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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: [email protected]: www.who.int/disabilities/