Model Disability Survey and World Health Surveys

Alarcos CiezaDisability and RehabilitationWorld Health Organization

Dis

ab

ling

barr

iers

– B

reak

to

incl

ud

e Model Disability Survey (MDS)

3

Chilean law requires the state to carry out a disability survey every

10 years

4

Civil society dialogs

0200400600800

10001200

1,047536

93 79

Participants of Discussion Rounds with Civil So-ciety

5

Topics addressed in the civil society dialogs

Accesibility

Labour Inclusion

Health Care Use and Dependency

Recreation Activities and Sports

Education

Gender, Emotionality and Sexuality

Political and Social Participation

Rights and Access to JusticeHealth

6

Comparison

ENDISC I MDS

X √

√ √

X √

X √

X √

X √

-5% 0% 5% 10% 15% 20% 25% 30%

9%

11%

13%

19%

23%

25%

ACCESIBILITY

Public transportation

Public buildings

Private buildings

Information

Places of recreation

Urbanisation

7

70% was covered by the MDS!!

Accesibility

Labour Inclusion

Health Care and Dependency

Culture, Recreation and Sports

Education

Gender, Emotionality and Sexuality

Political and Social Participation

Rights and Access to JusticeHealth

8

2004 2015

Article Number CRPD Article Name MDS

Annex 1 5 Equality and Non-discrimination ✔6 Women and disabilities ✔7 Children with disabilities ✔8 Awareness-raising ✔9 Accessibility ✔

10 Right to life 11 Situations of risk and humanitarian emergencies 12 Equal recognition before the law ✔13 Access to justice 14 Liberty and security of the person ✔

15Freedom from torture or cruel, inhuman or degrading treatment or punishment

16 Freedom from exploitation, violence and abuse 17 Protecting the integrity of the person ✔18 Liberty of movement and nationality ✔19 Living independently and being included in the community ✔20 Personal mobility ✔21 Freedom of expression and opinion, and access to information ✔22 Respect for privacy 23 Respect for home and the family ✔24 Education ✔25 Health ✔26 Habilitation and rehabilitation ✔

Target Indicator

ModelDisability

Survey

Universal targets Vulnerable persons Disability targets

1.1Poverty

3.8Health

coverage and

financial risk

protection

9.cAccess to ICT

and to internet

1.3Social

protection

4.5Gender

disparities, equal access in

education

8.5Full and

productive employment and decent

work

10.2Social,

economic and political

inclusion

% PwD below $1.25(PPP)/day * x x

% PwD covered by social protection/disability benefits

x x x

% PwD benefiting from health coverage x x x

School net attendance for CwD x x x

Unemployment rate (by PwD) x x x

% PwD owning a mobile phone * x x

% PwD with internet access * x x

* To be added in the next revisionx Already covered

Disability indicators for the SDG framework covered in the MDS

11

2004 2015

12

2004

13

2015

15Low Extreme

Disability

World population on the disability continuum

Nu

mb

er

of

pers

on

s

16

2004 2015

17

Environmental factors

Personal factors

Health condition

Impairment inbody functions & structures

Activitylimitation

Participationrestriction

Because of your health, do YOU HAVE …. ? 2004

2015

difficulties because of your health

The result of the interaction of capacity with the environment and the person

In the MDS we capture both,

19

2004

20

2015

Difficulties because ofyour health …

The result of the interaction of capacity with the environment and the person…

?

21

We want to understand disability and not only calculate its prevalence

Content of the MDS

Section3000 (A+B)

Environmental factors

Section 5000Health

Conditions &Capacity

Section 4000

Functioning

Section 1000

Socio-demographic Characteristic

s

Section 6000

Health Care Utilisation

Section 2000

Work History and Benefits

Section 7000

Well-Being

Section 8000

Empowerment

23

• First pilot study, August 2014

• Rural and urban areas

Convenience sample, 500 interviews

Example Cambodia

No difficulties

Extremedifficulties

CAPACITY(difficulties because of your

health)

Capacity scale

Fre

quen

cy

0 20 40 60 80 100

020

4060

Cut-off score 47.37

Severe capacity

difficulties

Mild capacity

difficulties

No capacity difficultie

s

Moderate capacity

difficulties

No Mild Moderate Severe0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

How much of a problem is getting things done as required at work?

