The Humble Economist

Tony Culyer

Tony currently holds the Ontario Chair in Health Policy and System Design at the University of Toronto and is a Professor of Economics at York, England where for many years he was Head of the Department of Economics & Related Studies and (for six years) Deputy Vice-Chancellor. He was Chief Scientist at the Institute for Work & Health and Chair of the WSIB’s Research Advisory Council. He currently chairs the Advisory Committee of NICE International and is Editor-in-Chief of the Elsevier on-line Encyclopaedia of Health Economics. He was Vice Chair of NICE from its foundation until 2003 and is currently on the board of CADTH. He also chairs the Policy and Editorial Committees of the Office of Health Economics in London. He was a founding editor of the Journal of Health Economics and has been on the boards of several other journals including the BMJ and the Journal of Medical Ethics. He was the first Organiser of the Health Economists’ Study Group in the UK. He is a Founding Fellow of the Academy of Medical Sciences, an Honorary Fellow of the Royal College of Physicians of London, a CBE and has an honorary doctorate from the Stockholm School of Economics.

His most recent book is The Humble Economist, an edited collection of his less technical papers.

The humble economist collects together the most important writings of Professor Tony Culyer, a founding father of health economics who helped set up the UK National Institute for Health and Clinical Excellence. It distils a powerful set of ideas that have profoundly influenced health policy and decision making, and shows how reason and evidence can be used to improve decision making in any area of social policy. The book comprises twenty-one short essays, selected and revised by Culyer himself, together with an introduction by the editors which draws out key themes and provides an overview of Culyer’s life and work. It is available in low cost paperback and ebook formats.

Praise for The Humble Economist

‘If you want to understand the origins of health economics, and the intellectual adventure of its development over the past four decades, then you must read this book.’
Bengt Jönsson, Stockholm School of Economics, Sweden

‘These essays illustrate to perfection what might be called the “Culyer paradox”. By minimising – or rather by closely defining – the contribution that economics should make to key social policy decisions, Tony Culyer has played a huge part in maximising its impact on them. An implacable opponent of cant, he is a passionate advocate of clarity. His work zings with wit and rigour. It can, in the nicest possible way, hurt your brain as he forces you to define your terms and understand your values before explaining where and how the dismal science can be applied to produce more illumined outcomes.’
Nicholas Timmins, Financial Times, UK

‘“Had I been present at the Creation, I might have given good advice.” Tony was. Tony has. On the leading edge of the modern “application of the discipline and tools of economics to the subject matter of health”, Professor Culyer’s work reflects a breadth of interests – in health, not just health care – and a concern for the usefulness of economic analysis. But it has also been built throughout on a careful consideration of the logical foundations of the discipline itself.’
Bob Evans, University of British Columbia, Canada

“Razor-sharp analysis with a smile”.
Peter Zweifel, University of Zurich, Switzerland

‘An excellent selection of academic contributions. Challenges “irrefragable taboos” with cast-iron scientific rigour and the weight of social legitimacy, against the adventures of partisan policy makers.’
Guillem Lopez Casasnovas, Pompeu Fabra University, Spain

‘Tony Culyer may be humble, but he should not be. Many have contributed to health economics, but no one else has led the profession and systematically organized the work of so many economists and policy makers into a coherent conceptual structure the way that Tony Culyer has. The Humble Economist should be read for clarity and insight, but also with gratitude and respect for someone who enlarged our understanding of welfare, policy and the economics of health.’
Tom Getzen, Executive Director, iHEA, USA

‘For 30 years Tony Culyer and I co-edited the Journal of Health Economics, and we also co-edited the 2000 page Handbook of Health Economics (2000 edition). Despite differences in how we each view the world and the profound differences in our two nation’s health care financing institutions and delivery systems, we had no serious disagreements in all those years about what constituted good health economics. Thus, I quibble with the Editors’ characterization of Tony as a “good social scientist”; I think Tony, though certainly humble, is a great social scientist. His papers were a joy to read when first published, and they certainly repay re-reading, something this volume facilitates.’
Joe Newhouse, Harvard University, USA

‘I have learned everything I know about health economics from Tony Culyer. This wonderful collection of essays will allow me – and many others – to continue to learn at the feet of the master.’
Sir Michael Rawlins, Founding Chair of NICE, UK

‘Tony Culyer is that rare beast; an inspirational economist. He knows the price and the value of everything. A must read for those who want to discover what economics can contribute to social policy – and to general social welfare.’
Julian Le Grand, London School of Economics, UK

‘A wonderful format to introduce a new generation of readers to the ideas of one of the great health economists. Culyer speaks in these essays in a unique voice – there is no one on either side of the Atlantic who writes and works with near this philosophical depth.’
Tom McGuire, Harvard University, USA

