Time to Play by the Rules

Right across the globe, Public Health authorities battle to prioritize the allotment of resources to effectively reduce the negative effects of disease. One tool that they use to try to achieve this is the Disability Weight scale. This sprang originally from the 1996 Global Burden of Disease report, commissioned by the World Health Organisation.

The scale attempts to measure diseases against each other to determine which result in the more severe disability, but how would you go about determining this?

The original method used was to gather an international group of public health officials in Geneva to decide on the weightings of 22 indicator diseases. This involved coming to a consensus that on a scale of 0 to 1 (where 0 was a state of total positive health and 1 equated to death) that X was a less healthy state than Y. Hundreds of other diseases where then measured against these indicators and slotted into relative positions.

Although the method was used on nine other occasions in different parts of the world, with similar results, you can see that this was not exactly an ideal way of determining the severity of different disabilities. Is the opinion of people working in public health really more valid than that of people actually experiencing these difficulties?

But having said that, whilst a methodology which surveyed the latter could have been employed, wouldn’t that have been equally flawed as the people involved would only have experience of their own difficulty and would find it difficult to quantify against another persons’?

A compromise was reached when the weightings were revisited in 2010. Groups of ordinary people were gathered in the U.S, Bangladesh, Indonesia, Tanzania, Peru and via an international internet survey. Each was presented with series of scenarios which involved two characters with a health issue and were asked to assess, on the same 0 to 1 scale, which was the less healthy. The more recent 2013 weightings were determined by using the 2010 data and adding the results of similar surveys carried out in Hungary, Italy, the Netherlands and Sweden.

Once again one could say that this method is no more reliable than the others, but this does not alter the fact that this is the basis on which Public Health resources are supposed to be allotted. So perhaps it might be a good idea to look at these weightings in a little more detail.

In the current weightings, severe anxiety sits with an equal rating with severe motor impairment, severe depression with severe stroke with long-term consequences, and schizophrenia has the highest disability ranking of all.

As a psychologist I am very much an advocate of the recovery model and I feel uneasy when it comes to measuring one person’s experience of distress against another’s. Also, as far as schizophrenia is concerned, most of the effort in recent years, at least in this country, has been focused on early intervention, thereby reducing the Duration of Untreated Psychosis (DUP) and meaning that this, perhaps, most stigmatized diagnosis is less frequently given.

However I have to say that I also find it galling that, despite these weightings, mental health remains the Cinderella when it comes to the allotment of health resources across the world and, it would seem, particularly in the UK. Politicians of all parties continue to call for parity in health services. They are not even playing by their own rules.

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