My goodness—and yours: a history, and some possible futures, of DALY meanings and valuation procedures

In the Global Burden of Disease (GBD) project the question has been raised whether disability-adjusted life years (DALYs) should measure average health only, or also capture concerns for fairness and equity. The following is a brief comment on this issue. I first distinguish between goodness in health care in terms of objective health gain, individual utility, and societal value. I then show the role of these concepts and their operationalization in the history of DALYs. I proceed to discussing the latest proposal for defining health in the GBD project (Murray et al. 2000), and its possible implications for procedures for determining disability weights. I finally discuss the pros and cons of different candidate weighting procedures.