Disability and Development: Gathering Empirical Evidence

1. 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

2. 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.

3. World Bank and disability – What is the link? • Successful implementation of the MDG’s 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

4. 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

5. Prevalence of Disability in Selected Countries Percent of Population Disabled Bangladesh 0.8 Niger 1.3 Egypt 4.4 Italy 5.0 Germany 8.4 United States 15.0 Australia 18.0

6. 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

7. 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.

8. 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 people’s 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

9. 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

10. 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?”

11. 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”

12. Purposes of Measurement • Monitoring and Evaluation • Baseline • Prevention – functioning • Inclusion – relation between functioning and participation • Outcome indicators Relation between functioning and participation

13. 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