Is it feasible or desirable to measure burdens of disease as a single number?
This paper questions the feasibility and desirability of creating a composite health index, such as the DALY (disability adjusted life years), that aggregates information about both mortality and morbidity into one number, to represent the burden of disease. Despite the expressed intention not to include contextual factors in the description of health states, in practice, doing so is unavoidable when trying to construct a health indicator. Including contextual factors leads to severe problems, however, regarding validity and reliability, and these are increased when evaluations of the described health states are made. This renders little confidence in DALYs as a measurement of the burden of disease. Using cost-effectiveness analyses and DALYs as tools in priority setting might have unwanted consequences, and this is not the only method of achieving economic efficiency. The use of this method might also serve to relieve politicians of the responsibility for resource allocation in the health sector. An alternative to a composite index is better and more comprehensive epidemiological data on sexual and reproductive health mortality, morbidity and diseases rather than the better use of health indicators of questionable validity and reliability. These kinds of data are now being collected in connection with the Global Burden of Disease Project. It should be up to the decisions-makers to allocate existing resources based on a balancing of the many good purposes and goals available.
Nygaard
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Centre for Partnership in Development, PO Box 23 Vinderen, N-0319 Oslo, Norway. nygaard@dis.no
D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D015276:Health Care Rationing / Q000191:economics / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D016387:Women's Health