Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years
Health metrics have evolved with increasing sophistication. The disability-adjusted life-year (DALY) has emerged as a widely used metric. While DALYs vary between countries, the global disability weights (DWs) that are integral to the DALY ignore the potential impact of local factors on the burden o...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/8/6/e012106.full |
| _version_ | 1827878795245256704 |
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| author | John G Meara Daniel Scott Corlew Helena Franco Manon Pigeolet Lisa Nussbaum |
| author_facet | John G Meara Daniel Scott Corlew Helena Franco Manon Pigeolet Lisa Nussbaum |
| author_sort | John G Meara |
| collection | DOAJ |
| description | Health metrics have evolved with increasing sophistication. The disability-adjusted life-year (DALY) has emerged as a widely used metric. While DALYs vary between countries, the global disability weights (DWs) that are integral to the DALY ignore the potential impact of local factors on the burden of disease. Developmental dysplasia of the hip (DDH), a spectrum of hip pathologies, typically develops during early childhood and is a leading cause of early hip osteoarthritis. This paper explores the variability in the DW for DDH in relation to to local health environments using select health system indicators.The DW for DDH increases with decreasing income level of countries. The Human Development Index and the Gross Domestic Product per capita are both negatively correlated with (p<0.05) the DW for DDH per country. For the indicators surgical workforce, surgical procedures and hospital beds per 1000 population, there is a significant negative correlation in countries not meeting the minimum standard of that indicator (p<0.05), while for countries meeting that minimum standard, the correlation between DW for DDH and the respective indicator is not significantly different from zero.Consideration should be given to re-establishing the DWs for health entities in countries that do not meet the minimum standards of a functional health system. This would more accurately reflect the burden of disease from a functional perspective in LMICs, and perhaps allow for more informed priority setting within LMICs and for donors. The establishment of these DWs should not start from scratch; our data suggest that the variability in DWs due to context can most likely be modelled using health system and financial protection indicators already in use today. |
| first_indexed | 2024-03-12T17:56:43Z |
| format | Article |
| id | doaj.art-9f07a259fd4c469592bf241a0ac5d3ee |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-03-12T17:56:43Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-9f07a259fd4c469592bf241a0ac5d3ee2023-08-02T13:45:07ZengBMJ Publishing GroupBMJ Global Health2059-79082023-06-018610.1136/bmjgh-2023-012106Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-yearsJohn G Meara0Daniel Scott Corlew1Helena Franco2Manon Pigeolet3Lisa Nussbaum4Department of Plastic and Oral Surgery, Boston Children`s Hospital, Boston, Massachusetts, USAThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USADepartment of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USAFaculty of Health Sciences, Université Libre de Bruxelles, Bruxelles, BelgiumDepartment of Plastic & Oral Surgery, Boston Children`s Hospital, Boston, Massachusetts, USAHealth metrics have evolved with increasing sophistication. The disability-adjusted life-year (DALY) has emerged as a widely used metric. While DALYs vary between countries, the global disability weights (DWs) that are integral to the DALY ignore the potential impact of local factors on the burden of disease. Developmental dysplasia of the hip (DDH), a spectrum of hip pathologies, typically develops during early childhood and is a leading cause of early hip osteoarthritis. This paper explores the variability in the DW for DDH in relation to to local health environments using select health system indicators.The DW for DDH increases with decreasing income level of countries. The Human Development Index and the Gross Domestic Product per capita are both negatively correlated with (p<0.05) the DW for DDH per country. For the indicators surgical workforce, surgical procedures and hospital beds per 1000 population, there is a significant negative correlation in countries not meeting the minimum standard of that indicator (p<0.05), while for countries meeting that minimum standard, the correlation between DW for DDH and the respective indicator is not significantly different from zero.Consideration should be given to re-establishing the DWs for health entities in countries that do not meet the minimum standards of a functional health system. This would more accurately reflect the burden of disease from a functional perspective in LMICs, and perhaps allow for more informed priority setting within LMICs and for donors. The establishment of these DWs should not start from scratch; our data suggest that the variability in DWs due to context can most likely be modelled using health system and financial protection indicators already in use today.https://gh.bmj.com/content/8/6/e012106.full |
| spellingShingle | John G Meara Daniel Scott Corlew Helena Franco Manon Pigeolet Lisa Nussbaum Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years BMJ Global Health |
| title | Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years |
| title_full | Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years |
| title_fullStr | Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years |
| title_full_unstemmed | Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years |
| title_short | Context matters for disability and priority setting for musculoskeletal diseases: revisiting the egalitarian approach to disability weights and disability-adjusted life-years |
| title_sort | context matters for disability and priority setting for musculoskeletal diseases revisiting the egalitarian approach to disability weights and disability adjusted life years |
| url | https://gh.bmj.com/content/8/6/e012106.full |
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