WorldHealthOrganizationClassificationAssessmentSurveys.ppt

WHO Slides: Participation and Environment in measurement of disability The ICF and statistics on disability and health Classification, Assessment, Surveys and Terminology (CAS/EIP) World Health Organization Geneva T Bedirhan Ustun and Marguerite Schneider Washington City Group on Measurement of Disability Washington D C, 18 - 20 February 2002 UN Disability rates Wide inter-country variation 60 fold difference (0.2 - 30%) Reliability unknown - not measured Construct validity not sure what is being measured Possible explanations for between country variations  real differences levels of development different environments population age structure time of data collection Methodological differences Census vs surveys different concepts of ‘disability’ different domains different questions different levels of severity Life expectancy Measuring number of years people are expected to live based on mortality statistics in countries Reliability: Good different measurements give similar results Differences indicate real and expected differences between countries developed vs developing responsive to health interventions internationally recognised consensus measure used in different indices: Human development index; Health system performance Need indicators with similar properties for disability Life expectancy and % disabled No relationship between country differences in % disabled and life expectancy disability measure lacks face validity LE and % disabled (2) Disability levels cannot be explained by other covariates, such as age structure development level life expectancy education level economic level other contextual variables... as disability % goes up, more face validity Current disability statistics are not clear What is wrong with disability statistics Not holistic focus more on the physical (vision, hearing and mobility and severe mental handicap) than mental health not multi-dimensional usually activity limitation or impairments or mix very