Quantifying be a contentious, as it has significant implications.

Quantifying the global burden of disease and allocation of resources are the major concern on the basis of DALY’s universal formula. It decides the amount of money to be spent on diseases along with the money to be spent on research along with measuring the burden of diseases. Hence the values and prospects attached with DALY are morally and ethically are argumentative1.

 

The burden of the disease affects an individual in a broader context (such as the burden also affects individual family, friends etc) but DALY measures in limited contexts. The burden actually does not calculate the individual’s differential ability to overcome their limitations. Irrespective of these DALY uses standardized maximum life expectancies which is probably higher than the developing countries2. DALY efforts are made to reduce waste, increase quality, and improve efficiency. The most difficult part of any approach combining data on quality of life and length of life is how to measure the quality of life. How should one value health states numerically on a scale of zero to one?Quantifying ill health on the basis of functional impairment and premature mortality, adjusting with age, sex and duration of illness appear to be a contentious, as it has significant implications. For measurement of actual ‘burden of illness’, irrespective of age and sex of an individual, more information is required about the instances individuals go through while experiencing ill-health, such as privately earned incomes, support from family and friends, support from public services etc1.

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In DALY calculations, pre-existing disability in a person, for e.g. being a physical handicap, is less contributed towards the disease burden even if illnesses are independent of his/her disability as compared to an abled person. Thus, on a cost-effectiveness basis, he/she will receive only a lower priority. However precisely on account of his/her pre-existing disability, their claim on public resources should be morally/ethically greater. The implications for resource allocation is inequitable on the application of DALY2 3.

 

Similarly, evaluation of pre-mature mortality with standardised expected life expectancy rates from other countries and context will have an ethical dilemma of excluding people who are living beyond the standardised expected life expectancy (YLL = 0). Discounting future benefits is also contentious. Why should a life year now be of more value than a life year twenty year ahead? The impact of discounting has its implications for the assessment of DALYs for preventive services versus curative services since effects of future benefits from Preventive services are inherently undervalued in DALY assessments factoring discounting. Even gender gaps seem to be emerging in the DALY framework. The concept of DALY assessments argues that gender gap is adjusted to correspond to ‘biological differences in survival potential’. This potentially underestimates the burden of disease for females relative to males (e.g. If the maximum standard expectation of life at birth is, say 78 years for men, but is adjusted to 80 years in the Burden of Disease study, the estimated burden for men thus becomes greater relative to women)4.

 

“A valuation of human beings according to their functional capacity contradicts values laid down in the Declaration of Human Rights: recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation.” The WHO responsible for the global burden of disease project aims at strengthening the scientific and ethical foundations of health policies, aiming to promote equity, quality, and efficiency. The current DALY protocol does not seem to accord with this and expected health outcome should not form a basis for discrimination.5

1Anand, S., Hanson, K., 1997. Disability-adjusted life years: a critical review. Journal of Health Economics 16, 685–702. doi:10.1016/S0167-6296(97)00005-2 

2Anand, S., Hanson, K., 1997. Disability-adjusted life years: a critical review. Journal of Health Economics 16, 685–702. doi:10.1016/S0167-6296(97)00005-2

3 Arnesen, T., Nord, E., 1999. The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ 319, 1423–1425.

4Anand, S., Hanson, K., 1997. Disability-adjusted life years: a critical review. Journal of Health Economics 16, 685–702. doi:10.1016/S0167-6296(97)00005-2

5Nord, E., 2013. Disability weights in the Global Burden of Disease 2010: Unclear meaning and overstatement of international agreement. Health Policy 111, 99–104. doi:10.1016/j.healthpol.2013.03.019

 1 Anand, S., Hanson, K., 1997. Disability-adjusted life years: a critical review. Journal of Health Economics 16, 685–702. doi:10.1016/S0167-6296(97)00005-2

2 Anand, S., Hanson, K., 1997. Disability-adjusted life years: a critical review. Journal of Health Economics 16, 685–702. doi:10.1016/S0167-6296(97)00005-2

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