Disability Measurement

May 7 11, 2012 Washington, D.C.

Somnath Chatterji Department of Health Statistics and Information Systems WHO Geneva

Key questions?
How many disabled people in the world?
What is disability ?

How can we measure disability ?

completely ? comparably ?

A Tower of Babel:
Lack of a common language

Source: DISTAT UNSD 2003

by Aidan Moesby

International Classification of Functioning, Disability and Health (ICF)

Classification for organizing & reporting health and disability data Conceptual model for understanding health and disability

The ICF model

The Washington Group

Develop a small set(s) of general disability measures
suitable for use in censuses, sample based national surveys, etc.

Recommend one or more extended sets of survey items to measure disability as components of population surveys Develop measures that are culturally comparable Use the ICF model as the framework Address methodological issues

The Washington Group

Focus on equalization of opportunity Has evolved to consider health and disability on a continuum of measurement Expanding work on children Expanding work on environmental factors Extensive cognitive testing; pilots in countries; implementation in censuses and national surveys

Health and Disability Continuum

Single domain
Seeing Functions
10/20 Mild-Moderate vision impairment: Needs eye glasses, contact lenses 2/20 Severe vision impairment: Needs operation 1/20 Complete vision impairment (blind): Needs assistance pension, device, assistant environmental modifications
Cognition Self Care Pain Sleep & energy Interpersonal relationships Overall

Multiple domains

Mobility Affect Vision

Next steps
Convergence of Health and Disability
Concepts Statistics Interventions

Develop methods for:

Individual assessment Population level estimates

Develop measures for:

environmental factors

Establish population norms for functioning Create an epidemiology of functioning

WB/ WHO Project: Design of Model Disability Survey

Objectives
Develop an INTEGRATED SET of Disability Questions
Indicate the population values for various purposes
Needs assessment (services, assistance, education, etc) Monitoring (progress in CRPD implementation, outcome of interventions, )

Serve for comparisons across and within countries Integrated so that the identified populations could be examined further
Links with censuses Links with disability surveys Links with health surveys

WB/ WHO Project: Design of Model Disability Survey

Scope of activities
Phase 1: Data collection, analysis and preliminary drafting
Understanding the science Database construction Micro-data collection and statistical analysis Expert consensus preliminary drafting

Phase 2: Cognitive testing and finalization

Cognitive testing Pilot study and finalization

Phase 3: Implementation of National Disability Surveys

Disability across domains by age

A comparison across health conditions

What needs to be done

Data accuracy, comparability and utility Conceptualization of disability Matching of purpose & measurement
approach Item properties Question order & wording Knowledge and awareness

Measuring Disability

Need to develop a single metric of disability Measurement that allows profiling of disability in different conditions, settings Measurement that allows identification of interventions Track changes over time and of interventions Development of measurement that is fit for purpose

Measuring Disability

Combining data from multiple sources censuses, surveys, administrative sources Integrating health and disability information sources including electronic health records Disaggregation of data by geography, socioeconomic status, gender and other stratifiers of interest