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DALYs system for 'measuring' disability

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 weeks edition of The Lancet.

Dr Daniel 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 Organisations (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 individuals 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 someones 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
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Contact: Daniel Mont
dmont@worldbank.org
Lancet
10-May-2007


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