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

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

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

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  1. Relevance • Potential • Meanings • Relevance of disability to the poverty dialogue • Potential Utility of the LSMS • Disability meanings

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

  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

  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

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  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

  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

  16. LSMS Potential • Deficits in surveillance • Disability rights Russian Survey on Household Conditions and Public Health

  17. LSMS Potential • Deficits in surveillance • Disability rights Albania Employment and Welfare Survey

  18. LSMS Potential • Deficits in surveillance • Disability rights Tanzania Human Development Resource Survey

  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

  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.

  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.

  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”

  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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