Zinc Deficiency and DALYs in India: Impact Assessment and Economic Analyses

  • A. J. Stein
  • M. Qaim
  • P. Nestel
Reference work entry


Although less obvious than outright lack of sufficient food,  micronutrient malnutrition represents an economic and public health problem in many countries. Over the last years  zinc deficiency has emerged as another major micronutrient deficiency, with a large proportion of the population being at risk, especially in the developing world. However, simple quantification of the number of people who suffer from a condition fails to take account of the depth of the problem. For comparison, monitoring or impact assessment purposes as well as  cost-effectiveness or more general economic analyses, the health loss of a condition needs to be measured in a more comprehensive index.

In this chapter the concept of disability-adjusted life years ( DALYs) is explained and a framework for its application to zinc deficiency is provided. DALYs were developed by the World Bank in collaboration with the World Health Organization (WHO) and are today used by many relevant organizations and for analyses in very different fields, in particular at the global level or in developing countries. By weighting the loss of an individual’s functioning due to ill health – relative to death and complete health – DALYs allow measuring morbidity and mortality in a single index that can be aggregated and compared across different conditions. The methodology is explained and discussed, and general data and parameters to calculate the loss of DALYs due to zinc deficiency are reported for the example of India.


Zinc Deficiency Micronutrient Deficiency Disability Weight World Health Report Remain Life Expectancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


average age of death or onset of disease




disability-adjusted life year


Food and Agriculture Organization


global burden of disease


gross domestic product


International Zinc Nutrition Consultative Group


not applicable


quality-adjusted life year


discount rate


recommended dietary intake


countries in the WHO’s South-East Asia region with high child and high adult mortality




