Imagine you are walking through a grocery store, fishing through the aisles in search of cereal, the last item on your list. You come across the row of colorful but uniformly sized boxes whose only distinction is their million-dollar-costing box design and a measly price tag. As you sift through the boxes and their respective price tags, you might be compelled to compare the types of cereal based on their taste and cost. Perhaps your desire to be healthy tempts you to buy that $6 box of cereal. Yet, for lack of a system of weighing these factors, you may either stand there in utter confusion while attracting the curious glances of fellow shoppers or cursorily make a decision to avoid the rather awkward realization that you are contemplating the decision so thoroughly. Though an outwardly trivial example, this situation reflects a decision-making process that involves seemingly irreconcilable factors.
The QALY, or quality-adjusted life year, is an indicator used by economists to compare disease burden and medical interventions on a singular numeric scale to facilitate and/or prioritize the allocation of health resources. Unfortunately, this results in many people with debilitating and life-threatening diseases to go unattended due to applications of QALY measurements. The main question health economists struggle with is thus “Are you worth it?” “Will the money required to treat you be worth the benefit to your quality of life?” How region-specific should the QALY be, and how often should it be updated? Are we, in fact, capable of achieving a level of accuracy so that economists do not wrongly apply the statistics and consequently misallocate health care resources?
I believe more can be learned about optimal ways to attack the issues of global health by exerting pressure on boundaries of different types of interventions and constantly re-examining the state of health. The success of interventions is largely dependent on the momentum of society and public health. If the scope of the intervention is over-ambitious but the local infrastructure is lacking, it is likely that resources will not be utilized optimally. On the other hand, there is always the risk of a myopic approach to an issue that fails to address possible underlying and ancillary issues.
Paul Farmer, a huge proponent of global health and human rights, has set his own agenda in motion, focusing much needed medical care on Haiti. Despite the many claims that HIV/AIDS treatment is not cost-effective, he has sought after his goal of wiping out the virus, constantly looking for ways to mitigate the costs of treatment. I see the need for others like Farmer who realize the imperfection and shortcomings of health economics and implement their own idea of how global health should be. It is possible that the benefits of Farmer’s ignorance to the DALY can only be seen in a country like Haiti, as the success of specific public health initiatives varies by country. Whatever the case may be, in an age where health disparities are so wide-spread, it’s important that region-specific initiatives be taken to address the unique health needs of populations.