 The QALY metric, however, is problematic for another reason. When evaluators are asked to rank the impact of a disability on quality of life they are asked to consider the overall “burden” of living with that decrement in health or functioning. Undoubtedly, part of that burden is the result of the social stigma, discrimination and lack of opportunities that characterizes the disabled life, in all cultures. People with disabilities typically have as a group the lowest employment and education participation rates of any sub-population (WHO 2011, Chapter 8), a fact that profoundly affects their quality of life, but which has as much to do with failed policy to combat stigma and lack of accommodation as it does with the underlying health condition. Yet the fact that the burden of living with a disability is caused as much by the social environment suggests that the QALY metric, even if it accurately describes the burden of disability, is unfair as a basis for resource allocation (Wasserman, Asch, Bickenbach 2008). In effect we are saying to the person with a disability that because stigma and failed policy make your life less valuable, we are not going to improve your life by giving you access to needed resources.