Biomedical subjects

Pascale A Allotey

Publications and source records attributed to Pascale A Allotey.

3 recordsLinked to original sources

PubMed2003

Measuring health in a vacuum: examining the disability weight of the DALY.

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

Australia↗

PubMed2003

Refugee intake: reflections on inequality.

BACKGROUND: Refugees represent one of the most marginalized populations with generally poor health outcomes and requirements often very different from, and in excess of, the populations in the countries of asylum. It stands to reason that countries that accept refugees should have the resources to support them. Although governments in industrialised countries are often vociferous about the generosity of their support for refugees, the appearance is that it is the poorest nations that bear the greatest burden. This has important implications for the allocation of resources to support the health and welfare needs of refugees. The distribution of refugees globally and the wealth of the countries of asylum are examined in this paper. METHOD: Data on the numbers of refugees accepted in each country were obtained from the United Nations High Commissioner for Refugees. These were used to analyse the 'fairness' of the distribution of refugees according to the economic capacity of the host countries. FINDINGS: A similar distribution of refugees prevails in the poorest quintile of countries and in the richest. Although there is considerable between-country variation, when account is taken of economic capacity, the poorest countries bear the greatest burden. INTERPRETATION: The distribution of refugees is in stark contrast to the humanitarian rhetoric of the industrialized countries. The implications of the inequitable distribution on health cannot be overemphasized.

Demography↗

PubMed2002

Objectivity in priority setting tools in reproductive health: context and the DALY.

The Disability Adjusted Life-Year (DALY) heralded a new age in the development of an evidence base for priority setting and resource allocation. The DALY was intended to represent sound measurement of the incidence and prevalence of conditions in a process by which burden of disease would be determined, health conditions prioritised and interventions evaluated. However, in the reification of objectivity, sight was lost of critical aspects of health and disease, namely that they are not independent of the context in which they occur. This is powerfully illustrated by many reproductive health conditions. Priority setting and resource allocation exercises need to take into account both objective measures and contextually relevant factors. Based on comparative data that highlights the effect of the development gradient on the burden of disease, this paper discusses the implications of context in the assessment of population health and priority setting, with a focus on reproductive health.

Cost of Illness↗