“National survey and census data cannot be compared directly with the World Health Survey or Global Burden of Disease estimates, because there is no consistent approach across countries to disability definitions and survey questions.
“In 2004, the latest year for which data are available from surveys and burden of disease estimates, the World Health Survey and Global Burden of Disease results based on very different measurement approaches and assumptions, give global prevalence estimates among the adult population of 15.6% and 19.4% respectively. The World Health Survey gives the prevalence of adults with very significant difficulties in functioning at 2.2%, while the Global Burden of Disease data indicate that 3.8% of the adult population is estimated to have “severe disability” – the equivalent of disability inferred for conditions such as quadriplegia, severe depression, or blindness.
“Based on 2010 population estimates – 6.9 billion with 5.04 billion 15 years and over and 1.86 billion under 15 years – and 2004 disability prevalence estimates (World Health Survey and Global Burden of Disease) there were around 785 (15.6%) to 975 (19.4%) million persons 15 years and older living with disability. Of these, around 110 (2.2%) to 190 (3.8%) million experienced significant difficulties in functioning. Including children, over a billion people (or about 15% of the world’s population) were estimated to be living with disability.”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“Higher disability rates among older people reflect an accumulation of health risks across a lifespan of disease, injury, and chronic illness (74). The disability prevalence among people 45 years and older in low-income countries is higher than in high-income countries, and higher among women than among men.
“Older people are disproportionately represented in disability populations (see Fig. 2.2). They make up 10.7% of the general population of Australia and 35.2% of Australians with disabilities (29). In Sri Lanka, 6.6% of the general population are 65 years or older representing 22.5% of people with disabilities. Rates of disability are much higher among those aged 80 to 89 years, the fastest-growing age cohort worldwide, increasing at 3.9% a year (90) and projected to account for 20% of the global population 60 years or older by 2050 (91).”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“Estimates of the prevalence of children with disabilities vary substantially depending on the definition and measure of disability. As presented above, the Global Burden of Disease estimates the number of children aged 0–14 years experiencing ‘moderate or severe disability’ at 93 million (5.1%), with 13 million (0.7%) children experiencing severe difficulties (46). In 2005 the United Nations Children’s Fund (UNICEF) estimated the number of children with disabilities under age 18 at 150 million (102). A recent review of the literature in low- and middle-income countries reports child disability prevalence from 0.4% to 12.7% depending on the study and assessment tool (103). A review in low-income countries pointed to the problems in identifying and characterizing disability as a result of the lack of cultural and language-specific tools for assessment (104). This may account in part for the variation in prevalence figures and suggests that children with disabilities are not being identified or receiving needed services.”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“Disability can be defined in many ways, depending on context. The definition chosen affects benefits eligibility, civil rights protections, prevalence estimates, social stigma, and personal identity.1–4 One report identified sixty-seven federal statutory definitions of disability alone.5
“Although there is no single way to define disability, there are prevailing concepts. Historically, the medical model has been dominant.6,7 It defines disability as an impairment or problem existing within the body or mind that can be identified by objective scientific or expert observations and ameliorated with the guidance or treatment of experts to help the person adapt and conform to the “normal” environment.3,7
“The social model challenges the medical model’s definition identifying disabled people as defective and disabled lives as inherently inferior to nondisabled lives.6,8 From a social-model perspective, disability occurs when a person with an impairment interacts with physical or social environments that do not take the full range of human body variation into consideration and are unaccommodating or hostile as a result. In the social model, disability is a social construct, and disabled people are an oppressed minority group with unique histories and perspectives.4,–11
“Critics identify limitations in both the medical and social models.2,6,12 They argue that disability is both a social and an embodied phenomenon. There have been models that draw on aspects of both models, such as the interactive or biopsychosocial model used by the World Health Organization.13“
Source: Monika Mitra, Linda Long-Bellil, Ian Moura, Angel Miles, and H. Stephen Kaye, Advancing Health Equity And Reducing Health Disparities For People With Disabilities In The United States, Health Affairs 2022 41:10, 1379-1386.