‘Most academic papers end with something like “this research will help develop tools which lead to better decision making.” And they stop there. Tony actually took the next step as well – he developed the tools, and implemented them for a better health care system.’
Phil Jacobs, University of Alberta, Canada

‘The breadth and depth of Tony Culyer’s knowledge of health economics, and the extent of his publications and achievements as an editor, are almost hard to believe. His many challenges to conventional wisdom among economists, and his never failing interest in unorthodox perspectives, are all the more impressive and enjoyable.’
Erik Nord, Norwegian Institute of Public Health, Norway

‘Tony Culyer’s writings were fundamental to my intellectual development as a practising health economist, and this book will enable current and new generations of health economists to benefit from his clarity and elegance of thought.’
Anne Mills, London School of Hygiene and Tropical Medicine, UK

‘This book demonstrates how Tony Culyer impressively and thought provokingly bridged the gap between economics and health care decision making, eloquently advancing both in the process. His contributions to health economics are humbling for all those working in the field.’
Werner Brouwer, Erasmus University Rotterdam, Netherlands

‘An insightful read for those who struggle to reconcile the two tasks of health policy – improving population health while distributing it equitably.’
Norman Daniels, Harvard University, USA

‘Culyer is a master of analytic distinctions and their importance for policy-oriented economics, distinctions between means and ends; analysts and decision-makers; reason and preferences; economic models and the real world. His analysis elucidates economics’ roots (now obscure to so many) in moral philosophy and social ethics and why, no matter how sophisticated and mathematical, it cannot escape these roots. His ability to situate practical policy issues within larger intellectual ideas and frameworks illuminates the nature of both the policy issues and abstract concepts. Economists and policy-makers alike will profit from this book.’
Jerry Hurley, McMaster University, Canada

‘This collection is full of Culyer classics – papers on which generations of Tony’s students, including me, cut our heath economics teeth. These classics and the new (to me) papers are all full of the sharp insights that have made Tony’s work essential reading for all heath economists, as well as non-economists working in the health sector. I for one am looking forward to settling down with a nice Malbec in front of an open fire and re-reading them all.’
Adam Wagstaff, World Bank, USA

‘Tony Culyer is one of the world’s leading health economists and has made remarkable contributions to health economics research, health policy and practice, and to building the field of health economics. Not everyone gets the opportunity to sit down with Tony to discuss health policy, ethics, and the National Health Service, but this volume is the next best thing. Enjoy the provocative and witty insights from an open minded expert.’
John Cawley, Cornell University, USA

‘Health policy is one of those topics about which everyone has an opinion about what everyone else should be doing. Economists, being human, find it challenging to be humble in this situation because, whatever else we can say about our characteristics, reluctance to offer opinions is usually not one of them. I remind myself, as I know Tony Culyer has, that in offering those opinions we economists as economists need to recognize that we were neither elected by our peers nor anointed by the divine to tell the world what to do; the humility that characterized his approach is one that I would urge both on economists in general and health economists in particular—though I do not expect most to be as single-minded, as graceful, and as witty in playing this role as he has been. There is a fork in the decision road—if you are not to use your own subjective judgment about values, where do you go to find them? One place surely is in the values of legitimate social decisionmakers, but the other is in the values of individual citizens. Tony has emphasized more the former in his approach, though with great caution and skill; I have been more inclined to search for values in the preferences of individual citizens. To me welfare economics should be viewed as a way to incorporate those preferences into analysis, though inevitably imperfectly, and such defense as I would offer for traditional welfare economics is based on its individualistic foundations, not on its technical formulation and use by elite experts. But, over the years, I have found it both ironic and encouraging that these two roads have come back together in my own thinking and (I think) in Tony’s, as we deal with the unfortunate necessity to have fallible human beings serve us as policymakers in dealing with those common issues in health care where markets either fall short of efficiency or fail on fairness grounds. Anthony Culyer’s work has made a major contribution in trying to attenuate this fallability by providing a bracing dose of clear thinking about both technique and values, and that is something about which no humility is needed.’
Mark Pauly, University of Pennsylvania, USA

‘As a ‘self-taught’ health economist, the writings of the founding fathers (indeed they were all men) of this discipline were invaluable in laying the foundation for my work. All aspiring health economists should be exposed to Tony Culyer’s work, which will now be all the more accessible through this collection of his most important essays. While Culyer has contributed in diverse ways to the health economics discipline, in my view one of his most important contributions has been to demonstrate the importance of analysing policy options based on evidence and a clear exposition of values.’
Diane McIntyre, University of Cape Town, South Africa