economic costs of living with disability and stigma in vietnam
DESCRIPTION
Economic costs of living with disability and stigma in Vietnam. Le Bach Duong On behalf of the research team Canberra, August 2014. PROJECT OVERVIEW. Project Rationale. ISDS Disability Survey (2006): high incidence of S&D against PWDs from society and institutions - PowerPoint PPT PresentationTRANSCRIPT
Economic costs of living with disability and stigma in Vietnam
Le Bach Duong On behalf of the research team
Canberra, August 2014
PROJECT OVERVIEW
Project Rationale• ISDS Disability Survey (2006): high incidence of
S&D against PWDs from society and institutions• Unavailability of quality data on disability,
especially disability-related stigma• Few studies on S&D are qualitative• Low awareness of disability-related stigma and
discrimination among the public, state institutions, and mass media
• Insufficient disability policies and programs regarding stigma and discrimination reduction
• Government’s needs of information/evidence for policies and programs
Project Purpose
1. Provide a profile of disability situation in Vietnam
2. Provide evidences of disability-related stigmas and their impact
3. Provide estimates of disability-related costs at household level
4. Estimate economic costs of disability-related stigmas at household level
5. Policy advocacy and public awareness raising
Project survey• Project time line: From March 2010 through August
2013• Survey sites: 6 provinces (Lang Son, Thai Binh,
Quang Nam, Kontum, Dong Nai, Vinh Long) and two largest cities (Hanoi and Ho Chi Minh City)
• Sample size: 4,224 of both PWDs and PWOD (out of over 20,000 household members screened for disability status) using the the Washington Group short set of six questions on disability, developed based on ICF framework.
RESEARCH APPROACH
Vicious cycle
Evidence from developing world as well as from Vietnam remains very little
Vicious cycle
Stigma
Disability
Costs of living with disability
Cost of disability-related stigma
Definitions
Disability and stigma
Methods• Development of stigma scale:
– Review of other health related stigma scales– Conduct a qualitative study to explore types of stigma
and its impacts on general activities, education, employment and health care among people with disability in Vietnamese context.
– Discussion with experts to revise the first version– Field study to assess validity and reliability of the scale:
200 persons with disability and 200 persons without disability
– A scale of 40 questions after validation study
• Stigma scale
40 questions: five options for choice: - Never (0); - Sometime (1); - Often (2) ; - Very often (3) - and Don’t
know (DK)
Overall stigma score: 120
• 7 sub stigma scale score
• High stigma: Overall stigma score is 49 or greater (stigma score at upper interquartile value or greater)
0 20 40 60 80 100stigmascore
PWD
NDP
Stigma score of people with and without disability
Total stigma score
General stigma score
Work related stigma
Family invest
Perceived stigma
Opportunity
Participation
Health related stigma
Discrimination
0 5 10 15 20 25 30 35 40 45 50
37.9
3.5
9.5
9.7
1.5
9.2
7.3
0.8
1.9
44.8
5
10.5
11.9
2.4
11.2
7.8
1.3
2.6
PWDPeople without disability
Subscale stigma score of people with and without disability
0 20 40 60 80 100stigmascore
above 64
between 45-64
between 25-44
between 15-24
Female
Male
Female
Male
Female
Male
Female
Male
NDP PWD
• Linear regression of stigma score across socioeconomic groups show stigma score was significantly higher among:– PWD vs. PWOD– Female vs. male– Age: younger people vs. older people– People lived in urban areas vs. rural areas– People who are poorer vs. the better off– People who had lower educational levels vs. those
with higher education
Vision
Hearing
Remem-bering
Walk
ing
Commu- nica
tion
Self-c
are0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
33.3 35.9
49.042.5
76.7
62.861.4
51.0
72.9
48.5
84.491.4
A little difficultyLot of difficulty
Percent of high stigma level attributed to disability: overall AR%=43.8%
Key messages
• PWD significantly had higher stigma score and 1.8 time higher risk of high stigma than people without disability did,
• The odds ratio of experiencing high stigma among PWD ranged from 1.5 to 11.7 depending on type of stigma and levels of difficulty
• The stigma score increased by increasing level of difficulty in all types of disabilities.
• The younger people suffered more from high stigma and had higher stigma score as compared to the older people.
Key message• Those with higher education levels
consistently had lower stigma score and lower risk of suffering from high stigma.
• The richest group significantly has lower stigma score than the poorest group did.
• PWD from the urban areas were more likely to have higher stigma score than those PWD from rural areas.
