Those who are responsible for health policy want to know how seriously diseases, injuries, and risk factors diminish health and how significantly different policies improve health. To provide this information, health economists have attempted to measure generic—that is “overall”—health, whose value they take to be its contribution to well-being, which they measure by eliciting preferences. This book provides a philosophically sophisticated overview of generic health measurement that suggests improvements in standard methods and proposes a radical alternative. It shows how to avoid relying on s ... More

Those who are responsible for health policy want to know how seriously diseases, injuries, and risk factors diminish health and how significantly different policies improve health. To provide this information, health economists have attempted to measure generic—that is “overall”—health, whose value they take to be its contribution to well-being, which they measure by eliciting preferences. This book provides a philosophically sophisticated overview of generic health measurement that suggests improvements in standard methods and proposes a radical alternative. It shows how to avoid relying on surveys and offers an account of fundamental evaluation that does not presuppose the assignment of values to the properties and consequences of alternatives. The book defends a naturalistic concept of health and its relations to measures such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). In examining current health-measurement systems, the book clarifies their value commitments and the objections to relying on preference surveys to assign values to health states. Relying on an interpretation of liberal political philosophy, it argues that the public value of health states should be understood in terms of the activity limits and suffering that health states impose. The book also addresses the moral conundrums that arise when policymakers attempt to employ the values of health states to estimate the health benefits of alternative policies and to adopt the most cost-effective. It concludes with a general discussion of the difficulties of combining consequentialist and nonconsequentialist moral considerations in policymaking.