United Nations


United States Dollar


World Health Organization




years lived with disability


years of life lost




zinc deficiency


  1. ACC/SCN (2000). Fourth Report on the World Nutrition Situation. United Nations Administrative Committee on Coordination, Sub-Committee on Nutrition, Geneva. http://www.unsystem.org/SCN/Publications/rwns/4RWNS.html.
  2. Allotey P, Reidpath D, Kouamé A, Cummin R. (2003). Soc Sci Med. 57: 949–958. http://dx.doi.org/10.1016/S0277-9536(02)00463-X.
  3. Anand S, Hanson K. (1998). World Dev. 26: 307–310. http://dx.doi.org/10.1016/S0305-750X(97)10019-5.
  4. Arcand JL. (2001). Econ Soc Dev. Paper No. 147. Food and Agriculture Organization of the United Nations, Rome. http://www.fao.org/DOCREP/003/X9280E/X9280E00.HTM.
  5. Arnesen T, Nord E. (1999). Br Med J. 319: 1423–1425. http://www.bmj.com/cgi/content/extract/319/7222/1423.
  6. Baltussen RMPM, Sanon M, Sommerfeld J, Würthwein R. (2002). Health Econ. 11: 155–163. http://dx.doi.org/10.1002/hec.658.
  7. Behrman JR, Alderman H, Hoddinott J. (2004). Hunger and Malnutrition. Copenhagen Consensus, Copenhagen. http://www.copenhagenconsensus.com/Default.aspx?ID=223.
  8. Census. (2007). Census of India. Registrar General & Census Commissioner, New Delhi. http://www.censusindia.gov.in/.
  9. Collier P, Hoeffler A. (2004). The Challenge of Reducing the Global Incidence of Civil War. Copenhagen Consensus, Copenhagen. http://www.copenhagenconsensus.com/Default.aspx?ID=221.
  10. FAO. (2004). The State of Food Insecurity in the World 2004. Food and Agriculture Organization of the United Nations, Rome. http://www.fao.org/sof/sofi/.
  11. FAO. (2005). The State of Food Insecurity in the World 2005. Food and Agriculture Organization of the United Nations, Rome. http://www.fao.org/sof/sofi/.
  12. Fox-Rushby JA. (2002). Disability Adjusted Life Years (DALYs) for Decision-Making? An Overview of the Literature. Office of Health Economics, London. ISBN 978-1899040377.Google Scholar
  13. Groce NE, Chamie M, Me A. (1999). Int Rehabil Rev. 49: 12–15. http://www.rehab-international.org/publications/rehabilitationreview.html.
  14. Hotz C, Brown KH. (eds.) (2004). Food Nutr Bull. 25: S91–S204. http://www.unu.edu/unupress/food/fnb25-1s-IZiNCG.pdf.
  15. IIPS. (2007). National Family Health Survey (NFHS-3), National Fact Sheet: India. International Institute for Population Sciences, Mumbai. http://www.nfhsindia.org/.
  16. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group. (2003). Lancet. 362:65–71. http://dx.doi.org/10.1016/S0140-6736(03)13811-1.Google Scholar
  17. Lyttkens CH. (2003). Eur J Health Econ. 4: 195–202. http://dx.doi.org/10.1007/s10198-003-0169-2.
  18. McGovern G. (2001). UN Chron. 38: 24–27. http://www.un.org/Pubs/chronicle/2001/issue3/0103p24.html.
  19. Murray CJL, Lopez AD (eds.) (1996). The Global Burden of Disease. Global Burden of Disease and Injury Series, Vol. 1., Harvard University, Cambridge, MA. http://www.hup.harvard.edu/catalog/MURGLO.html.
  20. Musgrove P. (2000). Health Policy Plann. 15: 110–115. http://dx.doi.org/10.1093/heapol/15.1.110.
  21. Olsen JA, Richardson J, Dolan P, Menzel P. (2002). The Moral Relevance of Personal Characteristics inSetting Health Care Priorities. Working Paper No. 17. Health Economics Research Programme, Oslo Univ, Oslo. http://www.hero.uio.no/publications.html.
  22. Prasad AS. (2003). Br Med J. 326: 409–410. http://dx.doi.org/10.1136/bmj.326.7386.409.
  23. Richardson J. (1999). Age Weighting and Discounting: What Are the Ethical Issues? Working Paper No. 109. Centre for Health Program Evaluation, Monash University, West Heidelberg. http://www.buseco.monash.edu.au/centres/che/che-publications.html#1999.
  24. Rijsberman F. (2004). The Water Challenge. Copenhagen Consensus, Copenhagen. http://www.copenhagenconsensus.com/Default.aspx?ID=228.
  25. Sachs JD, McArthur JW, Schmidt-Traub G, Kruk M, Bahadur C, Faye M, McCord G. (2004). Brookings Pap Econ Act. 1: 117–240. http://www.brookings.edu/press/Journals/2004/brookingspapersoneconomicactivity12004.aspx.
  26. Sen AK. (1976). Econometrica 44: 219–232. http://dx.doi.org/10.2307/1912718.Google Scholar
  27. Stein AJ. (2006). Micronutrient Malnutrition and the Impact of Modern Plant Breeding on Public Health in India. Hohenheim University, Stuttgart. http://www.uni-hohenheim.de/ub/opus/volltexte/2006/157/.
  28. Stein AJ, Meenakshi JV, Qaim M, Nestel P, Sachdev HPS, Bhutta ZA. (2005). Analyzing the Health Benefits of Biofortified Staple Crops by means of the Disability-Adjusted Life Years Approach: A Handbook. HarvestPlus Technical Monograph No 4. International Food Policy Research Institute, Washington, DC. http://www.harvestplus.org/pubshp.html#tech.
  29. Stein AJ, Meenakshi JV, Qaim M, Nestel P, Sachdev HPS, Bhutta ZA. (2008). Soc Sci Med. 66: 1659–1870. http://dx.doi.org/10.1016/j.socscimed.2008.01.006.
  30. Stein AJ, Nestel P, Meenakshi JV, Qaim M. S.chdev HPS, Bhutta ZA. (2007). Public Health Nutr. 10: 492–501. http://dx.doi.org/10.1017/S1368980007223857.
  31. Stein AJ, Qaim M. (2007). Food Nutr Bull. 28: 125–134. http://www.inffoundation.org/FNB/FNBindexNEW.html.
  32. Sachdev AJ, Stein HPS, Qaim M. (2006). Nat Biotechnol. 24: 1200–1201. http://dx.doi.org/10.1038/nbt1006-1200b.Google Scholar
  33. Stouthard MEA, Essink-BotM-L, Bonsel GJ. (2000). Eur J Public Health. 10: 24–30. http://dx.doi.org/10.1093/eurpub/10.1.24.
  34. Strauss J, Thomas D. (1998). J Econ Lit. 36: 766–817. http://www.aeaweb.org/journal/contents/june1998.html.
  35. Tan-Torres Edejer T, Aikins M, Black R, Wolfson L, Hutubessy R, Evans DB. (2005). Brit Med J. 331:1177. http://dx.doi.org/10.1136/bmj.38652.550278.7C.
  36. Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, Murray CJL. (2003). Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. World Health Organization, Geneva. http://www.who.int/choice/book/.
  37. UN. (2000). United Nations Millennium Declaration. General Assembly Resolution 55/2 of 8 September. United Nations, New York. http://www.un.org/millennium/declaration/ares552e.htm.
  38. UN-SCN. (2004). 5th Report on the World Nutrition Situation. United Nations System, Standing Committee on Nutrition, Geneva. http://www.unsystem.org/SCN/Publications/html/RWNS.html.
  39. UNDP. (2007). Statistics of the Human Development Report. United Nations Development Programme, New York. http://hdr.undp.org/en/statistics/.
  40. UNICEF. (2007). Monitoring and Statistics. UNICEF, New York. http://www.unicef.org/statistics/.
  41. WHO. (2001). Macroeconomics and Health: Investing in Health for Economic Development. World Health Organization, Geneva. http://whqlibdoc.who.int/publications/2001/924154550X.pdf.
  42. WHO. (2002). The World Health Report 2002. World Health Organization, Geneva. http://www.who.int/whr/2002/en/.
  43. WHO. (2007a). WHOSIS (WHO Statistical Information System). World Health Organization, Geneva. http://www.who.int/whosis/.
  44. WHO. (2007b). Life Tables for WHO Member States. World Health Organization, Geneva. http://www.who.int/whosis/database/life_tables/life_tables.cfm.
  45. Williams A. (1999). Health Econ. 8: 1–8. http://dx.doi.org/10.1002/(SICI)1099-1050(199902)8:1:≤1::AID-HEC399≥3.0.CO;2-B.
  46. World Bank. (1993). World Development Report 1993. World Bank, Washington, DC. http://go.worldbank.org/J6RBXR2BM0.
  47. World Bank. (2006). Repositioning Nutrition as Central to Development. World Bank, Washington, DC. http://go.worldbank.org/UGPWFYHNU0.
  48. World Bank. (2007a). Development Data & Statistics. World Bank, Washington, DC. http://www.worldbank.org/data/.
  49. Zimmermann R, Qaim M. (2004). Food Policy. 29: 147–168.http://dx.doi.org/10.1016/j.foodpol.2004. 03.001.

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© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • A. J. Stein
  • M. Qaim
  • P. Nestel

There are no affiliations available

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