“The phrase “health disparity” refers to adverse health differences affecting marginalized groups, arising from systemic factors that lead to social disadvantage.23 Health disparities are an equity issue and reflect both gaps in the quality of care received and broader patterns of injustice within society.24 Work on health disparities has largely focused on racial and ethnic minorities, but people with disabilities are increasingly recognized as a health disparity population.25 For example, through the Healthy People 2030 initiative, the Department of Health and Human Services has designated people with disabilities as a health disparity population.26 A challenge in identifying health disparities affecting disabled people is that some disabling conditions do inevitably lead to poorer health, regardless of individual circumstances, whereas in other instances, poorer health may be attributable to economic and social inequities such as barriers to health care access, thereby being accurately described as health disparities.1 Disentangling cause and effect in attributing and addressing these differences is an ongoing challenge.27
“People with disabilities are more likely to report poor health and experience higher rates of chronic health conditions than nondisabled people. Data published in 2012 and 2015 indicate that disabled adults were more likely to experience chronic conditions such as cardiac disease, diabetes, higher weight, and asthma and to lack emotional support.28,29 They were also more likely to experience both injuries and intimate partner and interpersonal violence, according to studies published in 2015 and 2016.30,31
“Disabled women are more likely than their nondisabled peers to have chronic health conditions and to describe their general health as fair or poor.21 Women with disabilities have lower rates of breast and cervical cancer screening compared with nondisabled women, and disabled women with circulatory or respiratory conditions have higher rates of breast cancer mortality than women without disabilities.32
“Limited research identifies differences in health status and outcomes based on type of disability.33 One study published in 2013 found that people with multiple disabilities had worse health outcomes and that people with hearing disabilities fared better on most outcomes than people with vision, physical, or cognitive disabilities.34 Another study published in 2019 found that adults with intellectual disabilities or autism were more likely to report comorbidities, including poor mental health, than adults with other disabilities.35“
Source: Monika Mitra, Linda Long-Bellil, Ian Moura, Angel Miles, and H. Stephen Kaye, Advancing Health Equity And Reducing Health Disparities For People With Disabilities In The United States, Health Affairs 2022 41:10, 1379-1386.
“For some environmental factors such as low birth weight and a lack of essential dietary nutrients, such as iodine or folic acid, the impact on the incidence and prevalence of health conditions associated with disability is well established in the epidemiological literature (106, 110, 111). But the picture differs greatly because exposure to poor sanitation, malnutrition, and a lack of access to health care (say, for immunization) are all highly variable around the world, often associated with other social phenomena such as poverty, which also represents a risk for disability (see Table 2.4) (80).
“People’s environments have a huge effect on the prevalence and extent of disability. Major environmental changes, such as those caused by natural disasters or conflict situations, will also affect the prevalence of disability not only by changing impairments but also by creating barriers in the physical environment. By contrast, campaigns to change negative attitudes towards persons with disabilities and largescale changes to improve accessibility in the transport system or to public infrastructure will reduce barriers to activities and participation for many persons with disabilities. Other environmental changes include assistance provided by another person or an adapted or specially designed tool, device, or vehicle, or any form of environmental modification to a room, home, or workplace.”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“Persons with disabilities experience worse educational and labour market outcomes and are more likely to be poor than persons without disabilities (119–129). A 2009 OECD study covering 21 upper-middle and high-income countries shows higher poverty rates among working-age people with disabilities than among working-age people without disability in all but three countries (Norway, Slovakia, and Sweden) (130). The relative poverty risk (poverty rate of working-age disabled relative to that of working-age non-disabled people) was shown to be the highest – more than two times higher – in Australia, Ireland, and the Republic of Korea, and the lowest – only slightly higher than for nondisabled people – in Iceland, Mexico, and the Netherlands. Working age people with disabilities were found to be twice as likely to be unemployed. When employed, they are more likely to work part-time. And unless they were highly educated and have a job, they had low incomes.”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“Most studies provide a snapshot of the labour market outcomes and poverty situation of working-age persons with disabilities. Few studies provide information about people’s socioeconomic status before the onset of disability and what has happened after it. A study using the British Household Panel Survey between 1991 and 1998 found that having less education, or not being in paid work, was a “selection” factor for disability (131). The study also found that employment rates fell with the onset of disability, and continue to fall with the duration of disability – indicating that people left the workforce early if they became disabled. Average income fell sharply with onset, but recovered subsequently, though not to predisability levels (131).”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“People with disabilities and their families often incur additional costs to achieve a standard of living equivalent to that of non-disabled people (120, 124, 148, 163). This additional spending may go towards health care services, assistive devices, costlier transportation options, heating, laundry services, special diets, or personal assistance. Researchers have attempted to calculate these costs by asking disabled people to estimate them by pricing the goods and services that disabled people report they need, by comparing actual spending patterns of people with and without disabilities, and by using econometric techniques (120, 124, 164).
