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Exploring the evolution of health indicators: Why did WHO abandon age-weighting and time discounting in 2010?
In the field of public health, disability-adjusted life year (DALY) has become an important tool for assessing the overall disease burden. This indicator not only calculates the number of life years lost due to premature death, but also takes into account the number of healthy years lost due to poor health or disability. Such a comprehensive assessment allows for a more effective comparison of health status between countries. As time goes by, the World Health Organization (WHO) made significant adjustments to the calculation method of DALY in 2010, abandoning age weighting and time discounting. The reasons behind this are worth further exploration.
Disability-adjusted life year (DALY) is an important indicator to measure the social disease burden by the number of healthy years lost.
DALYs were coined in the 1990s to quantify health outcomes between countries. It provides a more comprehensive indicator of health burden by combining mortality and disability rates. The classic calculation method is: DALY = number of years lost (YLL) + number of years lived with disability (YLD). Years lost represent years of life lost due to premature death from illness, while years of disability represent years of health lost due to illness or disability. This calculation makes DALY a key tool for understanding public health.
WHO's decision in 2010 to abandon age-weighting and time discounting reflected a rethinking of how health is assessed.
Age weighting and time discounting are two important factors that affect the calculation of health indicators. Age weighting assumes that the value of a life-year held by younger people is higher than that held by older people because younger people still have significant productive potential. This approach has been criticized because it may underestimate the health of children and the elderly. For example, if a 30-year-old is disabled by a disease for 10 years, his or her DALY calculation may be higher than that of a 70-year-old in the same situation, which raises ethical issues.
Time discounting is a common concept in economics, which refers to people's preferences for future health outcomes. For example, health status in 2040 may be considered less valuable than health status in 2020 due to the passage of time. But this kind of thinking not only emphasizes economic benefits, it can also lead to unfair assessments of patients who require long-term care.
As society pays more attention to health equity, they re-evaluate the rationality of age weighting and time discounting.
Since 2010, WHO has shifted its focus to calculating the prevalence of disease rather than its incidence, which allows for a more accurate assessment of health status. Through such changes, WHO intends to emphasize that the health of all age groups should be treated equally and the impact of health burden should be consistent regardless of age. In addition, this stance sends an important message to the outside world: everyone’s health is valuable, regardless of age or productivity.
Nevertheless, the DALY calculation method still faces challenges and criticism, with some arguing that it still implicitly accounts for economic considerations of productivity to some extent. Defenders respond that the DALY measure of disability is based on the impact of the disease on life, not on a person’s productive capacity. In fact, as revealed by the Global Burden of Disease Project, the number of DALYs caused by mental health problems such as depression is extremely large, indicating that the social impact of these diseases cannot be ignored.
In the allocation of health resources in various countries, the DALY indicator makes it easier for policymakers to carry out effective long-term planning and resource allocation.
Currently, many countries and regions are still using the DALY indicator to allocate public health resources. In the Democratic Republic of the Congo, for example, the total economic cost of stroke is estimated at US$ 2 trillion, demonstrating the overlapping impact of the disease on economic operations. Although the DALY results cannot be directly converted into economic figures, its role in resource allocation and health policy formation is an indisputable fact.
Health challenges around the world change over time, and DALY data for different regions and diseases can help us understand and respond to these challenges. From cancer in Australia to infectious diseases in Africa, DALYs provide a common language to understand a wide range of health issues. By analyzing these data, public health agencies can more accurately measure the burden of disease and develop targeted health policies.
In summary, WHO's decision to abandon age weighting and time discounting in 2010 was based on the emphasis on health equity and fully reflects society's concern for the health status of all age groups. Will this shift lead to more equitable public health policies?
