Social, cultural and environmental contexts and the measurement of burden of disease : an exploratory comparison of the developed and developing world

Abstract

The Disability Adjusted Life Year (DALY) is a measure of population health that was developed, as part of a World Bank initiated study, to inform health strategy development, priority setting, resource allocation and research, and to measure the global burden of disease. The innovative feature of the DALY was the combination of information on morbidity and mortality within a single index. Since its development in 1992, the rate at which it has been adopted by governments, multilateral agencies and researchers has been staggering. The enthusiasm with which the measure has been taken-up perhaps reflects a desire on the part of health policy makers to embrace an “evidence-based” approach to health policy. Although the DALY has been heavily criticised in some quarters, it has survived. There are a number of reasons why this may be: • It is a good measure of population health; • The enormous political will to see it succeed; and • The lack of empirical data to challenge the validity of the DALY; • In addition, many of the criticisms of the DALY have been about the implicit and explicit social values, which are hard to argue on technical grounds. This report details the findings of an empirical investigation of some of the technical and social assumptions on which the DALY is based.