We care about WALYs not QALYs

Hmm. I sort of thought "Quality Adjusted Life Year" effectively conveyed the thing I wanted (as opposed to Disability Adjusted Lifeyear, which definitely didn't)

In any case, if people are getting confused on that point, WALY seems to be good as a term to hold in reserve to explain to people who think we're all about health. (I think if we just popularized it as a new term, especially if we hadn't worked out any way to actually measure things other than health in a robust fashion, it'd just end up with the same problems as QALY)

Thanks for the post.

It might be worth saying even when making clear that QALYs aren't the only things that EAs care about that even welfare maximisation doesn't have no be the only thing EAs care about; this might vary based on one's conception to EA, but given the movement at least currently accommodates for non-utilitarians (and I hope it continues to do so!) we don't want to fall into a WALY-maximisation trap any more than a QALY-maximisation trap.

That is to say: this post tells us, "look, specifically in the realm of health, there does seem to be ways of measuring things, but we actually care about measuring welfare". I'd suggest we say instead: "look, specifically in the realm of health, there does seem to be ways of measuring things, but we might actually want to measure any given value we might care about".

Or rather than using a different term, we could just expand the scope of the existing QALY term to include all forms of wellbeing? I was under the impression that QALYs can be used for mental health already. It's good that emotional wellbeing is being considered as important by EAs -- according to WHO, depression is the biggest cause of disability in the world and is on track to becoming the "second cause of the global disease burden." Furthermore, treating depression in the developing world is more economically feasible than you would think.

This is a mega-important point.

Especially re 2, whenever I use QALY as an example I immediately follow it up by talking about the difficulty of comparing QALYs to other things that are really good to increase, like improved education or better access to political institutions for marginalised people. This helps undermine both the 'you only care about QALYs' attack as well as the 'you don't care about systemic change' attack. It makes it clear we do care about those things, even if we don't have great ways to assess effectiveness there yet.

Generally: agree with the point.

Terminology: I think we should not try to push the term WALY; it sounds silly enough as an acronym that it is hard to build momentum around. I've heard health economists discuss this issue and complain about 'WALY' as a term, and I don't think there's an ideal solution. It would have been nice if QALYs had been called HALYs ("health-adjusted life year"), leaving QALY as the more general term. "Wellbeing QALY" is one alternative, but it's quite clunky.

Great post! I think the WALY / QALY distinction - and how to explain it carefully - should be taught to anyone running a giving game. As someone who organised a game recently, I found it tricky to navigate the trade-off between emphasising the basics ( "QALYs are a really important metric!") and the caveats ("It's only one of many important metrics"). This article by NICE helped me think the issue through.

I'm pleased and surprised to hear you say this. I'd thought that the default EA metric was QALYs: I've had more conversations than I can count with EAs saying that QALYs are probably not the best metric overall or even for health itself. A couple of points.

1. There no common sense understanding of the term - unlike 'health' - there are also three different and incompatible accounts of well-being (hedonism, desire-satisfaction, objective list).Saying "we're in favour of well-being" can be equally mysterious.

2. I think there's something a bit weird about saying "this is what we actually mean, but don't tell anyone in case they think we're weird". I worry it's getting a bit, well, Scientological, if you're at the stage where you have various versions of the truth: one for the public, another for those in the know.

3. My suggestions is to talk about "HALYs" - Happiness adjusted life years. Not only is this what we actually care about (if we're utilitarians, though I presume any view should value happiness, all other things being equal), happiness is much more intuitive than well-being and it sounds less silly.

Excellent point!

Especially if we consider the layman's definition of what health is: "being free from illness or injury". This definition opens up the promotion of health to the same kind of objections that fells Negative Utilitarianism, namely: if all that mattered was reducing suffering, isn't the easiest way to do so merely getting rid of all the sentient beings?

We should be open to the possibility that making the world less ill might also make it worse off, if there was also a simultaneous loss of those other things of value besides health that offset the reduction of illness.

We should be clear that when we focus on QALY's it is only because it (arguably) is one of the most tractable ways of promoting well-being.

I often see media coverage of effective altruism that says "effective altruists want to maximise the number of QALYs in the world." (e.g. London Review of Books).

The specific example you mention is particularly puzzling: it is a review of Doing Good Better, which makes this point very clearly (pp. 39-40):

the same methods that were used to create the QALY could be used to measure the costs and benefits of pretty much anything. We could use these methods to estimate the degree to which your well-being is affected by stubbing your toe, or by going through a divorce, or by losing your job. We could call them well-being-adjusted life years instead. e idea would be that being dead is at 0 percent well-being; being as well off as you realistically can be is at 100 percent well-being. You can compare the impact of different activities in term of how much and for how long they increase people’s well-being. In chapter one we saw that doubling someone’s income gives a 5 percentage points increase in reported subjective well-being. On this measure, doubling someone’s income for twenty years would provide one WALY.

Thinking in terms of well-being improvements allows us to compare very different outcomes, at least in principle. For example, suppose you were unsure about whether to donate to the United Way of New York City or to Guide Dogs of America. You find out that it costs Guide Dogs of America approximately $50,000 to train and provide one guide dog for one blind person. Which is a better use of fifty dollars: providing five books, or a 1/1,000th contribution to a guide dog? It might initially seem like such a comparison is impossible, but if we knew the impact of each of these activities on people’s well-being, then we could compare them.

Suppose, hypothetically, that we found out that providing one guide dog (at a cost of $50,000) would give a 10 percentage points increase in reported well-being for one person’s life over nine years (the working life of the dog). at would be 0.9 WALYs. And suppose that providing five thousand books (at a cost of $50,000) provided a 0.001 percentage point increase in quality of life for five hundred people for forty years. at would be two WALYs. If we knew this, then we’d know that spending $50,000 on schoolbooks provided a greater benefit than spending $50,000 on one guide dog.

The difficulty of comparing different sorts of altruistic activity is therefore ultimately due to a lack of knowledge about what will happen as a result of that activity, or a lack of knowledge about how different activities translate into improvements to people’s lives. It’s not that different sorts of benefits are in principle incomparable.