Box 4.

Divided opinion on the DALY

The World Bank defines the DALY (disability adjusted life year) as “a unit used for measuring both the global burden of disease and the effectiveness of health interventions, as indicated by reductions in the disease burden. It is calculated as the present value of the future years of disability-free life that are lost as the result of the premature deaths or cases of disability occurring in a particular year.”¹⁴

One proponent of the DALY is Richard Feachem, executive director of the Global Fund for AIDS, TB, and Malaria. Feachem chaired the advisory committee for the World Development Report 1993. In 1999 he said that the report “broke new ground in presenting the global burden of disease analysis and inventing the metric of the DALY, which has now become widely adopted in discussions about health sector development. It broke new ground in taking forward the debate about cost effectiveness, as you're able to measure mortality outcomes and morbidity outcomes through the DALY.”¹⁵

But critics questioned the methods and the ethical assumptions used in calculating the DALY, and they believed that DALYs were an inappropriate and unfair criterion for resource allocation. Sudhir Anand, professor of economics at the University of Oxford, and Kara Hanson of the London School of Hygiene and Tropical Medicine, argued that “the DALY information set consists only of age, sex, disability status, and time period, which does not allow individuals' socioeconomic circumstances to be taken into account. An equitable approach to resource allocation will use a criterion which attaches a greater weight to the illness of more disadvantaged people.”¹⁶