Quality of life and subjective well-being Paul Dolan Director, Centre for Well Being in Public Policy University of Sheffield, Sheffield, UK [But soon to be Imperial College London]

What could I possibly know that you lot don’t know already? How could information on SWB play into public policy? How could information on SWB play into public policy? –I’ll give you ten reasons why policy-makers should use SWB What difference would SWB make in the health sector? What difference would SWB make in the health sector? –I’ll give some idea of the difference between QALYs and WALYs What type of SWB should we use? What type of SWB should we use? –I’ll show some differences between LS and DRM And what do the public make of all this? And what do the public make of all this? –I’ll show you some pilot data

Ten reasons for SWB in policy 1. Enriching the informational base of policy making  Added information in hard to choose cases 2. Providing a means for assessing subjective states  Some are measured anyway (e.g. fear of crime) 3. Aiding prediction of objective policy outcomes  Health (even exposure to cold), productivity etc. 4. Aiding prediction of behaviours and choices  Suicide, pro-social behaviour etc. 5. Testing assumptions about revealed preferences  Paradox of choice

Ten reasons for SWB in policy 6. Testing assumptions about stated preferences  Focusing effect, false theories of well-being etc. 7. Aiding valuation of hard to quantify costs and benefits  Hedonic pricing 8. Helping to set policy ‘defaults’  Criterion for libertarian paternalism 9. Fostering joined-up government  An alternative to a money metric 10. The psychological Heisenberg principle  What society measures influences things it seeks

Valuation in health Decision utility central to attempts to value health Decision utility central to attempts to value health –e.g. WTP, SG, TTO Imagine living in health state, H, for ten years: Imagine living in health state, H, for ten years: –moderate pain or discomfort; moderately anxious or depressed Alternatively you could take a gamble: Alternatively you could take a gamble: –full health if successful, death if not What p (and 1-p) make you indifferent? What p (and 1-p) make you indifferent? –UH = p[FH] + (1-p)[D] = p Values used by NICE to calculate cost-per-QALY Values used by NICE to calculate cost-per-QALY

What difference would SWB make? Pain is not as bad as forecast but mental health problems are worse

But what type of SWB should we use? Life sat U-index Sleep hours Depressed Optimistic BMI Income Married From Kahneman et al, American and French women DRM study (n=1600)

Focusing effects –“Nothing is as important as when you’re thinking about it” Life satisfaction ratings may pick up those things we think are important to us at the time of the assessment Life satisfaction ratings may pick up those things we think are important to us at the time of the assessment But do they pick up those things that affect us as we live our lives? But do they pick up those things that affect us as we live our lives?

The focus of policy The main goal of government … 1. Improving happiness 2. Providing public services 3. Reducing misery 4. Supporting close social networks 5. Choice in public services -3 = strongly disagree 3 = strongly agree 3 = strongly agree Which of our measures (if any) pick up what citizens consider to the legitimate role of public policy?