The population's health faces an array of diseases and injuries. Limited
resources compel policy-makers everywhere to focus on threats that are
regarded most relevant in terms of public health. The World Health
Organization and Worldbank developed an innovative concept which
expresses the burden of disease in Disability Adjusted Life Years
(DALY). The DALY provides knowledge on the size of health problems and
the potential benefit of proposed measures set against similar and
comparable data of other problems. However, apart from the obvious
advantages, the DALY-concept has been criticized concerning key aspects
of the methodology. This thesis addressed four of these controversial
aspects: namely (1) deriving disability weights for disorders with
complex and heterogeneous recovery patterns, (2) the disregard of
comorbid diseases, (3) the arbitrariness of the in- and exclusion of
long-term sequelae, and (4) the absence of a criterion to identify cases
that are relevant from a public health perspective. These controversial
aspects were addressed with regards to two health (care) domains where
these aspects are particularly problematic. Both health domains,
injuries and infectious intestinal disease, are featured by
heterogeneous health outcomes, including the extremes of the severity
spectrum and duration, with all types of time-severity relations.
This thesis demonstrated satisfactory alternative solutions to these
four controversial issues of the DALY concept. As a result, the
DALY-concept may be used for burden of disease studies of conditions in
which these controversial issues emerge in particular. Application of
alternative solutions proposed in this thesis may improve burden of
disease estimates considerably.http://repub.eur.nl/res/pub/21187/Proefschrift%20Juanita%20A%20Haagsma.pdf
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