Improving health and wellbeing metrics
Measuring subjective wellbeing to improve lives as effectively as possible
This profile is tailored towards students studying economics, health sciences and psychology and cognitive sciences, however we expect there to be valuable open research questions that could be pursued by students in other disciplines.
Why is this a pressing problem?
The quality-adjusted life-year (QALY) and the disability-adjusted life-year (DALY) are widely used to evaluate healthcare interventions and quantify the burden of disease. Some people also use these metrics informally as a general indicator of value. However, they have a number of major shortcomings in their current form. For example:
They focus on a relatively narrow set of health domains, ignoring many other areas of life that matter to us.
They normally assess the disutility of health states using preferences of the general public, who tend to be poor at predicting the impact of changes in health on their overall quality of life.
They give no weight to positive mental states, beyond the relief of mental or physical illness.
They fail to capture the severity of the most horrendous conditions.
The main alternative, often used within central government, is cost-benefit analysis. CBA allows direct comparisons both within and across domains by expressing all outcomes in monetary terms. (See the UK Treasury’s Green Book for an example of this approach.) However, it generally relies on stated or revealed preferences, which are often a poor measure of welfare for a variety of reasons.
These problems lead to serious misallocation of resources in public institutions, such as national governments, and in some non-profit entities as well.
An alternative metric is the wellbeing-adjusted life-year (WELLBY). This is structurally identical to the QALY but quantifies value in terms of subjective wellbeing (SWB), typically measured using self-reported happiness or life satisfaction.
In the conference talk below, Michael Plant and Clare Donaldson of the Happier Lives Institute cover some of the issues with currently widely used measures of impact and explain the benefits of the WELLBY as an alternative.
-
Research papers
A handful of economists have worked specifically on a WELLBY for general use, including Paul Frijters, Christian Krekel and Richard Layard. Dozens of others economists have worked on closely related issues, including Andrew Clark, John Helliwell, Jan De Neve, Nick Powdthavee, Redzo Mujcic, Alois Stutzer and Martijn Burgers. Health economists such as Tessa Peasgood, John Brazier and Paul Dolan have promoted the use of wellbeing in healthcare prioritisation.
In psychology and behavioural science, some key figures include Daniel Kahneman, Paul Dolan, Ed Diener, Martin Seligman and Sonja Lyubomirsky.
Specific research includes:
Peasgood et al., (2019) Priority Setting in Healthcare Through the Lens of Happiness
Brazier, J. and Tsuchiya, A. (2015) Improving Cross-Sector Comparisons: Going Beyond the Health-Related QALY
Dolan, P. and Kahneman, D. (2008), Interpretations Of Utility And Their Implications For The Valuation Of Health
Plant, M. (2019) Doing Good Badly? Philosophical Issues Related to Effective Altruism
Diener, E., Lucas, R. E., & Oishi, S. (2018) Advances and Open Questions in the Science of Subjective Well-Being
Clarke et al., (2018) The Origins of Happiness: The Science of Well-Being over the Life Course
This 2022 essay from the Happier Lives Institute explores how using the WELLBY would change funding priorities in global health.
Organisations
The Happier Lives Institute and the Happiness Research Institute are organisations using wellbeing adjusted life years to inform decision-making.
Contributors: The thanks for building this profile go to Derek Foster. Learn more about how we create our profiles.
