{"id":3257,"date":"2017-11-15T11:04:42","date_gmt":"2017-11-15T10:04:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3257"},"modified":"2017-12-04T17:03:18","modified_gmt":"2017-12-04T16:03:18","slug":"life-and-death-apples-and-oranges","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/life-and-death-apples-and-oranges\/","title":{"rendered":"Life and Death: Apples and Oranges?"},"content":{"rendered":"<p><em><strong>Guest Post: Carl Tollef Solberg, Ole Frithjof Norheim and Mathias Barra<br \/>\nArticle: <a href=\"http:\/\/jme.bmj.com\/content\/early\/2017\/10\/27\/medethics-2017-104365\">The Disvalue of Death in the Global Burden of Disease<\/a><\/strong><\/em><\/p>\n<p><em>The<\/em> <em>global burden of disease (GBD) study <\/em>is \u201ca systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time.\u201d It was initiated by <a href=\"http:\/\/www.who.int\/topics\/global_burden_of_disease\/en\/\">the WHO<\/a> in the late 1980\u2019s, and since then, <a href=\"http:\/\/www.worldbank.org\/en\/topic\/health\/publication\/global-burden-of-disease-generating-evidence-guiding-policy\">the World Bank<\/a> and several universities have joined the effort. Publications reporting on the GBD regularly feature in top journals, like <a href=\"http:\/\/thelancet.com\/gbd\">The Lancet<\/a> and <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/nejmra1201534#t=article\">the New England Journal of Medicine<\/a>. Furthermore, the GBD study \u2013 which uses the <em>disability-adjusted life year<\/em> <em>(<\/em><em>DALY)<\/em> as its health metric \u2013 is increasingly informing policymaking. In 2007 The Institute for Health Metrics and Evaluation (IHME) marked a new era with increased activity for the GBD. On <a href=\"http:\/\/www.healthdata.org\/gbd\/about\">the IHME&#8217;s home-page<\/a> the GBD\u2019s DALY-driven data for charting the burden incurred by disability and mortality is described as \u201cjust like [a] gross domestic product.\u201d<\/p>\n<p>In the GBD, <em>disease burden<\/em> is measured as DALYs \u2013 a measure for burden composed of the two components <em>years lived with disability (YLDs)<\/em> and <em>years of life lost (YLLs)<\/em>. The YLDs measure how much an individual is burdened by disease while still <em>alive<\/em>; the YLL on the other hand, measures how much a person is burdened by <em>death<\/em>. Thus, whereas morbidity (YLD) is something that happens to an individual, loss of life itself (YLL) occurs when that individual\u2019s life ends or has ended. YLLs quantify something that involves no experience and does not take place among living individuals. This casts doubt on whether the YLL is an individual burden at all. If it is not, then YLDs and YLLs may be as \u2018apples and oranges\u2019.<\/p>\n<p><!--more--><\/p>\n<p>The DALY\u2019s greatest weakness may be that it is marketed as a mostly descriptive measure. If this dulls the perceived need for continuous questioning and updating of the underlying methodology for measuring disease burden, it might not accurately reflect what must be the ultimate aim of the GBD: in what way morbidity and mortality does <em>matter<\/em> to the peoples of the world.<\/p>\n<p>We suggest a revisionary strategy for making the YLD and the YLL comparable\u2014an appeal to counterfactual harm. This strategy, however, forces the DALY-authors to take a stance on at which developmental stage deaths begins to be bad for the one who dies.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest Post: Carl Tollef Solberg, Ole Frithjof Norheim and Mathias Barra Article: The Disvalue of Death in the Global Burden of Disease The global burden of disease (GBD) study is \u201ca systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/life-and-death-apples-and-oranges\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[443,591],"tags":[],"class_list":["post-3257","post","type-post","status-publish","format-standard","hentry","category-jme","category-life-and-death"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Life and Death: Apples and Oranges? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/life-and-death-apples-and-oranges\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Life and Death: Apples and Oranges? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest Post: Carl Tollef Solberg, Ole Frithjof Norheim and Mathias Barra Article: The Disvalue of Death in the Global Burden of Disease The global burden of disease (GBD) study is \u201ca systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/life-and-death-apples-and-oranges\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2017-11-15T10:04:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2017-12-04T16:03:18+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2017\\\/11\\\/15\\\/life-and-death-apples-and-oranges\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2017\\\/11\\\/15\\\/life-and-death-apples-and-oranges\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Life and Death: Apples and Oranges?\",\"datePublished\":\"2017-11-15T10:04:42+00:00\",\"dateModified\":\"2017-12-04T16:03:18+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2017\\\/11\\\/15\\\/life-and-death-apples-and-oranges\\\/\"},\"wordCount\":406,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"JME\",\"Life and Death\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2017\\\/11\\\/15\\\/life-and-death-apples-and-oranges\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2017\\\/11\\\/15\\\/life-and-death-apples-and-oranges\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2017\\\/11\\\/15\\\/life-and-death-apples-and-oranges\\\/\",\"name\":\"Life and Death: Apples and Oranges? 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