Revisiting the Disability-Adjusted Life Year (DALY) as a Health Metric: Rigorous Science or Ableist Guesswork?

This research brief presents a methodological critique of the disability-adjusted life year (DALY), questioning the validity of this metric and arguing that it functions to uphold structural ableism in public health and healthcare. I establish first that the disability weights underlying the DALY are subjective social valuations of health states and are not valid measures of “the magnitude of health loss associated with specific health outcomes” as the Global Burden of Disease Study claims. I then document ableism throughout the assessment protocols used in creating the disability weights for the DALY at the levels of (a) selection of participants to complete the valuation, (b) description of health states for valuation, and (c) consideration of context where the valuation occurs. I conclude the research brief by examining two questions. First, why have the creators of the DALY and its champions positioned a subjective and ableist social valuation as rigorous science? And second, what does the widespread acceptance of the DALY across health disciplines reveal about the pervasiveness of structural ableism in health policy?