-based study we examined whether and why 50 members of the general public from across Glasgow and Newcastle traded-off the policy characteristics and health and non-health outcomes of a Universal Basic Income and a Minimum Income Guarantee using Benefit Trade-Off and qualitative questions in one-to-one face-to-face interviews. For a majority of respondents, choices were driven by outcomes over policies characteristics, although for a substantial minority it was policy characteristics and not outcomes that influenced preferences. Qualitative data provide support for the different choices. As respondents trade-off policy characteristics and policy outcomes reflecting different preferences for each, studies looking at either in isolation may under- and over-state preferences. Similarly, failure to account for process utility in policymaking may result not only in the misallocation of resources but a lack of social acceptability, which could jeopardise the chances of a policy being implemented in the first place.
