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Relevance of disability to the poverty dialogue Potential Utility of the LSMS Disability meanings






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Relevance Potential Meanings. Relevance of disability to the poverty dialogue Potential Utility of the LSMS Disability meanings. Relevance Potential Meanings. Relevance of disability to the poverty dialogue Epidemiology of disability Dynamics of disablement
Relevance of disability to the poverty dialogue Potential Utility of the LSMS Disability meanings

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Slide 1

  • Relevance

  • Potential

  • Meanings

  • Relevance of disability to the poverty dialogue

  • Potential Utility of the LSMS

  • Disability meanings

Slide 2

  • Relevance

  • Potential

  • Meanings

  • Relevance of disability to the poverty dialogue

    • Epidemiology of disability

    • Dynamics of disablement

  • Potential Utility of the LSMS

  • Disability meanings

Slide 3

  • Relevance

  • Potential

  • Meanings

  • Relevance of disability to the poverty dialogue

  • Potential Utility of the LSMS

    • Status of existing systems

    • connecting disability to rights and economic empowerment

  • Disability meanings

Slide 4

  • Relevance

  • Potential

  • Meanings

  • Relevance of disability to the poverty dialogue

  • Potential Utility of the LSMS

  • Disability meanings

    • emerging conceptions and the context of reform

Slide 5

Relevance

  • Epidemiology

  • Dynamics

Epidemiology of Disablement

Chronic illness is the underlying cause for 45% of all disability1; 20% of all disability is attributable to injury2.

Rates of occurrence highest among low income groups.

1LaPlante, M., & Carlson, D. (1996). Disability in the United States: Prevalence and causes, 1992. Disability Statistic Report (7). Washington, DC: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.

2 Yamaki, K. & Rutkowski-Kmitta, V. (2001). Injury as a Cause of Disability: A national-level Longitudinal Analysis. University of Illinois at Chicago: Department of Disability and Human Development.

Slide 6

Relevance

  • Epidemiology

  • Dynamics

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.

Slide 7

Relevance

  • Epidemiology

  • Dynamics

Dynamics of poverty & disability

  • Path from Poverty to Disability 1

  • chronic health conditions

  • lack of health care access

  • environmental risk

  • Path from Disability to Poverty 1

  • burden of care costs

  • lack of access

  • linkage to other vulnerable groups: elderly, gender, minority groups

1 Elwan, A. (1999). Poverty and disability: A survey of the literature. Washington, DC: World Bank, Social Protection Unit.

Slide 8

Relevance

  • Epidemiology

  • Dynamics

U.S. Disability Prevalence Rates by Age Cohort

and Poverty Level

Pathways

Rates across age cohorts suggest significantly higher rates of acquired disability among poor Americans.

Cannot account for “directional ambiguity” in disability statistics.

below poverty level

above poverty level

Source: Fujiura, G.T., Yamaki, K., & Czechowicz, S. (1998). Disability among ethnic and racial minorities in the United States. Journal of Disability Policy Studies, 9, 111-130.

Slide 9

Relevance

  • Epidemiology

  • Dynamics

Pathways

Poverty and psychopathology natural experiment during longitudinal monitoring of psychiatric disorders in North Carolina.

Found direct impact of income “intervention” on occurrence of childhood mental illness.

Impact of Income Intervention on Childhood Psychopathology

Persistently Poor

Ex-Poor

Never Poor

Source: Costello, E.J. (2003). Relationship between poverty and psychopathology: A natural experiment. JAMA, 290, 2023-2029.

Slide 10

Relevance

  • Epidemiology

  • Dynamics

  • Relevance of disability to the poverty dialogue: Summary

    • Disability and poverty are inextricably linked;

    • Represents a significant population effect;

    • Impact likely more pronounced in the developing world.

Slide 11

Illness/Impairment

Function/Activity

Context & Participation

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Current Status and Technical Challenges in Disability Surveillance Statistics

3 Conceptual Pillars of National Data Systems

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.

Slide 12

LSMS Potential

  • Deficits in surveillance

  • Disability rights

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.

Slide 13

LSMS Potential

  • Deficits in surveillance

  • Disability rights

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.

Slide 14

Lack of active disability surveillance in developing nations

highly variable methodology

Little attention to social and economic status in the developing world

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Potential of the LSMS

Current limitations in international surveillance systems

Slide 15

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Potential of the LSMS

Disablement Screened in Survey Protocol?

1 Activity limitation codes

2 Impairment/Condition-specific codes

3 Indirect identification

4 Acute illness only

5 No related codes

(very preliminary classification)

Albania 19962

Armenia 19963

Azerbaijan 19953

Bosnia 20011

Bulgaria 19972

China 19973

Côte d'Ivoire 19853

Côte d'Ivoire 19863

Côte d'Ivoire 19873

Côte d'Ivoire 19883

Ghana 1987/883

Ghana 1988/893

Guatemala 20003

India 19982

Kosovo 20001

Morocco 19913

Nepal 19962

Nicaragua 19933

Nicaragua 19983

Panama 19973

New Guinea 19965

Peru 19853

Lima, Peru 19903

Peru 19913

Peru 19943

Russia 19921

South Africa 19932

Tajikistan 19993

Tanzania 1991/933

Tanzania 19933

Viet Nam 1992/934

Slide 16

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Russian Survey on Household Conditions and Public Health

Slide 17

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Albania Employment and Welfare Survey

Slide 18

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Tanzania Human Development Resource Survey

Slide 19

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Potential of the LSMS

  • rates range widely as a function of definition as in other international analyses;

  • generally below the 10 to 15% rates seen in Western nations based on activity limitation definitions and the 5-10% estimates for severe disability (WHO, 1982; Helander, 1995)

  • stability of estimates given sample sizes an issue

Slide 20

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Disability Rights & Economic Empowerment

  • Living standard statistics as extension of public policy and planning

  • Demography as “political arithmetic”

  • Social inequities as the proper point of emphasis in disability statistics

Statistics as a Tool of Reform:

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.

Slide 21

LSMS Potential

  • Deficits in surveillance

  • Disability rights

Disability Rights & Economic Empowerment

Statistics as a Tool of Reform

"It's not the figures themselves," she said finally. "It's what you do with them that matters."

(K.A.C. Manderville, The Undoing of Lamia Gurdleneck)1

1 This quote is from Maurice George Kendall and Alan Stuart, "The advanced theory of statistics", volume 2.

Slide 22

Disability Meanings

Disability Meanings

  • Changing conceptions of disability

  • Impairment historically associated with suffering and defect

  • Emerging paradigms of disability challenge cultural conceptions of “normality”

Slide 23

Disability Meanings

Disability and Poverty in the Developing World: Perspective from Disability Statistics

  • Disability health agenda linked to broader civil and human rights themes;

  • Intersection of disablement and poverty of special interest since it underscores structural relationships within societies;

  • Statistical data can galvanize still nascent rights movements.

Concluding Comments:


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