"Health and happiness: some open research topics"
This has been 90% complete for >6 months but finishing it has never seemed the top priority. The draft summary is below, and I can share the drafts with interested people, e.g. those looking for a thesis topic.
While studying health economics and working on the 2019 Global Happiness and Wellbeing Policy Report, I accumulated a list of research gaps within these fields. Most are related to the use of subjective wellbeing (SWB) as the measure of utility in the evaluation of health interventions and the quantification of the burden of disease, but many are relevant to cause prioritisation more generally.
This series of posts outlines some of these topics, and discusses ways they could be tackled. Some of them could potentially be addressed by non-profits, but the majority are probably a better fit for academia. In particular, many would be suitable for undergraduate or master's theses in health economics, public health, psychology and maybe straight economics – and some could easily fill up an entire PhD, or even constitute a new research programme.
The topics are divided into three broad themes, each of which receives its own post.
Part 1: Theory
The first part focuses on three fundamental issues that must be addressed before the quality-adjusted life-year (QALY) and the disability-adjusted life-year (DALY) can be derived from SWB measures, which would effectively create a wellbeing-adjusted life-year (WELBY).
Topic 1: Reweighting the QALY and DALY using SWB
Topic 2: Anchoring SWB measures to the QALY/DALY scale
Topic 3: Valuing states 'worse than dead’
Part 2: Application
Assuming the technical and theoretical hurdles can be overcome, this section considers four potential applications of a WELBY-style metric.
Topic 4: Re-estimating the global burden of disease based on SWB
Topic 5: Re-estimating disease control priorities based on SWB
Topic 6: Estimating SWB-based cost-effectiveness thresholds
Topic 7: Comparing human and animal wellbeing
Parts 1 and 2 include a brief assessment of each topic in terms of importance, tractability and neglectedness. I'm pretty sceptical of the ITN framework, especially as applied to solutions rather than problems, and I haven't tried to give numerical scores to each criterion, but I found it useful for highlighting caveats. Overall, I'm fairly confident that these topics are neglected, but I'm not making any great claims about their tractability, importance or overall priority relative to other areas of global health/development, let alone compared to issues in other cause areas. It would take much more time than I have at the moment to make that kind of judgement.
Part 3: Challenges
The final section highlights some additional questions that require answering before the case for a wellbeing approach can be considered proven. These are not discussed in as much detail and no ITN assessment is provided (the Roman numerals reinforce their distinction from the main topics addressed in Parts 1 and 2).
(i) Don’t QALYs and DALYs have to be derived from preferences?
(ii) In any case, shouldn’t we focus on improving preference-based methods?
(iii) Should the priority be reforming the QALY rather than the DALY?
(iv) Are answers to SWB questions really interpersonally comparable?
(v) Which SWB self-report measure is best?
(vi) Whose wellbeing is actually measured by self-reported SWB scales?
(vii) Whose wellbeing should be measured?
(viii) How feasible is it to obtain the required data?
(ix) Are more objective measures of SWB viable yet?
Part 3 also concludes the series by considering the general pros and cons of working on outcome metrics.