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There are a number of methods that can be applied to determine measures of the quality oflife (QoL) or wellbeing that result from aspects of FF. One common measure of lostwellbeing is the ‘burden of disease’ associated with the health outcomes resulting from NFF.This measure is limited in that it only measures illnesses and injuries as QoL and does notinclude aspects of overall family happiness and wellbeing that are not associated with healthoutcomes. However, no data were identified on the latter in this scoping exercise.2.3.6.1 BURDEN OF DISEASE — DALYS AND QALYSIn the last decade, a non-financial approach to valuing human life has been derived, whereloss of wellbeing and premature mortality – called the ‘burden of disease and injury’ – aremeasured in DALYs. This approach was developed by the World Health Organization(WHO), the World Bank and Harvard University for a study that provided a comprehensiveassessment of mortality and disability from diseases, injuries and risk factors in 1990,projected to 2020 (Murray and Lopez, 1996). Methods and data sources are detailed furtherin Murray et al (2001) and the WHO continues to revisit the estimates for later years.A DALY of 0 represents a year of perfect health, while a DALY of 1 represents death. Otherhealth states are attributed values between 0 and 1 as assessed by experts on the basis ofliterature and other evidence of the quality of life in relative health states. For example, thedisability weight of 0.18 for a broken wrist can be interpreted as losing 18% of a person’squality of life relative to perfect health, because of the inflicted injury. Total DALYs lost froma condition are the sum of the mortality and morbidity components – the Year(s) of Life Lostdue to premature death (YLLs) and the Year(s) of healthy life Lost due to Disability (YLDs).The DALY approach has been successful in avoiding the subjectivity of individual valuationand is capable of overcoming the problem of comparability between individuals and betweennations, although some nations have subsequently adopted variations in weighting systems,for example age-weighting for older people. This report treats the value of a life year asequal throughout the lifespan.As these approaches are not financial, they are not directly comparable with most other costand benefit measures. In public policy making, it is often desirable to apply a monetaryconversion to ascertain the cost of an injury, disease or fatality or the value of a preventivehealth intervention, for example, in CBA. Such financial conversions tend to utilise‘willingness to pay’ or risk-based labour market studies as described in the next section.2.3.6.2 WILLINGNESS TO PAY AND THE VALUE OF A STATISTICAL LIFE YEARThe burden of disease as measured in DALYs can be converted into a dollar figure using anestimate of the Value of a ‘Statistical’ Life (VSL). As the name suggests, the VSL is anestimate of the value society places on an anonymous life. Since Schelling’s (1968)discussion of the economics of life saving, the economic literature has focused onwillingness to pay (WTP) – or, conversely, willingness to accept – measures of mortalityand morbidity, in order to develop estimates of the VSL.Estimates may be derived from observing people’s choices in situations where they rank ortrade off various states of wellbeing (loss or gain) either against each other or for dollaramounts e.g. stated choice models of people’s WTP for interventions that enhance health orwillingness to accept poorer health outcomes or the risk of such states. Alternatively, riskstudies use evidence of market trade-offs between risk and money, including numerouslabour market and other studies (such as installing smoke detectors, wearing seatbelts orbike helmets and so on).48