No Mild Moderate Severe0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

To what extent does your workplace or school make it easy or hard for you to do the things you need or want to do at work or school?

N

No

disability

N=27

Mild

disability

N=144

Moderate

disability

N=200

Severe

disability

N=128

Currently not working

29 3,7 % 4,51 % 4,4 % 14,43 %

Working 399 96,3 % 94,73 % 93,41 % 79,38 %

Other working situation**

11 0 0,75 % 2,2 % 6,19 %

**sick leave, retired by age

How much of a problem do you have in engaging in local or national politics and in civil society organisations?

No Mild Moderate Severe0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

No Mild Moderate Severe0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

How much of a problem did you have with voting in the last elections?

• Finished: Cambodia (N=500), Chile (N=300), Malawi (N=500), Pakistan (N=3977)

• Ongoing: Oman (N=500)

• In preparation: Brazil (N=2000)

27

Pilot Studies

National Disability Surveys

• Finished: Sri Lanka, Chile

• Planned: Oman, Brazil, The Philippines

AFRO

EURO

EMROAMRO

SEARO

WPRO

Regional implementation from 2016 on

29

Implemented by WHO in 2002–2004 in partnership with 70 countries to generate information on the health of adult populations and health systems.

The total sample size in these cross-sectional studies includes over 300 000 individuals (representing 64% of the world population) .

World Health Survey

31

32

The WHO Multi-Country Surveys team developed SAGE as a data collection platform to compile comprehensive information on the health and well-being of adult populations.

SAGE has adapted and added to the methods and instruments developed by WHO for the World Health Survey.

Study on Global Ageing and Adult Health (SAGE)

33

SAGE collects household data primarily on persons aged 50 years and older in China, Ghana, India, Mexico, Russian Federation and South Africa

Data also collected in the adult population aged 18 to 49 years in 23 additional countries.

34

HEALTH STATES

Capacity in multiple domains

VALUATION OF HEALTH

STATES

WELL BEING

INDIVIDUAL CHARACTERISTICS· Socio-demographics· Income· Economic activity· Health Insurance· Minority status

· TIME USE· SOCIAL NETWORKS /

COHESION

COVERAGE

UTILISATION OF SERVICES

HEALTH & HEALTH RELATED OUTCOMES

RISKS FACTORSCHRONIC DISEASES· Tobacco· Alcohol· Physical Inactivity· Nutrition· Morbidity - Health conditions

MORTALITY

HOUSEHOLD CHARACTERISTICS· Composition· Living conditions· Economic status· Consumption· Geographical location

Overlap SAGE MDS

35

HEALTH STATES

Capacity in multiple domains

VALUATION OF HEALTH

STATES

WELL BEING

INDIVIDUAL CHARACTERISTICS· Socio-demographics· Income· Economic activity· Health Insurance· Minority status

· TIME USE· SOCIAL NETWORKS /

COHESION

COVERAGE

UTILISATION OF SERVICES

HEALTH & HEALTH RELATED OUTCOMES

RISKS FACTORSCHRONIC DISEASES· Tobacco· Alcohol· Physical Inactivity· Nutrition· Morbidity - Health conditions

MORTALITY

HOUSEHOLD CHARACTERISTICS· Composition· Living conditions· Economic status· Consumption· Geographical location

Overlap SAGE MDSFUNCTIONING

in multiple domains

ENVIRONMENTAL FACTORS

• Facilitating and hindering aspects of the broad environment

• Social Support & Relationships

• Attitudes of others• Accessibility to Information• Personal assistance• Assistive devices: mobility

and self-care, seeing, hearing & communication

• Facilitators: education, work and at home

EMPOWERMENT

+ WG-6

Need of care and support

because of health

problems

36

Alarcos Cieza, MSc, MPH, PhDDisability and RehabilitationWorld Health OrganizationAvenue Appia 201211 Geneva 27Switzerland Tel.: +41 22 791 1998Fax: +41 22 791 4874Email: ciezaa@who.intWebsite: www.who.int/disabilities/