Model Disability Survey and
World Health Surveys
Alarcos Cieza
Disability and Rehabilitation
World Health Organization
Disabling barriers – Break to include
Model Disability Survey (MDS)
Chilean law requires the state to carry out
a disability survey every 10 years
3
Civil society dialogs
Participants of Discussion Rounds with Civil Society
1200
1000
800
600
1,047
400
536
200
93
79
0
Organizations of
people with
disabilities
Public Institutions
related with topic
Schools
Universities and
technical institutions
4
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 Justice
Health
5
Comparison
ACCESIBILITY
Public transportation
25%
Public buildings
23%
Private buildings
13%
Information
Places of recreation
Urbanisation
0%
19%
11%
9%
10%
20%
ENDISC I
MDS
X
√
√
√
X
√
X
√
X
√
X
√
30%
6
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 Justice
Health
7
2004
2015
8
Article
CRPD Article Name
Number
Annex 1
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Equality and Non-discrimination
Women and disabilities
Children with disabilities
Awareness-raising
Accessibility
Right to life
Situations of risk and humanitarian emergencies
Equal recognition before the law
Access to justice
Liberty and security of the person
Freedom from torture or cruel, inhuman or degrading treatment or
punishment
Freedom from exploitation, violence and abuse
Protecting the integrity of the person
Liberty of movement and nationality
Living independently and being included in the community
Personal mobility
Freedom of expression and opinion, and access to information
Respect for privacy
Respect for home and the family
Education
Health
Habilitation and rehabilitation
MDS
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
Disability indicators for the SDG
framework covered in the MDS
Universal targets
Target
Model
Disability
Survey
1.1
Poverty
*
x
Indicator
% PwD below
$1.25(PPP)/day
% PwD covered by social
protection/disability
benefits
% PwD benefiting from
health coverage
School net attendance for
CwD
Unemployment rate (by
PwD)
% PwD owning a mobile
phone
% PwD with internet
access
3.8
Health
coverage
and
financial
risk
protection
Vulnerable persons
9.c
Access to ICT
and to
internet
8.5
10.2
4.5
Full and
Social,
1.3
Gender
productive
economic
Social
disparities,
employment and political
protection equal access in
and decent
inclusion
education
work
x
x
x
Disability targets
x
x
x
x
x
x
x
x
x
x
*
x
x
*
x
x
* To be added in the next revision
x Already covered
2004
2015
11
2004
12
2015
13
Number of persons
World population on the disability
continuum
Low
Disability
Extreme
15
2004
2015
16
2004
Because of your health, do YOU HAVE …. ?
Health condition
Impairment in
body functions
& structures
Activity
limitation
Environmental factors
2015
Participation
restriction
Personal factors
17
In the MDS we capture both,
difficulties because of your health
The result of the interaction of capacity with the
environment and the person
2004
19
Difficulties because of
your health …
2015
The result of the interaction of
capacity with the environment
and the person…
?
20
We want to understand
disability and not only
calculate its prevalence
21
Content of the MDS
Section
1000
Section
2000
Section
3000
(A+B)
Section
4000
Sociodemographic
Characteristics
Work History
and Benefits
Section
5000
Section
6000
Section
7000
Section
8000
Health
Conditions &
Capacity
Health Care
Utilisation
Well-Being
Empowerment
Functioning
Environmental
factors
Example Cambodia
•
First pilot study, August 2014
•
Rural and urban areas
Convenience sample, 500 interviews
23
Moderate
capacity
difficulties
Mild capacity
difficulties
40
Severe
capacity
difficulties
0
20
Frequency
No
capacity
difficulties
60
Cut-off score
47.37
No 0
difficulties
20
40
60
CAPACITY
Capacity scale
80
(difficulties because of your health)
100
Extreme
difficulties
How much of a problem is getting
things done as required at work?
100.0%
No
N
Currently not
working
29
Working
399
disability
Mild
Moderate
disability disability
Severe
80.0%
disability
N=27
N=144
N=200
N=128
3,7 %
4,51 %
4,4 %
14,43 %
60.0%
40.0%
Other working
situation**
96,3 %
94,73 %
93,41 %
79,38 %
20.0%
11
0
0,75 %
2,2 %
6,19 %
0.0%
**sick leave, retired by age
No
Mild
Moderate
Severe
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?
80.0%
60.0%
40.0%
20.0%
0.0%
No
Mild
Moderate
Severe
100.0%
80.0%
How much of a problem do
you have in engaging in
local or national politics
and in civil society
organisations?
60.0%
40.0%
20.0%
0.0%
No
Mild
Moderate
Severe
100.0%
80.0%
60.0%
How much of a problem did
you have with voting in the
last elections?
40.0%
20.0%
0.0%
No
Mild
Moderate
Severe
Pilot Studies
• Finished: Cambodia (N=500), Chile (N=300),
Malawi (N=500), Pakistan (N=3977)
• Ongoing: Oman (N=500)
• In preparation: Brazil (N=2000)
National Disability Surveys
• Finished: Sri Lanka, Chile
• Planned: Oman, Brazil, The Philippines
27
Regional implementation from 2016 on
EURO
SEARO
AMRO
EMRO
AFRO
WPRO
World Health Survey
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) .
29
31
Study on Global Ageing and Adult Health (SAGE)
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.
32
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.
33
Overlap SAGE MDS
HOUSEHOLD
CHARACTERISTICS
 Composition
 Living conditions
 Economic status
 Consumption
 Geographical location
INDIVIDUAL
CHARACTERISTICS
 Socio-demographics
 Income
 Economic activity
 Health Insurance
 Minority status
 TIME USE
 SOCIAL NETWORKS /
COHESION
COVERAGE
HEALTH
STATES
Capacity in
multiple
domains
VALUATION
OF HEALTH
STATES
UTILISATION
OF SERVICES
RISKS FACTORS
CHRONIC DISEASES
 Tobacco
 Alcohol
 Physical Inactivity
 Nutrition
 Morbidity
- Health conditions
WELL BEING
HEALTH & HEALTH
RELATED OUTCOMES
MORTALITY
34
Overlap SAGE MDS
FUNCTIONING
in multiple domains
HOUSEHOLD
CHARACTERISTICS
 Composition
 Living conditions
 Economic status
 Consumption
 Geographical location
INDIVIDUAL
CHARACTERISTICS
 Socio-demographics
 Income
 Economic activity
 Health Insurance
 Minority status
 TIME USE
 SOCIAL NETWORKS /
COHESION
COVERAGE
Need of
care and
support
because of
health
problems
HEALTH
STATES
Capacity in
multiple
domains
UTILISATION
OF SERVICES
+ WG-6
VALUATION
OF HEALTH
STATES
RISKS FACTORS
CHRONIC DISEASES
 Tobacco
 Alcohol
 Physical Inactivity
 Nutrition
 Morbidity
- Health conditions
•
•
•
•
•
•
WELL BEING
EMPOWERMENT
HEALTH & HEALTH
RELATED OUTCOMES
•
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
MORTALITY
& communication
Facilitators: education, work
and at home
35
Alarcos Cieza, MSc, MPH, PhD
Disability and Rehabilitation
World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
Tel.: +41 22 791 1998
Fax: +41 22 791 4874
Email: ciezaa@who.int
Website: www.who.int/disabilities/
36