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The DALY, context and the determinants of the severity of disease: an exploratory comparison of paraplegia in Australia and Cameroon

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  • Allotey, Pascale
  • Reidpath, Daniel
  • Kouamé, Aka
  • Cummins, Robert

Abstract

This paper summarises the findings of an empirical investigation of some of the technical and social assumptions on which the disability adjusted life year (DALY) is based. The objectives of the study were to examine the notion that the burden of disease is broadly similar without regard to country, environment, gender or socio-economic status and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors. The study was a multi-factorial exploratory study employing qualitative and quantitative techniques to obtain data on the effects of country (development), environment (urban versus rural), gender and socio-economic status on people with paraplegia. The data provided an extensive and detailed compilation of context rich descriptions of living with paraplegia. Striking features of the data were the differences between countries with respect to the impact of the health conditions on functioning and highlight a context in which paraplegia of like clinical severity can be fatal in one environment and not in another. While there has been some focus on the control of social determinants of disease, there has been little work on the social determinants of the severity of disease. The underlying assumptions of the DALY, which ignore context in the assessment of the burden of disease, risk exacerbating inequalities by undervaluing the burden of disease in less-developed countries. There is a need to continue to subject the development of indicators to rigorous debate to determine a balance between the assumption of a global "average social milieu" and the treatment of each individual as belonging to their own context in the assessment of population health in order for indicators to be meaningful cross-culturally.

Suggested Citation

  • Allotey, Pascale & Reidpath, Daniel & Kouamé, Aka & Cummins, Robert, 2003. "The DALY, context and the determinants of the severity of disease: an exploratory comparison of paraplegia in Australia and Cameroon," Social Science & Medicine, Elsevier, vol. 57(5), pages 949-958, September.
  • Handle: RePEc:eee:socmed:v:57:y:2003:i:5:p:949-958
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    Citations

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    Cited by:

    1. Jan Reinhardt & Ulrich Mansmann & Bernd Fellinghauer & Ralf Strobl & Eva Grill & Erik Elm & Gerold Stucki, 2011. "Functioning and disability in people living with spinal cord injury in high- and low-resourced countries: a comparative analysis of 14 countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(3), pages 341-352, June.
    2. Arnesen, Trude & Kapiriri, Lydia, 2004. "Can the value choices in DALYs influence global priority-setting?," Health Policy, Elsevier, vol. 70(2), pages 137-149, November.
    3. Stein, Alexander J. & Meenakshi, J.V. & Qaim, Matin & Nestel, Penelope & Sachdev, H.P.S. & Bhutta, Zulfiqar A., 2005. "Health benefits of biofortification - an ex-ante analysis of iron-rich rice and wheat in India," 2005 Annual meeting, July 24-27, Providence, RI 19468, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
    4. Vijayasingham, Lavanya & Jogulu, Uma & Allotey, Pascale, 2021. "Ethics of care and selective organisational caregiving by private employers for employees with chronic illness in a middle-income country," Social Science & Medicine, Elsevier, vol. 269(C).
    5. Lavanya Vijayasingham & Uma Jogulu & Pascale Allotey, 2018. "Enriching the Organizational Context of Chronic Illness Experience Through an Ethics of Care Perspective," Journal of Business Ethics, Springer, vol. 153(1), pages 29-40, November.

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