1. Look at the health measurement matrix below. The vertical axis describes states of disability while the horizontal axis describes the level of distress the patient is experiencing. What do we mean by the level of distress? The term distress is an attempt to capture both the physical and mental effects of being ill. This is very subjective but severe distress might mean considerable, continuous physical pain with perhaps a high level of anxiety and fear. Each combination on the matrix needs to be given a numerical score so that a cardinal interval scale is created. The reference points are healthy = 1 and dead = 0.

Disability Distress	None	Mild	Moderate	Severe
No disability	1.000
Slight social disability
Severe social disability and/or slight impairment of performance at work. Able to do all housework except very heavy tasks
Choice of work or performance at work very severely limited. Housewives and old people able to do light housework only but able to go out shopping
Unable to undertake any paid emplyment. Unable to continue any education. Old people confined to home except for escorted outings and short walks and unable to do shopping. Housewives able only to perform a few simple tasks
Confined to chair or to wheelchair or able to move around in the house only with support from an assistant
Confined to bed
Unconscious

a) Complete the matrix using your own values based on your own personal preferences. Each number should be to no more than three decimal places e.g. no disability/no distress will score 1.000, while confined to bed/mild distress might score 0.564. Try to be as consistent as possible. The scores are likely to reflect your own personal experiences - particularly experiences of illness. Note that it is possible to have a negative score if you feel a particular combination of disability and distress is worse than death.

Fill in the table, then click here to see the values that researchers got.

b) Compare your scores with others in your group and discuss why different people have come to different conclusions.

a) How might society re-allocate resources between hip replacement surgery and screening for breast cancer to achieve a more efficient outcome? (Remember that the most efficient allocation of resources is when the marginal cost paid is equal to the marginal benefit or utility received).

b) Why might many people be unhappy with this?

Type in your answer, then click here to compare your answer with our guide answer.

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