In this brief video, Dr. Christopher Murray, Director of the Institute of Health Metrics and Evaluation at the University of Washington, explains the background behind the Global Burden of Disease project. In his TED talk: “What does a $100 million public health data revolution look like?” TEDMED, Dr. Murray explains the impetus for this project and what it is expected to achieve.
In “The Rise, Critique and Persistence of the DALY in Global Health,” the author summarizes several criticisms of the Global Burden of Disease project, focusing on the disability-adjusted life year and its short-comings. Briefly, these include the following:
- The DALY fails in its goal of guiding resource allocation because does not account for differences in resource availability between countries.
- The DALY also fails to measure disease burden because the disability weights used are arbitrary and may not really be standard across contexts or countries.
- DALYs devalue the lives of people with life-long disabilities, since their lives are weighted so they have less value than completely healthy lives.
- Using economic discounting that makes future lives less valuable than current ones also discounts the emergency of future problems and the reemergence of old problems (like tuberculosis) that are relatively controlled in the present.
- Measuring the burden of disease and resource allocation at the same time requires conflating economics with health, and faces the ethical conundrum of putting a price on life.
- The data that underly the GBD measures are often incomplete and, in countries with limited diagnostic capability, skewed by the limited availability of reliable data.
For the full article as well as some examples of these problems, click here.
For students who would like to learn more about the Global Burden of Disease project and its work, please see the following article: Murray CJ. Measuring the global burden of disease N Engl J Med. 2013; 369(5): 448-457. PMID: 23902484. This article provides additional background on the science and methods used of the global burden of disease project, and includes a summary of the major findings of GBD project from its findings through 2010.
For those who wish to know more about what underpins the health of populations around the world, we recommend the special issue of the Economist entitled “Universal Health Care: An Affordable Necessity” dated April 28, 2018.