Improving health and wellbeing metricsMeasuring subjective wellbeing to improve lives as effectively as possible

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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.

Explore existing research

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:

Organisations

The Happier Lives Institute and the Happiness Research Institute are organisations using wellbeing adjusted life years to inform decision-making.

Find a thesis topic

If you’re interested in working on this research direction, below are some ideas on what would be valuable to explore further. If you want help refining your research ideas, apply for our coaching!

Economics

Existing preliminary research arguably permits the construction and application of a rough WELLBY. But further work is required to ensure it fully captures what matters. This includes:

  • Establishing the ‘dead’ point on SWB scales (the zero point of the WELLBY scale): Below what level is it better to be dead?
  • Developing methods for valuing the most severe states: Are the worst states more bad than the best ones are good? How much worse? How can we know this?
  • Establishing the cardinality of the WELLBY: How can we ensure a one-point increase represents the same change in welfare on all parts of the scale? Are measures of valence best understood as linear, lognormal, or something else?
  • Choosing a SWB measure: What is wellbeing, and how can it best be measured?

 

Once this is achieved to some level of satisfaction, the new metric can be used to improve priority-setting. Projects include:

  • Re-estimating the global burden of disease: Which illnesses, injuries and disabilities cause the most unhappiness?
  • Estimating the global burden of unhappiness: Out of all the problems in the world – mental and physical disorders, unemployment, poverty, etc – what accounts for the most disutility?
  • Re-prioritising causes areas and interventions: Which projects are most cost-effective?
  • Comparing human and animal wellbeing: Can the WELLBY approach tell us anything about cross-species prioritisation?

 

You can find further ideas in the Happier Lives Institute’s research agenda. Rethink Priorities has also done research on possible directions for further research related to metrics used to evaluate health interventions.

Health sciences

Existing preliminary research arguably permits the construction and application of a rough WELBY. But further work is required to ensure it fully captures what matters. This includes:

  • Establishing the ‘dead’ point on SWB scales (the zero point of the WELBY scale): Below what level is it better to be dead?
  • Developing methods for valuing the most severe states: Are the worst states more bad than the best ones are good? How much worse? How can we know this?
  • Establishing the cardinality of the WELBY: How can we ensure a one-point increase represents the same change in welfare on all parts of the scale? Are measures of valence best understood as linear, lognormal, or something else?
  • Choosing (or developing) a SWB measure: What is wellbeing, and how can it best be measured?

 

Once this is achieved to some level of satisfaction, the new metric can be used to improve priority-setting. Projects include:

  • Re-estimating the global burden of disease: Which illnesses, injuries and disabilities cause the most unhappiness?
  • Estimating the global burden of unhappiness: Out of all the problems in the world – mental and physical disorders, unemployment, poverty, etc – what accounts for the most disutility?
  • Re-prioritising causes areas and interventions: Which projects are most cost-effective?
  • Comparing human and animal wellbeing: Can the WELBY approach tell us anything about cross-species prioritisation?

 

Within healthcare, a less ambitious approach would be to increase the extent to which preference-based health utility measures track wellbeing. For example:

  • Using preferences of patients with experience of the relevant conditions rather than members of the general public (Brazier et al., 2018).
  • Developing methods for improving the general public’s understanding of the wellbeing effects of the condition being valued (McTaggart-Cowen et al., 2011).
  • Adding wellbeing dimensions to health utility instruments (e.g. E-QALY).

You can find further ideas in the Happier Lives Institute’s research agenda. Rethink Priorities has also done research on possible directions for further research related to metrics used to evaluate health interventions.

Psychology and cognitive sciences

Existing preliminary research arguably permits the construction and application of a rough WELLBY. But further work is required to ensure it fully captures what matters. This includes:

  • Establishing the ‘dead’ point on SWB scales (the zero point of the WELLBY scale): Below what level is it better to be dead?
  • Developing methods for valuing the most severe states: Are the worst states more bad than the best ones are good? How much worse? How can we know this?
  • Establishing the cardinality of the WELLBY: How can we ensure a one-point increase represents the same change in welfare on all parts of the scale? Are measures of valence best understood as linear, lognormal, or something else?
  • Choosing (or developing) a SWB measure: What is wellbeing, and how can it best be measured?

 

Once this is achieved to some level of satisfaction, the new metric can be used to improve priority-setting. Projects include:

  • Re-estimating the global burden of disease: Which illnesses, injuries and disabilities cause the most unhappiness?
  • Estimating the global burden of unhappiness: Out of all the problems in the world – mental and physical disorders, unemployment, poverty, etc – what accounts for the most disutility?
  • Re-prioritising causes areas and interventions: Which projects are most cost-effective?
  • Comparing human and animal wellbeing: Can the WELLBY approach tell us anything about cross-species prioritisation?

You can find further ideas in the Happier Lives Institute’s research agenda. Rethink Priorities has also done research on possible directions for further research related to metrics used to evaluate health interventions.

Further resources

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