Dalys System For 'Measuring' Disability Needs To Be Replaced

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Dalys System For 'Measuring' Disability Needs To Be Replaced

http://www.medicalnewstoday.com/medicalnews.php?newsid=70466

DALYs (disability-adjusted life years) - the frequently used

indicator for relative effects of public health interventions which

specifically incorporate disability - need to be updated or

replaced, says a Viewpoint in this week's edition of The Lancet.

Dr Mont, Disability and Development Team, The World Bank,

Washington DC, USA, says that the notion of disability embodied in

DALYs does not accord with that in the World Health Organisation's

(WHO) International Classification of Functioning, Disability and

Health (ICF).

He says: " Disability and health are difficult concepts to measure.

In fact, the appropriate measure of disability depends on the reason

behind its measurement. "

He adds: " Critics claim that DALYs devalue the lives of disabled

people. A year lived with a disability is counted as something less

than a year lived without one. Conversely, saving the life of an

individual with a disability does not improve the summary measure of

health as much as saving the life of a person without a disability.

" The fear is that this fact will drive resources away from disabled

people, making them even more vulnerable and disadvantaged than they

already are in many societies. "

With the ICF approach, the medical condition does not matter;

however functional status does - in particular how the individual's

functioning interacts with the environment to create disability.

The Viewpoint cites the example of a child born deaf, whose ability

to function depends not only on its inability to hear but on the

ability of its family and the community to use sign language.

Dr Mont says: " The effect on someone's life comes not from their

functional status - in this case their mode of communication but

from the extent to which that mode of functioning has been

accommodated. "

The Viewpoint goes on to discuss the problems that can stem from the

views of some doctors that disability is a disorder to be cured

rather than a functional status that needs to be accommodated.

Dr Mont says: " The main difficulty with DALYs is that they do not

value interventions that enhance the lives of people with

disabilities. To do so, they must draw on the social model of

disability to look at how the environment interacts with functional

status. "

He concludes: " We should develop a limited set of measures aimed at

addressing different aspects of health, which coincide within the

approach taken by the ICF. Health - and indeed disability - are too

complex to be encapsulated with one measure. "

www.lancet.com