Summary
By quantifying the total disease burden and the contribution
of different diseases and risk factors, DALYs are a highly valuable measure to set priorities for public health
research and policy. Furthermore, if data allow, DALYs
may be calculated for different socioeconomic groups or
geographic regions, allowing for a more detailed perspective
on public health. By regularly updating the DALY estimates
based on the best available data, trends in public
health may be monitored over time, and the impact of
macro-level policies may be evaluated. As a result, DALYs
may be important tools to support policy that aims to
improve general population health and reduce health inequalities
[39]. For this reason, the IHME is initiating national and subnational burden of disease studies, worldwide
[40]. The WHO Regional Office for Europe is collaborating
with IHME to facilitate national burden of disease
study in the European region and enhance consistency of
burden estimates.
Current DALY estimates for Belgium highlight the importance
of non-communicable diseases and injuries.
However, several constraints can be identified that might
hamper the policy relevance of the currently available estimates.
First, most DALY estimations remained academic
exercises, with little or no direct knowledge transfer to the
concerned policy instances. Indirect knowledge transfer
may have occurred by referring to existing burden estimates
in research proposals, but the effect is difficult to
assess. Second, while global estimates provide a broad
overview of the health status in Belgium, it remains a
question to what extent these estimates are grounded in
the best available local data. There may also be issues
related to timeliness and ownership of these global estimates.
Third, while national research groups did more
efforts to apply local data sources, there appears to be
little consistency in the applied DALY calculation methodology.
As a result, the individual DALY studies cannot be
combined to obtain a comparable evaluation of Belgians’
health. Researchers are therefore advised to calculateDALYs under different social weighting scenarios, and
to present at least relative DALY estimates (e.g., DALYs
per 100,000 people-year).
To overcome these limitations and generate a systematic
and truly comparable measurement of Belgians’
health, DALYs should be integrated in the different official
data collection systems. This is already the case in
the Netherlands and Australia, where DALYs are guiding
health policy since the past 10–20 years [34,41]. In
Belgium, various large and important data generation systems
are in place that could provide the data required for
calculating DALYs. However, there are also some potential
hurdles, such as a lack of timeliness of certain databases, a
restricted access to hospital data for routine use, a limited
harmonization between regional databases, and the absence
of certain diseases from the major databases. Given
the increasing importance of neurological, mental and
musculoskeletal disorders, the absence of comprehensive,
harmonized databases for these disorders is particularly
striking. Nevertheless, we believe that the
routine quantification of disease burden in terms of
DALYs would provide a significant added value to public
health policy in Belgium and should be integrated in all
national mechanisms for the translation of evidence
into policy.