Abstract
Measuring an individual’s health states presupposes the ability to compare them. I maintain that our ability to compare quantities or magnitudes of health are severely limited. It is easier to compare values of health states, but those values are context dependent and often unreliable.
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Notes
It may also be the case that no comparison is possible, because the entity, like the square root of 2 is not the sort of thing that is healthy or unhealthy.
I am concerned with whether health states are generally complete, not with whether there might be a few rare cases of incomparable health states, which might be accommodated as exceptions.
This is over-simplified. Pre-menopausal adult women are capable of bearing children, which is arguably a more valuable activity than any of which men are capable. So this condition needs to be relativized to reference classes. But that would rule out comparisons of activity limitations across genders or age groups.
This is overly simple, because distress and pain in some circumstances are healthy and their absence pathological.
The global burden of disease (GBD) studies (Salomon et al. 2012) purport to measure the level of health itself of the sequela of disease and injury, but if the arguments above are sound, the global burden of disease studies are assigning values rather than measuring health itself. The GBD studies rely on the paired comparisons made by a large sample of respondents and also purport to establish three-digit values. These are “disability weights” rather than quality weights and vary from 0 if there are no disabilities to 1 if the disability is as bad as death.
The HRQoL of health is sometimes understood as a vector specifying the levels of a person’s health along the various dimensions along which health states are ranked, and what I am calling HRQoL is then called the value or utility of the health state.
In the case of the paired comparisons used by the GBD, it is assumed that the more agreement there is that S is better than Sʹ, the larger the difference in the values of S and Sʹ.
As a referee correctly pointed out, this is a general problem with taking averages of the traits of differing entities, like the average weight of mammals. But the generality of the problem does not lessen its seriousness here.
Moreover, if one asks those with paraplegia or with dyslexia to value these health states, one might discover that they assign much larger values to paraplegia and dyslexia than do most manual laborers or white-collar workers.
Moreover, by means of techniques such as the standard gamble or time tradeoffs these systems provide apparent justification for assigning ratio-scale (cardinal) and interpersonally comparable values to health states.
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Hausman, D. Comparability of health states. Philos Stud (2023). https://doi.org/10.1007/s11098-023-02061-y
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DOI: https://doi.org/10.1007/s11098-023-02061-y