This is a mega-important point.
Especially re 2, whenever I use QALY as an example I immediately follow it up by talking about the difficulty of comparing QALYs to other things that are really good to increase, like improved education or better access to political institutions for marginalised people. This helps undermine both the ‘you only care about QALYs’ attack as well as the ‘you don’t care about systemic change’ attack. It makes it clear we do care about those things, even if we don’t have great ways to assess effectiveness there yet.
(For the benefit of others interested, I can share a little bit but not very much in person/on phone.)