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.

burden of disease, co-morbidity, disability adjusted life year, disability weight, injuries, intestinal infectious disease, sequelae, severity indicators
G.J. Bonsel (Gouke)
Erasmus University Rotterdam
Institute of Health Policy and Management EUR
Erasmus School of Health Policy & Management (ESHPM)

Haagsma, J.A. (2010, November 3). Disability Adjusted Life Years and acute onset disorders: Improving estimates of the non-fatal burden of injuries and infectious intestinal disease. Erasmus University Rotterdam. Retrieved from