“Several recent studies have attempted to estimate the extra cost of disability. In the United Kingdom estimates range from 11% to 69% of income (124). In Australia the estimated costs – depending on the degree of severity of the disability – are between 29% and 37% of income (120). In Ireland the estimated cost varied from 20% to 37% of average weekly income, depending on the duration and severity of disability (164). In Viet Nam, the estimated extra costs were 9%, and in Bosnia and Herzegovina 14% (148). While all studies conclude that there are extra costs related to disability, there is no technical agreement on how to measure and estimate them (163).”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“People with disabilities experience lower rates of employment, are more likely to be economically disadvantaged, and are therefore less likely to afford private health insurance (114). Employed people with disabilities may be excluded from private health insurance because of pre-existing conditions or be “underinsured” (114) because they have been denied coverage for a long period (11), or are excluded from claiming for treatment related to a pre-existing condition, or must pay higher premiums and out-of-pocket expenses.”
Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.
“• Children and other vulnerable groups should never be separated from their family and community and be placed in an institution. Yet, this happens all too often – mainly due to poverty, disability, adversity or misperception. Living in an institution leads to harm, with significant negative, life-long consequences on an individual’s physical, psychological and emotional development. The prevalence of unresponsive caregiving practices, the high risk of institutional sexual abuse, and the extremely high mortality figures are especially alarming.
“• The Convention of the Rights of the Child, the UN Convention on the Rights of Persons with Disabilities and the UN Guidelines for the Alternative Care of Children all recognise that the ideal setting for a child to grow up in, and for persons with disabilities to fulfil their potential and participate as full citizens, is within a family environment that provides a nurturing and loving atmosphere, or, when necessary, within a community-based care system which is suitable to meet their individual needs.
“• In addition to the human rights case, there is a strong economic case for choosing family- and community-based care over institutions. The cost of providing family- and community- based care is often less expensive and the social return is much higher. When children leave institutional care as adults, they often become dependent on the state for basic welfare, and are more likely to experience exclusion, violence, substance abuse and come into conflict with the law, which comes at a higher cost to society.”
Source: UNICEF. Ending institutionalisation and strengthening family and community based care for children in Europe and beyond. June 2018.
Breaking News
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- Oregon Becomes First US State To Guarantee Its Residents Access To Affordable Healthcare January 20, 2023January 20, 2023 In the November 2022 general election, Oregon voters narrowly approved Oregon Measure 111, the Right to Healthcare Amendment. The measure amended the state constitution, adding a guarantee of access to affordable healthcare for all Oregon residents. According to Ballotpedia, last accessed Jan. 20, 2023: “Ballot title “The ballot title was as follows:“Amends Constitution: State must ...
- Massive Savings Possible In US Health System October 21, 2021October 21, 2021 The management consulting firm McKinsey & Company has issued a new report estimating that administrative changes and efficiencies could save the US health system more than a quarter trillion dollars. As noted in a Viewpoint article published in JAMA on October 20: “The analysis dissected profit and loss statements of individual health care organizations, estimated ...
- Health Care in the US Compared to Other High-Income Countries August 6, 2021On August 4, the Commonwealth Fund issued a new report entitled Mirror, Mirror 2021: Reflecting Poorly / Health Care in the US Compared to Other High-Income Countries. The report compares health care systems in eleven nations: the United States, Canada, Switzerland, France, Sweden, New Zealand, Germany, the United Kingdom, Australia, the Netherlands, and Norway. The report’s key ...
- Medical Debt in Collections in the US August 6, 2021On July 20, JAMA published an article on medical debt in collections in the US entitled “Medical Debt in the US, 2009-2020.” The researchers found: “In this retrospective analysis of credit reports for a nationally representative 10% panel of individuals, an estimated 17.8% of individuals in the US had medical debt in collections in June 2020 ...
Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.
Page last updated Nov. 2, 2022 by Doug McVay, Editor.
