What Do DALYs Mean for Pediatrics?

What Do DALYs Mean for Pediatrics? 150 150 Dave Ghose

An emerging, innovative metric could radically change childhood health policy.

A new way of looking at illness is beginning to change how public health officials view life and death. The concept — called DALYs — offers a fuller view of disease that could have a big impact on pediatrics if embraced.

Unlike death tolls — the traditional method for measuring the gravity of illness — this new health metric takes into account both age and impairment. DALYs (disability-adjusted life years) recognize that not all deaths are the same. When a congenital condition kills an infant, that death accumulates more DALYs (pronounced “dallies”) than when a senior citizen dies of lung cancer, for instance. Also, DALYs consider the suffering associated with nonfatal conditions, such as depression and back pain. The method recognizes the intuitive insight that a healthy life is more than just being alive, while also giving medical leaders a better way to compare a wide variety of diseases and risk factors, from cancer and tooth cavities to car crashes and schizophrenia.

“Our experience has been that as people learn about it and understand it, they really recognize the utility and strength of using it to guide their policy and decisionmaking,” says Nicholas Kassebaum, MD, assistant professor with the University of Washington’s Institute for Health Metrics and Evaluation (IHME), which has pioneered the use of DALYs with its ongoing Global Burden of Disease project.

Dr. Kassebaum, also a pediatric anesthesiologist at Seattle Children’s Hospital, says DALYs point to the significance of fatal childhood diseases. “Each death of a child is much more health loss than the death of an adult, and the DALYs reflect that,” Dr. Kassebaum says. And while the tragic nature of childhood disease obviously is well known, Dr. Kassebaum says DALYs “replace the intuitive feeling with something concrete and actionable” and could serve as a basis for increasing pediatric research funding.

But it isn’t as simple as throwing money at what kills the most children.

Cancer and cardiovascular disease are the most lethal childhood conditions — and attract the most attention and resources — but Dr. Kassebaum says DALYs indicate some lower-profile neonatal and congenital disorders are just as serious. What’s more, as with adults, DALYs reveal the often hidden impact of chronic conditions such as anxiety, depression and dental issues that don’t get as much attention from researchers.

“It’s important to start looking at how chronic diseases also measure up among kids,” Dr. Kassebaum says.

The Bill & Melinda Gates Foundation, which funds the IHME in Seattle, and public health officials in a handful of countries such as Mexico and Australia have embraced DALYs. But the response has been more tepid in the United States. The National Cancer Institute and the National Heart, Lung and Blood Institute have shown interest in using DALYs to guide their research priorities, Dr. Kassebaum says, but no major changes have occurred yet.

“I haven’t seen examples of this being translated into policy action in this country as of yet,” Dr. Kassebaum says.

The change will take time, Dr. Kassebaum says.

“Some of it is familiarity,” he says. “Some of it is tradition. But when individuals and groups become familiar with the concept, then they seem very excited to embrace it.”



Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C and others. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. December 2012. 380(9859): 2197-2223.