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Disability Adjusted Life Years in a Regional and Cultural Perspective.: Who Should weight the disabilities?
Nordic Council of Ministers, Nordic School of Public Health NHV.
2006 (English)Independent thesis Advanced level (degree of Master (Two Years))Student thesis
Abstract [en]

The concept of disability adjusted life years (DALY) came forward in the early 1990’s to be used as a measurement of the burden of disease. The DALY combines the burden with regard to premature death and years lived with a disease. Much criticism has been raised since then with regard to e.g. ethics. This thesis focuses on the lack of contextual aspects of the DALY-concept because the measurement has a universal standard for all diseases in all countries. One aim of the study is to describe how regional and cultural context influence the view of disability and therefore contradicts with the underlying approaches of the DALY-concept. The regional and cultural differences are illustrated by examples like paraple-gia. Published burden of disease studies are examined for contextual considerations. The conclusion of the analysis is that regional and cultural issues are not taken into ac-count when using the DALY-approach of health assessments in public health. The second aim of the study is to discuss who should value the life of disabled. Follow-ing the transition of health, different views of fair health have developed and the need of health care. Underlying this assessment is an implicit valuation of disabilities among lay-people and health care professionals. If one uses DALY as a general measurement for the burden of disease and prioritising resources for disabled it is discussed who should be involved in the calculation of disability weights and a model for the collabo-ration is described. The conclusion is that lay people must be involved in a facilitated process. Overall the thesis show that the development of DALY is a serious attempt to give a simple tool for understanding and prioritise the complex challenges in public health. At present, an agenda for development of contextual DALY’s is needed.

Abstract [da]

Begrebet Disability Adjusted Life Years (DALY) kom frem i starten af 1990’erne som et redskab til at måle sygdomsbyrde. DALY kombinerer sygdomsbyrden med hensyn til for tidlig død og år levet med handicap. Megen kritik af DALY er rejst fx i forhold til etiske aspekter. Denne opgave fokuserer på manglen på kontekst i DALY-konceptet fordi instrumentet anvender en universel standard for alle sygdomme på tværs af lande. Ét formål med opgaven er at beskrive hvorledes regionale og kulturelle sammenhænge influerer synet på handicap og dermed er i modstrid med de bagvedliggende antagelser i DALY-konceptet. De regionale og kulturelle forskelle er illustreret ved eksempler som paraplegi. Publicerede sygdomsbyrde studier gennemgås i sammenhæng med regionale eller kulturelle overvejelser. Analysen konklusion er, at regionale og kulturelle hensyn ikke indarbejdet i DALY tilgangen. Det andet formål med opgaven er at diskutere, hvem skal vurdere handicappedes liv. Som følge af udviklingen af befolkningernes sundhedstilstand har opfattelse af helbred og adgang til sundhedsvæsenet ændret sig. I bedømmelsen heraf ligger en implicit vurdering af handicap bland såvel lægfolk som sundhedsprofessionelle. Hvis man anvender DALY som generelt mål for sygdomsbyrden og prioriterer på baggrund heraf, så diskuteres hvem der skal deltage i værdisætningen af vægtene, der indgår i beregningerne. En model for samarbejde omkring vægtene beskrives. Konklusionen er, at lægfolk bør involveres i processen med støtte af udefra kommende konsulenter. Overordnet viser opgaven, at udviklingen af DALY er et seriøst tiltag på et simpelt værktøj til at forstå og prioritere komplekse udfordringer i folkesundheden. For indeværende er der behov for en dagsorden for videreudviklingen af kontekstrelateret DALYs.

Place, publisher, year, edition, pages
2006. , 40 p.
Series
Master of Public Health, MPH, ISSN 1104-5701 ; MPH 2006:22
Keyword [en]
Public Health, Disability Adjusted Life Years, DALY, Context, Culture, Collaboration, Facilitation
Keyword [da]
Folkesundhed, Disability Adjusted Life Years, DALY, kontekst, kultur, samarbejde, konsulent
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3260OAI: oai:DiVA.org:norden-3260DiVA: diva2:731828
Presentation
2006-09-20, Nordic School of Public Health NHV, Box 12133, 402 42 Göteborg, Sweden, 13:00 (English)
Supervisors
Note

ISBN 91-7997-155-5

Available from: 2014-07-03 Created: 2014-07-02 Last updated: 2014-07-08Bibliographically approved

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