Derek Foster
Research Articles
Health and happiness research topics—part 1: background on QALYs and DALYs
This series of posts describes some of the metrics commonly used to evaluate health interventions and estimate the burden of disease, explains some problems with them, presents some alternatives, and suggests some potentially fruitful areas for further research.[1] It is primarily aimed at members of the effective altruism (EA) community who may wish to carry out one of the projects. Many of the topics would be suitable for student dissertations (especially in health economics, public health, psychology, and perhaps philosophy), but some of the most promising ideas would require major financial investment. Parts of the sequence—particularly the first and last posts—may also be worth reading for EAs with a general interest in evaluation methodology, global health, mental health, social care, and related fields.
Health and happiness research topics—Part 3: The sHALY: developing subjective wellbeing-based health metrics
The sHALY (subjective wellbeing-based health-adjusted life-year) describes health states using a conventional QALY or DALY classification system, or ideally a broader “HALY+” system described in Part 2. But it assigns values (“weights”) to those states according to their effect on life satisfaction and/or hedonic wellbeing. This helps avoid some problems with hypothetical preferences, such as the difficulty of imagining what it’s like to be in a different health state and the neglect of non-health consequences of health conditions.
Health and happiness research topics—part 2: the HALY+: improving preference-based health metrics
The most widely-used HALYs are the quality-adjusted life-year (QALY) and disability-adjusted life-year (DALY). For reasons covered in Part 1, they tend to inaccurately estimate the overall wellbeing impact of many conditions, leading to serious misallocation of resources. The (hypothetical) HALY+ incorporates incremental improvements to the most common versions of the QALY and DALY, so that they more closely track subjective wellbeing (and perhaps other things people care about) while avoiding some potential problems with pure wellbeing measures. The extent to which they would resolve each of my core concerns with current HALYs is summarized in the conclusion.