Disability and Development: Gathering Empirical Evidence

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Disability and Development Gathering Empirical
Evidence

• Estadísticas sobre Personas con Discapacidad
•  Managua Nicaragua
• 31 Agosto 1 Septiembre 2004
• Daniel Mont
• Disability and Development Unit
• The World Bank

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G. Fujiura HD Learning Days
Epidemiology of Disablement
Proportion of Lives Lived with Chronic Conditions
GBD Analysis suggests significantly higher rates
of disablement and impact in underdeveloped
regions of the world
Murray, C.J.L. Lopez, A.D. (1996). The global
burden of disease A comprehensive assessment of
mortality and disability from diseases, injuries,
and risk factors in 1990 and projected to 2020.
Cambridge, MA Harvard University Press.
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World Bank and disability What is the link?

• Successful implementation of the MDGs results in
  the prevention of disability and increased
  productivity for disabled people
• Two-way causality between disability and poverty
• Disabled people are disproportionately poor, and
  poor people are disproportionately disabled
• Doing a good job on poverty alleviation requires
  taking disabled people into account

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Disability and Poverty Research Concerns

• The definition of disability is complex
• Different definitions and different data
  collection methodologies yield different rates
• Data on disability often not collected, or at
  least not given proper attention

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Prevalence of Disability in Selected Countries
Percent of Population Disabled Bangladesh 0
.8 Niger 1.3 Egypt 4.4 Italy 5.0 Germa
ny 8.4 United States 15.0 Australia 18.0
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Source of Concepts for Measurement ICF Model

Health Condition (disorder or disease)

Body Functions Structure
Activity
Participation
Environmental Factors
Personal Factors
Source ICIDH-2, 1999
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G. Fujiura HD Learning Days
Current Status and Technical Challenges in
Disability Surveillance Statistics
Fujiura, G.T. Rutkowski-Kmitta, V., (2001).
Counting disability. In G. Albrecht, K. Seelman,
M. Bury (Eds). Handbook of disability studies,
pp. 69-96. Thousand Oaks, CA Sage.
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What is the purpose of measurement?

• Directing resources towards inclusion
• Prevalence Rates
• We need to establish the prevalence rate of
  disability in developing countries in order to
  provide an idea of the scope of the impact of
  disability on peoples lives, but there are
  different prevalence rates for different
  conceptions of disability depending on the issue
  being addressed.
• Relation to poverty, income, health, and
  education
• Link with economic well-being measures and the
  MDGs to demonstrate the importance to development

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Purposes of Measurement

• Provision of Services
• Identifying people in need of rehabilitation
• Determining accommodations needed for inclusion
• Highly variant across cultures
• Needs a lot of detail better suited for
  household surveys as opposed to censuses

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Purposes of Measurement

• Monitoring the level of functioning in the
  population
• Participation, Activities, or Impairment?
• Answer influences extent of focus on environment
• Implications for international comparability
• US NHIS Survey Are you limited in the kind or
  amount of work you can do because of a physical,
  mental or emotional problem?

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Purposes of Measurement

• Assessing Equalization of Opportunity
• Collect info on impairments and outcomes
• Connection is made in analysis, not data
  collection
• Negative correlation implies lack of opportunity,
  i.e. disability

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Purposes of Measurement

• Monitoring and Evaluation
• Baseline
• Prevention functioning
• Inclusion relation between functioning and
  participation
• Outcome indicators
• Relation between functioning and participation

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Data Collection Issues

• Survey design
• Purpose of measurement
• Quality of questions
• Stigma
• Willingness to respond
• Willingness to ask
• Interpretation of response
• Cultural and environmental differences
• Small sample size especially by type of
  disability