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Disability Models and Measures Sophie Mitra Fordham University [email protected] Conference: Improving the measurement of disability and the physical access of the disabled: Lessons from international experience, February 10, 2012 Moscow, 27 September 2011 1
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Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University [email protected]

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Page 1: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Disability Models and Measures

Sophie Mitra

Fordham University

[email protected]

Conference: Improving the measurement of

disability and the physical access of the

disabled: Lessons from international experience,

February 10, 2012

Moscow, 27 September 2011 1

Page 2: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Part 1. Models used to Define Disability

- The Medical Model

- The Social Model

- The Nagi Model

- The ICF (International Classification of

Functioning, Disability and Health)

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Page 3: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

The Medical (or Bio-Medical) Model

The medical model considers disability as a problem of the individual that is directly caused by a disease, an injury or other health conditions.

The medical model locates the problem with the person. A person is in the „sick role‟ (Parsons, 1975).

This model is strongly normative.

The major concern at the political level is to provide health care and rehabilitation services.

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Page 4: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

The Social Model

Disability is not a problem of the individual, it is a

problem created by the social environment and

requires social change.

This model has many different versions. We review

briefly below two versions.

The UK social model: At the heart of this model

lies societal oppression (Oliver, 1990).

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Page 5: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

The Social Model (Cont.)

The oppressed minority model. Persons with

disabilities face discrimination and segregation

through barriers in the environment. Their

experiences are therefore perceived as similar to

those of an oppressed minority group.

Social inequalities encountered by persons with

disabilities are considered as similar to those

encountered by other minorities (Hahn, 2002, p.

171).

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Page 6: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

The Nagi Model

The Nagi model is widely used in the economics of

disability field. It identifies functional limitations as

the restrictions that impairments impose on the

individual‟s ability to perform the tasks of his or her

roles and normal daily activities.

Disability is a social construct.

For instance, a 12-year old girl with mental

retardation does not attend school, she stays home

with her parents helping with household chores.

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Page 7: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

The ICF model

Health condition

Body Functions

and Structures

Activities Participation

Personal

Factors

Environmental

factors

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Page 8: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Disability under the Capability Approach:

Disability has been defined in terms of capability or functioning deprivation (Burchardt 2004; Mitra 2006; Morris 2009; Terzi 2005; Welch 2007)

Disability occurs when an individual is deprived of practical opportunities or functionings as a result of an impairment or health condition.

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Page 9: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

The Capability Approach is a holistic approach

It accounts for the variety of factors that may lead to disability.

In particular, the Capability Approach recognizes that poverty

can be the cause of disability.

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Page 10: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Part 2. Disability Measures

• Disability is difficult to measure.

• There is no gold standard measure.

• Disability measures vary depending on

research and policy objectives.

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Page 11: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Disability Measures (Cont.)

I focus on disability measures that use

household survey or census data with

questions on:

Impairments.

Functional limitations.

Activity limitations.

A combination of the above.

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Page 12: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Impairment Measures

Impairment measures of disability focus on

the presence of impairment intrinsic to the

individual.

For example, individuals may be queried

about blindness, deafness, mental retardation,

stammering and stuttering, complete or

partial paralysis.

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Page 13: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Functional Limitation Measures

Functional limitations refer to difficulties

experienced with particular bodily functions

such as seeing, walking, hearing, speaking,

climbing stairs, lifting and carrying.

The above two measures of disability,

impairments and functional limitations

measure disability as per the medical model

and capture problems in body functions and

structures under the ICF.

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Page 14: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Activity Limitations Measures

Activity limitations are limitations in activities of

daily living (ADL) such as bathing or dressing.

Activity limitations may also include participation

limitations in major life activities such as going

outside the home, work or housework for working

age persons, and school or play for children. This

measure may be considered to capture disability as

per the social model as well as the activity

limitations and participation restriction under the

ICF.

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Page 15: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Different measures lead to very different prevalence estimates

Chile is an interesting case where estimates are available for

both impairment and activity limitation measures. The

impairment prevalence rate is almost 10 times lower at 2.2%

than the activity limitation rate at 21.7% (IDRM 2004).

In South Africa, estimates vary from a low of 3.7% in the

1999 October Household Survey, to a high of 12.8% in the

National Health and Population Survey where chronic

illnesses were counted as disabilities (Emmett (2006)).

CASE (1999) is the only study specifically designed to

measure disability prevalence and assess the well being of

PWDs. In this study, in 1997, disability prevalence stood at

5.9%. 15

Page 16: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Examples of disability questions:

India NSS 58th 2001: A person is considered

disabled “if the person has restrictions or lack of

abilities to perform an activity in the manner or

within the range considered normal for a human

being.”

South Africa GHS 2010 „Is the person limited in

his/her daily activities at home, at work or at school

because of a long-term physical or mental condition

lasting six months or more?‟

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Page 17: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Examples of disability questions (Cont.):

India Census 2001:“If the person is

physically/mentally disabled, give appropriate code

number from the list below: in seeing, in speech, in

hearing, in movement, mental.”

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Page 18: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Washington Group Short

Disability Measure

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Page 19: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Identification of persons with disabilities:

Disability score and cutoff

e.g. WHO-World Bank (2011)

• Challenges in calculating a score

• Challenges in setting the cutoff

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Page 20: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Identification of persons with disabilities for a given measure

(Cont):

Use of self-reported severity:

for instance, persons reporting severe or

extreme limitations are identified as having a

disability (Mitra, Posarac & Vick 2011;

Loeb, Eide & Mont 2008)

Note: Mild and moderate limitation self reports

are not as reliable as severe/extreme

(Lafortune et al 2007; Miller et al 2010).

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Page 21: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Main sources

IDRM (2004), Regional Report of the Americas, International Disability Rights Monitor, International Disability Network, Chicago.

Lafortune G., G. Balestat and the Disability Study Expert Group Members (2007) Trends in Severe Disability among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications. OECD Health Working Paper 26.

Loeb M E, Eide A H, Mont D (2008) Approaching disability prevalence: the case of Zambia. European Journal of Disability Research. 2, 32 - 43.

Miller, K., D. Mont, A. Maitland, B. Altman, and J. Madans. (2010). “Results of a Cross-national Structured Cognitive Interviewing Protocol to Test Measures of Disability.” Quality and Quantity 45(4): 801-815, DOI: 10.1007/s11135-010-9370-4.

Mitra, S. (2006) The Capability Approach and Disability, Journal of Disability Policy Studies, 16, No. 4, pp. 236-247.

Mitra, S., Posarac, A. and Vick, B.. Disability and Poverty in Developing Countries: a Snapshot from the World Health Survey (long version:World Bank Social Protection Working Paper series 1109).

WHO and World Bank (2011). World Report on Disability. Geneva: World Health Organization and World Bank.

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Page 22: Disability Models and Measures - …siteresources.worldbank.org/.../WorldReportOnDisability_Mitra-en.pdf · Disability Models and Measures Sophie Mitra Fordham University mitra@fordham.edu

Thank you!

[email protected]

www.fordham.edu/economics/mitra/

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