Disability and the Evaluation fo Public Health Interventions

Disability Adjusted Life Years (DALYs), a common indicator for assessing the relative impacts of public health interventions, explicitly incorporates disability. However, the conceptualization of disability embodied in the DALYs is not consistent with the International Classification of Functioning, Disability, and Health (ICF) or the social model of disability model upon which it draws. Instead, it is based on a medical model that ties disability to medical diagnoses. As a result, DALYs do not give credit to public health interventions that improve the lives of disabled people by mitigating or accommodating their functional statuses. This paper builds on this point, expressed in an upcoming paper in The Lancet (Mont, 2007), by running simulations of policy interventions in Zambia, and using detailed data collected on activity and participation limitations to determine how those interventions could be assessed differently using DALYs and using indicators that are more tied to the social model of disability and Amartya Sen's capability approach. Increased attention is being paid to inclusive development, as witnessed by the recent signing of the UN Convention on the Rights of Persons with Disabilities, it will be important to construct indicators that can properly assess the effects of public health policies and