Leprosy Mailing List – June 27, 2015
Ref.: (LML) Disability Adjusted Life Years (DALYs)
From: Joel Almeida, Kochaikanal, India
Dear Pieter,
Many thanks to Dr. Beise for her perceptive comments about DALYs. I am not concerned to defend DALYs. Their originators can do so. However, DALYs are enormously influential in priority-setting, so we can't afford to ignore them. If we do, even more people will become disabled by leprosy, and fewer opportunities will be available to these people. Of course, we can develop better and more detailed information with which to calculate DALYs. We should be doing that.
Some concerns may be outdated. Concepts behind DALYs and disability weights have been updated since the criticisms referred to. Updated concepts are described here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61680-8/fulltext
Among other things, age weighting is abolished. This was formerly used and partly based on economic criteria. A year of human life is treated as equally valuable whether it is lived by an unemployed child, a retired person, an unemployed adult, or an employed person. Only health loss is considered.
Health loss (e.g. spinal cord injury) is quantified by disability weight. Rehabilitation services are shown as having an impact on that disability weight, even though they do not cure the spinal cord injury. We can use an analogous approach for leprosy. Untreated deformities may well be observed (in our individuals and populations) to have a greater disability weight than "treated" deformities (treated by reconstruction and/or rehabilitation). We need to quantify the reduction in disability weight attributable to our interventions, bearing in mind that health loss can be physical or emotional or both.
It is true that everyone should strive to build societies that are more open and accessible to individuals with functional limitations. We should probably even strive for universal insurance against disabilities. However, this presupposes that we recognise functional limitations. For example, we need to acknowledge that a person who has lost one limb is better off, in terms of health loss, than a person who has lost two limbs; the two persons being materially identical in other respects. Otherwise the person who has lost two limbs might reasonably object to our views.
In summary, DALYs are what influence priorities. We need to improve the quality of information which goes into calculations of DALYs lost to leprosy. This should help avoid the gross under-estimates that have hit leprosy so hard and so unjustly.
Of course, it may be that we can convert the whole world to an alternative to DALYs, yet to be imagined. I leave that to others.
Regards,
Joel Almeida
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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