Patricia Lima Pereira

Student of Master in Public Health and Social Protection

Institute of Public Health- Jagiellonian University Medical College

15th, January 2010

Causes of disability: A challenge for research

in Latin America

Wide range of definitions

Different types of classifications

Different methods used to measure the disability

Difficulties in comparing disability statistics

1

Disability prevalence (%), by census data 14.4

6.4 5.3 4.7 4.6 3.92.6 2.2 1.8 1.8 1.1

HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

1

Disability prevalence (%) by household surveys

Uruguay Chile El Salvador

7.6

5.3

1.5

HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

1

Disability prevalence (%)by national studies using ICF-2001

HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

Chile Ecuador Panamá Nicaragua

12.912.1 11.6

10.3

1

Disability prevalence (%) in Chile,by different data sources

0

4

8

12

2.25.3

12.9

HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

1

Under-estimation of disability Core Impairment vs. Impairment

Continuum

BlindnessDeafnessMobilityMental retardation

All other impairments – moderate to mild

2

Evolution of the definition of disability

From International Classification of Impairments, Disabilities and Handicaps (ICIDH)

1980

To International Classification of Functioning, Disability, and Health (ICF)

2001

3

International Classification of Impairments, Disabilities and Handicaps (ICIDH) 1980

Impairment Disability Handicap

CAUSES

The “medical model of disability” regards disability only as an individual pathological problem, in need of cure, rehabilitation and adaptation to society.

3

congenital

disease or infectioninjury or

trauma

Underlying causes of impairments3

36%

34%

3%

27%

Vietnam

52%

21%

18%

9%

Uruguay

8%9%

67%

16%

Nicaragua

Illness

Birth

Aging

Acci-dents

3

Adquired diseases

Traffic accidents

Occupational disease

Violence

Poverty

Problems at birth Aging

Main causes of disability in Latin America 3

International Classification of Functioning, Disability, and Health (ICF) 2001

Dimensions of Functioning

Body Functions and Body Structures

Activities

Participation

Dimensions of Disability

Impairments

Activity limitations

Participation restrictions

The “social model of disability” does not deny medical & rehabilitativeneeds of persons with disabilities, but draws attentions to social, physical,informational and institutional barriers, which contribute disability.

3

Body Functi

ons and

Structures

Activi- ties

Partici-pation

Health conditio

n

Personal

factors(gender,

age, socialbackground, education, profession,

etc.)

Environmental

factors (architectural characteristics, legal and

social structures,

ect.) 

Contextual factors

Diseases,

disorders

injuries3

Causes of disabilityUsing the approach of the ICF - 2001

4

Diseases,

disorders

injuries

Health conditio

n

Personal

factors(gender,

age, socialbackground, education, profession,

etc.)

Environmental

factors (architectural characteristics, legal and

social structures,

ect.) 

Contextual factors

Disability

 

CAUSES

CAUSES

CAUSES

4

Diseases,

disorders

injuries

Health conditio

n

Disability

 

England Department of Health. Health Survey for England 2001

Headings of the International Classification of Diseases, 10th revision (ICD-10)

4

63 categories

Diseases,

disorders

injuries

Health conditio

n

England Department of Health. Health Survey for England 2001

Headings of the International Classification of Diseases, 10th revision (ICD-10)

53%1

7%

11%

9%

9%

Musculoskele-tal system and connective tissue

Diseases of the circulatory system

Problems of old age

Diseases of the respiratory system

Ear and mas-toid processes

4

Diseases,

disorders

injuries

Health conditio

n

Personal

factors(gender,

age, socialbackground, education, profession,

etc.)

Environmental

factors (architectural characteristics, legal and

social structures,

ect.) 

Contextual factors

Disability

 

4

Environmental

factors (architectural characteristics, legal and

social structures,

ect.) 

Disability

 

4

Diseases,

disorders

injuries

Health conditio

n

Environmental

factors (architectural characteristics, legal and

social structures,

ect.) 

4

Personal

factors(gender,

age, socialbackground, education, profession,

etc.)Contextual factors

Disability

 

Personal

factors(gender,

age, socialbackground, education, profession,

etc.)

Disability

 

4

Poverty is both a cause and consequence of disability

Takamine, Yutaka (2003). Disability Issues in East Asia: Review and WaysForward.

Poor people

20 -30% Poor with disability

Disabled

persons

Poor disabled Persons (40%

more are poor) 4

Limitations of the ICF approach

5

Limitations of the ICF approach 5

Focus on disability experience and ignores etiology of health conditions

“In the ICF we would record the loss of limb as such, regardless of whether the loss was the result of a landmine, diabetes or a traffic accident. The impairment remains the same. Similarly, we would document the fact that a person was not working regardless of whether the underlying health condition was ‘flu, depression, or back pain”.

Training Manual on Disability Statistics (WHO/ ESCAP 2008)

Focus on disability experience and ignores etiology of health conditions

Limitations of the ICF approach 5

IT MAY BE CONSIDERATE A LIMITATION?

Identification of the cause of disability may assist policymakers to make decisions about the type of preventive programs appropriate for their country

5

COMPULSORY USE OF HELMETS

HEALTH CARESERVICES

ACCESS TO CLEAN WATER

Could that create problems in the future?

Would it reduce the availability of data necessary to evaluate health prevention interventions at population levels?

Tendency focus in disability experience, neglecting the causes

Remaining questions 6

CDC. Prevalence and Most Common Causes of Disability Among Adults in the United States. Morbidity and Mortility Weekly Report (MMWR), available on http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a2.htm#tab2. Retrieved on 04/01/10. 18:02, 2005.

DANE Colombia. Censo Nacional de Población. Informe preliminar cifras de población con discapacidad. Bogotá: Departamento Administrativo Nacional de Estadística, 2006.

DCDGRD Colombia. Información estadística de la discapacidad. Dirección de Censos y Demografía Grupo de Registros Demográficos. Colombia , 2004.

England Department of Health. Health Survey for England 2001. Available on: http://www.archive2.official-documents.co.uk/document/deps/doh/survey01/disa/disa01.htm. Retrieved on 03/01/2008. 21:20, 2001.

Hernandez Collado, Héctor. «Encuesta Nicaragüense para Personas con Discapacidad (ENDIS).» 2003. Murray, Christopher, and Alan López. The Global Burden of Diseases, Global Burden of Disease and Injury

Series. World Health Organization, Harvard School of Public Health, World Health, 1996. PAHO. La discapacidad en Nicaragua: situación actual y perspectivas. Panamerican Health Organization,

2005. Sánchez, S, M Sanabria, and N Medina. "Nutritional profile of indigenous children under five years old in

Paraguay. Indigenous Household Survey 2008." Pediatric Research, 2009: 65:4 (479). Takamine, Yutaka. «Disability Issues in East Asia: Review and Ways.» 2003. Vásquez, Armando. «La discapacidad en América Latina.» En Discapacidad: lo que todos debemos saber,

de Alicia Amate y Armando Vásquez, 9-24. Washington: OPS, 2006. WHO. «Health in the Americas 2007. Volume I Regional.» avalaible on www.who.int, 2007. WHO. International Classification of Functioning, Disability and Health. Geneva: World Health Organization,

2001. WHO/ ESCAP. Training Manual on Disability Statistics. World Health Organization / United Nations Economic

and Social Commission for Asia and the Pacific Region, 2008.

Bibliography