Using healthy life years (HeaLYs) to assess programming needs in a public health unit

In December 1997, the Ontario Ministry of Health published a document, Mand atory Health Programs and Services Guidelines (MPG),(1) which directed publ ic health units in Ontario to address population health in specific areas: chronic diseases, injury and substance abuse, early detection of cancer, ch ild health, sexual and reproductive health, and infectious diseases. The Mi nistry also encouraged needs/impact-based planning in public health units a nd identified needs assessment as the first step in this process.(2) Coinciding with the release of the MPG, responsibility for funding public h ealth programming in Ontario was downloaded to municipalities (January 1, 1 998). This change further added to the demand to assess population health n eeds in order to allocate municipal resources judiciously while simultaneou sly meeting the requirements of the MPG. To accurately assess population health needs within the context of the MPG, both the acute effects (e.g., death, hospitalization) and the long-term ef fects (e.g., pain, suffering, lost productivity, family impact) of ill-heal th must be considered. In 1996 the World Health Organization (WHO) in colla boration with the World Bank developed a method of assessing disease burden , called Disability Adjusted Life Years (DALYs) which incorporated these co mponents.(3,4) Using this method, WHO compared the burden due to different causes for each of eight geographic groupings. Canada was included in the " established market economies". Hyder, Rotllant and Morrow modified the WHO method as Healthy Lift Years (HeaLYs) using a natural history of disease ap proach and demonstrated their model to be more appropriate in assessing hea lth needs in smaller geographic areas.(5,6) This paper uses the HeaLYs method to assess population health needs in Well ington and Dufferin counties in 1995 and discusses the implications for res ource allocation to meet the requirements of the MPG.