However, there seems to be no way of distinguishing the case where person A and B start of as perfectly healthy and we may help the former more
If you improve the number of years lived for a healthy person, that is “straightforward” on the DALY view—it’s +1 DALY for every extra year of life added.
The question of improving the quality of their life is a harder one—I think the suggestion from the DALY framework is that if the person has perfect health, there isn’t any way to improve the quality of their life (because it’s already perfect). …However, we know that’s not actually true, because there is no DALY weight for getting tickets to go see Hamilton, while I think that would improve nearly anyone’s life. That’s just an area where DALY metrics are incomplete, but you could extend the DALY framework that way, by asking people questions like “If you could choose between an free Hamilton tickets but had a 1% chance of death, would you take the tickets?” (I’d probably take the tickets at a 0.005% chance of death.)
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and the cases where B is already blind and we may add “five years at their current state of well-being”. This seems to not be ideal.
This one is also “straightforward” in the DALY view—you’re adding more years at their current disability weight. If I recall correctly, an extra year of life that would otherwise not have been lived, but lived with blindness is worth +0.8 DALY. Thus adding “five years at their current state of well-being” (that is, blindness but no other issues), would be +4 DALY.
If you improve the number of years lived for a healthy person, that is “straightforward” on the DALY view—it’s +1 DALY for every extra year of life added.
The question of improving the quality of their life is a harder one—I think the suggestion from the DALY framework is that if the person has perfect health, there isn’t any way to improve the quality of their life (because it’s already perfect). …However, we know that’s not actually true, because there is no DALY weight for getting tickets to go see Hamilton, while I think that would improve nearly anyone’s life. That’s just an area where DALY metrics are incomplete, but you could extend the DALY framework that way, by asking people questions like “If you could choose between an free Hamilton tickets but had a 1% chance of death, would you take the tickets?” (I’d probably take the tickets at a 0.005% chance of death.)
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This one is also “straightforward” in the DALY view—you’re adding more years at their current disability weight. If I recall correctly, an extra year of life that would otherwise not have been lived, but lived with blindness is worth +0.8 DALY. Thus adding “five years at their current state of well-being” (that is, blindness but no other issues), would be +4 DALY.