The World Health Organization Disability Assessment Schedule 2.0 as a global metric of functioning: Implications for health economics and sustainable health systems
Disability is an increasingly important driver of healthcare utilization, long-term care needs, and health system sustainability worldwide. The World Report on Disability marked a major shift in understanding disability as a global health and development issue, emphasizing functioning, participation, and environmental barriers within the International Classification of Functioning, Disability and Health (ICF) framework. As population aging and chronic conditions increase the global burden of disability, robust measures are needed to assess functioning alongside traditional indicators of mortality and morbidity. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), developed within the ICF framework, provides a standardized and cross-culturally applicable measure of functioning and disability. This conceptual review examines the potential contribution of WHODAS 2.0 to population health measurement, health economics, and sustainable health policy. Although disability-adjusted life years and quality-adjusted life years dominate population health assessments and economic evaluations, functioning remains insufficiently represented in these frameworks. WHODAS 2.0 directly assesses functioning based on individuals’ everyday experiences and complements burden-of-disease and utility-based metrics by capturing domains that conventional indicators may overlook. Integrating functioning into population health assessment could support disability assessment, outcome monitoring, policy development, health system evaluation, and economic evaluation. We argue that WHODAS 2.0 is the most mature operational candidate currently available for measuring functioning at the population level and for advancing functioning as a third core health indicator alongside mortality and morbidity.
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