bo presentation nov 28th 2016 - united nations · bo presentation nov 28th 2016.pptx author: sophie...
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Disability, Health and Human Development Sophie Mitra Fordham University
3rd Expert Mee+ng on Monitoring and Evalua+on for Disability-‐inclusive Development (MEDD), United Na+ons, Nov. 28th, 2016
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Research Questions
1. How should disability be defined to analyze and inform policies related to wellbeing? 2. What is the prevalence of func+onal difficul+es? 3. What inequali+es are associated with func+onal difficul+es?
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Literature
1. How should disability be defined to analyze, and inform policies, related to wellbeing in less resourced sePngs? • ICF (WHO 2001), social model (UNCRPD 2006), individual model (Global Burden of Disease)
2. What is the prevalence of func+onal difficul+es? • WHO-‐World Bank (2011); Mitra and Sambamoorthi (2013) 3. What inequali+es are associated with func+onal difficul+es? • Growing evidence of associa+ons in some aspects of wellbeing (educa+on, subjec+ve wellbeing) and of mul+ple depriva+ons (e.g. Trani et al 2013, 2015).
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Conceptual Framework: Sen’s Capability Approach
Func+onings (what people manage to do or be) and/or capabili+es (the prac+cal opportuni+es people have) are the evalua+ve space for human development (Sen 1999).
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Sen’s Capability Approach (Cont.)
Source: Robeyns (2005)
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The Human Development Model
• The objec+ve of the model and its applica+ons are to describe, explain and compare people’s func+onings and/or capabili+es, with a focus on how health condi+ons or impairments may relate to other func+onings/capabili+es.
• The end of research or policy ini+a+ves guided by this model is to enhance the capabili+es/func+onings of individuals.
• Disability is defined as a depriva+on in terms of func+oning(s) (and/or capability) among persons with a health condi+on or impairment.
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D. Health Depriva+ons
(Impairments & Health Condi+ons)
E. Wellbeing (func+onings/capabili+es)
A. Personal factors C. Structural factors B. Resources
The Human Development Model (Cont.)
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The Human Development Model (Cont.)
• Responses to improve wellbeing may have several entry points: health (preven+ng health condi+ons and impairments, improving health in general), resources (enhancing access to goods and services), and structural factors (e.g. change of aPtude or physical environment).
• This comes in contrast with earlier models.
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Methods: Data
• Four panel household surveys collected as part of the Living Standard Measure Study of the World Bank.
Ethiopia: Rural Socioeconomic Survey (2011/12, 2013/14)
Malawi: Integrated Household Survey (2010/11, 2012/13)
Tanzania: Na+onal Panel Survey (2010/11,2012/13)
Uganda: Na+onal Panel Survey (2009/10, 2010/11, 2011/12)
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Methods: Disability Measures
• The data includes the Washington Group on Disability Sta+s+cs recommended short set of ques+ons on limita+ons in: seeing; hearing; walking/climbing steps; self care ; learning/memorizing; communica+ng (Altman 2016).
• Each of the ques+ons has a four point answer scale: (1) No difficulty; (2) Yes – some difficulty; (3) Yes a lot of difficulty; (4) Cannot walk at all.
• This research uses -‐ Disability dummy variables (moderate; severe) -‐ Func+onal score = (Score – MinScore) / (MaxScore – MinScore)
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Results
• Results from the analysis of LSMS data in Ethiopia, Malawi, Tanzania, and Uganda dispel a number of myths or common assump+ons in rela+on to disability when disability refers to func+onal difficul+es:
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Result #1: Disability is not rare and does not affect a small minority.
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
Ethiopia Malawi Tanzania Uganda
Prevalence of func9onal difficul9es
Moderate
Severe
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Result #2: Disability is not static.
0% 20% 40% 60% 80% 100%
Ethiopia
Uganda
Severe func9onal difficul9es over two years
Both waves
Wave 1 only
Wave 2 only
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Result #3: Disability is relevant to development policy. It is highly correlated with poverty.
0
2
4
6
8
10
12
14
16
Ethiopia Malawi Tanzania Uganda
Prevalence of severe func9onal difficul9es by asset quin9le
Bokom quin+le
Top quin+le
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Result #4: Disability is relevant to development policy. It is highly correlated with poverty (Cont.).
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0.000
0.056
0.042
0.083
0.111
0.125
0.167
0.208
0.222
0.250
0.278
0.292
0.333
0.375
0.389
0.417
0.444
0.458
0.500
0.556
0.583
0.611
0.625
0.667
0.708
0.722
0.750
0.833
0.889
1.000
Func9onal score
Adjusted Mul9dimensional Poverty Headcount vs. func9onal score
Uganda
Ethiopia
Malawi
Tanzania
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Result #4: Disability is relevant to development policy (Cont.).
• Sugges+ve evidence that func+onal difficul+es are in part due to poverty
• Sugges+ve evidence that func+onal difficul+es may cause poverty
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Result #5: Disability is not a specialist issue. It is a cross-‐cutting and is relevant at least to poverty, health, gender and aging policies.
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
15 25 35 45 55 65 75
Mean func9onal score
Age
Func9onal score by age in Ethiopia
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Summary • The human development model and its applica+on to four countries in Africa suggest that in policy and research, disability needs to be considered through mul+-‐sectoral approaches related to aging, health, gender and poverty.
• It also suggests that mul+ple track approaches are needed including at least inclusion, targeted and preven+on interven+ons.
• The current wisdom in the disability field that leaves out preven+on and is omen based on a minority approach from the social model, is unlikely to be conducive to human development for all.
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Body func+ons and structures
(Impairments)
Ac+vi+es (Limita+ons)
Par+cipa+ons (Restric+ons)
Personal factors Environmental factors
Health condi+ons (disorders or diseases)
The ICF