This document discusses issues with using the Global Burden of Disease (GBD) study methodology to measure health. It notes that the GBD asks participants to compare different health states based on physical and mental limitations, but that health involves more than just limitations. There is no clear explanation of how to construct a scalar measure of limitations. Additionally, the types of comparisons people make in the studies do not actually seem focused on limitations. The document raises questions about what the high correlations in disability weights across countries actually represent.

1. DEPARTMENT OF PHILOSOPHY
Does GBD2010 Measure Health?
Dan Hausman
Department of Philosophy
University of Wisconsin-Madison

2. DEPARTMENT OF PHILOSOPHY
GBD2010 Paired Comparisons
“Now, we want to learn how people compare
different health problems.
A person’s health may limit how well parts of his
body or his mind work. As a result, some people
are not able to do all of the things in life that
others may do, and some people are more
severely limited than others.”
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3. DEPARTMENT OF PHILOSOPHY
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“I am going to ask you a series of questions about
different health problems. In each question I will describe
two different people to you. You should imagine that
these two people have the same number of years left to
live, and that they will experience the health problems
that I describe for the rest of their lives. I will ask you to
tell me which person you think is healthier overall, in
terms of having fewer physical or mental limitations on
what they can do in life.
[What about suffering?]
Some of the questions may be easy to answer, while
others may be harder. There are no right or wrong
answers to these questions. Instead, we are interested in
finding out your personal views.” (Salomon 2012b, p. 2)

4. DEPARTMENT OF PHILOSOPHY
Are there right and wrong answers?
The first person has a high fever and pain, and feels
very weak, which causes great difficulty with daily
activities.
The second person has a low fever and mild
discomfort, but no difficulty with daily activities.
Who do you think is healthier overall, the first
person or the second person?
[in terms of having fewer physical or mental
limitations on what they can do in life]
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5. DEPARTMENT OF PHILOSOPHY
What comparisons are people making?
Cannabis dependence (.329): “has mood swings,
anxiety and hallucinations, and has some difficulty
in daily activities” vs.
Profound intellectual disability (.157) “has low
intelligence, cannot understand basic requests or
instruction, and requires constant assistance for
nearly all activities”
Who do you think is healthier overall [“in terms of
having fewer physical or mental limitations on
what they can do in life”]?

6. DEPARTMENT OF PHILOSOPHY
Deafness (.033) “cannot hear at all, even loud
sounds”
Symptomatic benign prostatic hypertrophy (.070)
“feels the urge to urinate frequently, but when
passing urine it comes out slowly and sometimes
is painful”
Who do you think is healthier overall [“in terms of
having fewer physical or mental limitations on
what they can do in life”]?
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7. DEPARTMENT OF PHILOSOPHY
Can disability weights be uniform?
Spinal cord lesion below neck: treated (.047) “is
paralyzed from the waist down and cannot feel
or move the legs. The person uses a lightweight
and comfortable wheelchair to move around”
How extensive are the “physical or mental
limitations on what they can do in life?”
1995 paraplegia disability weight: .671
Are these limitations the same in different
physical, cultural, and technological
environments?
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8. DEPARTMENT OF PHILOSOPHY
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Allotey, Reidpath, Kouamé, and Cummins (2003)

9. DEPARTMENT OF PHILOSOPHY
What might explain the results?
Ambiguity concerning “sickness”
Heteroscedasticity (limited variance
near the ends of the scale)
Similarities in disagreement
What significance should be attached
to the mean value of a latent
variable that purportedly explains
comparisons? 9

10. DEPARTMENT OF PHILOSOPHY
Conclusion
Health is not only a matter of activity
limitations.
There is no explanation of how to construct
a scalar measure of activity limitations.
Respondents are not ranking health states
by activity limitations.
The high correlation in disability weights
across countries is baffling.
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