Weighing up disability

Is it possible to agree on a universal weighting of disability? T B Üstün and colleagues report in today's Lancet on an effort to discover whether respondents from 14 countries could agree on rankings of disability states. The measure they used was the disability-adjusted life-year (DALY), introduced in the World Bank's 1993 World Development Report Investing in Health?1 World Development Report. Oxford University Press, New York1993: 3-5 Google Scholar On the grounds that any discussion of health policy must begin with an assessment of the size of health problems, the report introduced the DALY as a unit of measure for “the global burden of disease”. As predicted in 1993, 2 World Bank's cure for donor fatigue. Lancet. 1993; 342: 63-64 Abstract PubMed Scopus (20) Google Scholar the DALY has proven controversial. Because the measure has programmatic implications and could dictate priorities for action and funding-and, by extension, national health policies— emotions run high. Multiple-informant ranking of the disabling effects of different health conditions in 14 countriesRank order of disabling effects of health conditions is relatively stable across countries, informant groups, and methods. However, the differences are large enough to cast doubt on the assumption of universality of experts' judgments about disability weights. Further studies are needed because disability weights are central to the calculation of disability-adjusted life years. Full-Text PDF