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In its 1993 World Development Report, “Investing in Health,” the World Bank applied the concept of Disability Adjusted Life Years (DALY) as an indicator of the “time lived with a disability and the time lost due to premature mortality.” The language of the report is full of references to “global burdens” and the “cost effectiveness of different interventions at reducing the disease burdens due to a particular condition.” Obviously the World Bank is trying to do the right thing by assessing priorities for intervention in health matters, but by defining individuals by lost productivity instead of medical need, the bank imposes an actuarial value on its largesse. Those deemed least useful in certain cultures - women, children, aged, and disabled persons will, as Nirmala Erevelles says, “have little or no entitlement to health services at public expense.”

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