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The primary cause of DALYs in high-income countries, such as Australia, is ischemic heart disease, whereas in lower-income countries like the Democratic Republic of the Congo, primary causes include infectious diseases like malaria (Institute for Health Metrics and Evaluation, 2019). It is well understood that contributing factors for chronic illness like heart disease are related to lifestyle factors common to high-income countries, such as sedentariness and a diet high in sugar and saturated fats. A number of sociopolitical and economic factors help to explain the high prevalence in low-income countries of communicable diseases, like malaria, which have essentially been eradicated in higher-income countries.
Apart from highly transmissible parasite strains and vectors and weather which allows for year-round transmission (Centers for Disease Control and Prevention, 2021), contributing factors to the high prevalence of malaria in low-income countries include poor-quality housing, reduced access to treatment and preventive services, and poor infrastructure. Poor-quality housing, consisting of mud walls, earthen or dirt/sand flooring, grass or thatch roofing, and open windows allow mosquito vectors to easily enter family homes and infect vulnerable individuals, including children and pregnant women (Degarege, et al., 2019). Additionally, reduced access to treatment and preventive services, such as anti-malarial medication, insecticide-treated bed nets, and health education, leads to increased mortality from malaria and increased spread of disease (Degarege, et al., 2019). Finally, poor-quality public infrastructure, including lack of water drainage systems and unpaved roads, in which rainwater may collect and stagnate, create breeding grounds for mosquitoes, which then become vectors and increase transmission of the disease (Sweeney, 2019). The socioeconomic and political investment in each of these factors in high-income countries has likely contributed to their eradication of malaria.
The DALY is a particularly helpful measure given the varying categories of communicable and non-communicable disease and injury when comparing morbidity and mortality because it allows for the direct comparison of disparate causes, each with its own etiology, risk factors, and prevention and control measures. Essentially, the DALY allows us to compare “apples and oranges” directly and on equal terms.