We care about WALYs not QALYs

By Benjamin_Todd @ 2015-11-13T19:21 (+21)

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).

This is wrong. QALYs only measure health, and health is not all that matters. Most effective altruists care about increasing the number of "WALYs" or well-being adjusted life years, where health is just one component of wellbeing.

(Some effective altruists also care about goods besides welfare, such as the environment and justice. Depending on your view of population ethics, you might also distinguish between achieving WALYs by improving lives vs. adding to the number of people alive).

This is a bad misconception since it makes it look like we have a laughably narrow view of what's good. Even a hardcore hedonistic utilitarian would at least care about *happiness* rather than just health, and very few people are hedonistic utilitarians.

Why does effective altruism get misinterpreted as thinking we only care about QALYs?

1) Sometimes community members actually say "we want to maximise the number of QALYs". I think we should stop doing this. Instead say something more like: "we want to maximise the number of people who have good lives", or just "maximise the good we do" and then if someone asks what "good" means, you can say it's people having happy or flourishing lives.

2) Sometimes when people ask us "how do you measure 'good'?" we talk about QALYs as an example. This is what happens in Will's book. I think this is a reasonable move - the idea of QALYs is really important to introduce to new people - but it can create the impression that you only care about QALYs. The QALY bit will be the most memorable, and people won't remember your disclaimers. This means if you're explaining QALYs you need to put a lot of emphasis on how that's not all that matters. You can do this by instead leading with "you can measure your impact by choosing good proxies within the cause you're working in e.g. in health there's QALYs, in education you can look at improvements in test scores and income, in economic empowerment programs you can look at income change, and so on. Use the best proxies you have available." Alternatively you can introduce the idea of QALYs, but then point out what we ultimately care about is welfare; it's just that right now health is the cause where quantification is easiest. 

Edit: I don't propose publicly promoting and using the term "WALYs" - just bear in mind "WALYs not QALYs" to help you remember. (My suggestions about what to say publicly are just above in 1 and 2).

undefined @ 2015-11-14T15:30 (+9)

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)

undefined @ 2015-11-16T14:31 (+1)

Agree - added a clarification at the bottom of the main post.

undefined @ 2015-11-17T16:29 (+3)

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".

undefined @ 2015-11-17T21:39 (+1)

Agree - I mention that in brackets, and think it's also good to clarify if you have the opportunity.

undefined @ 2015-11-17T18:14 (+2)

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.

undefined @ 2015-11-17T18:46 (+2)

Can 'we' actually do that? If someone hears us talking about QALYs, they are either already going to know what they are (which is a health measure as far as the rest of the world is concerned) or they're going to look it up an get a Wikipedia definition, not our definition.

And yes QALYs can be and are used for mental health, but that's because it's still health, which isn't quite the same as wellbeing.

undefined @ 2015-11-16T12:27 (+2)

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.

undefined @ 2015-11-16T12:27 (+2)

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.

undefined @ 2015-11-13T21:13 (+1)

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.