Key message
• Percentage of high stigma level attributed to disability ranged from 33% to 91% and depends on types and levels of difficulty:– People with communication, remembering and
self -care difficulties had higher prevalence of high stigma than the people with other disabilities
Cost of living with disability
Indirect methodsThe standard of living approach
1. Extension of the standard of living
approach
2. Oaxaca decomposition
technique
The standard of living approach
• With the same income, PWD experience a lower standard of living than PWOD, because of diversion of money resources to goods and services required because of their disability.
• For a given standard of living it is possible to compare what incomes PWD and PWOD have=the extra costs incurred by disability
Extra cost = Y1-Y0= -b/a
S = aY + bD + gX + k
The standard of living
Annual cost of living with disability, by type (VND 000)
Overall Vision Hearing Moving Remembering Self-care Communication
4,343,468 5,777,743
9,148,149
4,112,796
9,620,848
4,785,109
14,996,645
3,990,565 4,648,145
9,044,692
5,597,888
8,697,379
3,032,961
11,018,077
OLS model Ordered logit model
Annual cost of living with disability, by age (VND 000)
Elderly Non-elderly Elderly Non-elderlyOLS model Ordered logit model
13,345,277
3,731,021
12,636,462
3,256,848
Annual cost of living with disability, by gender (VND 000)
Men Women Men WomenOLS model Ordered logit model
3,882,576
4,568,803
2,104,986
5,824,080
Annual cost of living with disability, by location (VND 000)
Urban Rural Urban RuralOLS model Ordered logit model
6,496,479
2,483,784
5,000,932
3,194,453
Cost of living with disability, by severity (VND 000)
Some difficulty A lot of difficulty Can’t not do at all
1,853,006
8,644,090
15,470,795
1,872,476
7,849,516
12,863,675
OLS model Ordered logit model
Cost of living with disability + stigma
1. Extension of the standard of living approach
• Create a new variable1. Non-disabled & Low-stigma2. Non-disabled & High-Stigma3. Disabled & Low-stigma4. Disabled & High-Stigma
Annual cost of living with both disability and stigmaUsing median value of stigma score as cut-off point
Cos
t of
livi
ng w
ith d
isab
ility
and
an
y le
vel o
f st
igm
a
Cos
t of
livi
ng w
ith d
isab
ility
and
hi
gh le
vel o
f st
igm
a
Cos
t of
livi
ng w
ith d
isab
ility
and
an
y le
vel o
f st
igm
a
Cos
t of
livi
ng w
ith d
isab
ility
and
hi
gh le
vel o
f st
igm
a
OLS model Ordered logit model
4,343,468
17,903,837
3,990,565
15,906,502
Annual cost of living with both disability and stigmausing upper bound of interquatile as cut-off point
4,343,468
19,858,344
3,990,565
18,262,581
Annual household income by disability and stigma status (median of stigma score as the cut-off point)
(VND 000)
Low stigma High stigma Overall
109,036
62,406
89,062
106,432
52,803
75,801
Non-disabled Disabled
19.5% explained by stigma status
Annual household income by disability and stigma status (upper bound of inter-quartile of stigma score as the cut-off point)
(VND 000)
31.6% explained by stigma status
Low stigma High stigma Overall
97,577
48,966
89,062 91,643
46,324
75,801
Non-disabled Disabled
Key messages
1. The cost of living with disability in Vietnam is substantial – Per household with PWD: 8.8%-9.5% of annual household income =
VND 3.9-4.3 million or US$ 200-218 per year– For whole Vietnam: @ 6 million with disabled person= 1.2-1.3
billion USD per year
2. Communication difficulty was shown to result in highest additional costs.
3. The costs of living with disability in Vietnam were higher among households with disabled person aged 60 years old and over, among households with female disabled person and disable household located in urban area
4. The costs of living with disability increased as people had more severe impairment
Key message5. Stigma aggravated the cost of living with
disability– The cost of living with both disability and stigma
was about 4 to 5-times higher than that of living with disability with any level of stigma; and
– Stigma status explains 19.5%-31.6% of the income gaps between PWD and PWOD households
Cost of living with disability
Cost of living with disability
Stigma
PROJECT PRODUCTS
• Report dissemination organized jointly by ISDS, HMU, PHAD and the Communist Party’s Central Committee for Culture and Communication.
• A peer-review publication (Global Public Health journal); another on stigma to come
• A guide for reduction of disability-related stigma for Party organs and the mass media
• Thousands of a disability bulletin disseminated to all provinces
• Training courses on disability organized at the University of Labour and Social Affairs (under the Ministry of Labour, Invalids and Social Affairs)
• A tools for addressing disability-related stigma
Thank you a million