1. Patricia Lima Pereira Student of Master in Public Health and Social Protection Institute of Public Health- Jagiellonian University Medical College 15th, January 2010 Causes of disability: A challenge forresearch in Latin America

2. 1 Difficulties in comparing disability statistics Wide range of definitions Different types of classifications Different methods used to measure the disability

3. Disability prevalence (%), by census data 1 HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

4. Disabilityprevalence (%)byhouseholdsurveys 1 HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

5. Disability prevalence (%)by national studies using ICF-2001 1 HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

6. Disability prevalence (%) in Chile,by different data sources 1 HEALTH IN THE AMERICAS, 2007.VOLUME I–REGIONAL

7. 2 Under-estimation of disability Core Impairment vs. Impairment Continuum Blindness Deafness Mobility Mental retardation Allotherimpairments – moderatetomild

8. 3 Evolution of the definition of disability From International Classification of Impairments, Disabilities and Handicaps (ICIDH) 1980 To International Classification of Functioning, Disability, and Health (ICF) 2001

9. International Classification of Impairments, Disabilities and Handicaps (ICIDH) 1980 3 CAUSES The “medical model of disability” regards disability only as an individual pathological problem, in need of cure, rehabilitation and adaptation to society.

10. 3 Underlying causes of impairments

11. 3

12. 3 Main causes of disability in Latin America Traffic accidents Adquired diseases Occupa tional disease Violence Poverty Problems at birth Aging

13. International Classification of Functioning, Disability, and Health (ICF) 2001 3 The “social model of disability” does not deny medical & rehabilitative needs of persons with disabilities, but draws attentions to social, physical, informational and institutional barriers, which contribute disability.

14. 3 Health condition Diseases, disorders injuries Personal factors (gender, age, social background, education, profession, etc.) Environmentalfactors (architectural characteristics, legal and social structures, ect.) Contextualfactors

15. Causes of disability Using the approach of the ICF - 2001 4

16. 4 CAUSES Health condition Diseases, disorders injuries Disability CAUSES CAUSES Personal factors (gender, age, social background, education, profession, etc.) Environmentalfactors (architectural characteristics, legal and social structures, ect.) Contextualfactors

17. 4 Health condition Diseases, disorders injuries England Department of Health. Health Survey for England 2001 Headings of the International Classification of Diseases, 10th revision (ICD-10) Disability 63 categories

18. 4 Health condition Diseases, disorders injuries England Department of Health. Health Survey for England 2001 Headings of the International Classification of Diseases, 10th revision (ICD-10)

19. 4 Health condition Diseases, disorders injuries Disability Personal factors (gender, age, social background, education, profession, etc.) Environmentalfactors (architectural characteristics, legal and social structures, ect.) Contextualfactors

20. 4 Disability Environmentalfactors (architectural characteristics, legal and social structures, ect.)

21. 4 Health condition Diseases, disorders injuries Disability Environmentalfactors (architectural characteristics, legal and social structures, ect.) Personal factors (gender, age, social background, education, profession, etc.) Contextualfactors

22. 4 Disability Personal factors (gender, age, social background, education, profession, etc.)

23. Poverty is both a cause and consequence of disability 4 Takamine, Yutaka (2003). Disability Issues in East Asia: Review and Ways Forward.

24. Limitations of the ICF approach 5

25. Limitations of the ICF approach 5 Focus on disability experience and ignores etiology of health conditions “In the ICF we would record the loss of limb as such, regardless of whether the loss was the result of a landmine, diabetes or a traffic accident. The impairment remains the same. Similarly, we would document the fact that a person was not working regardless of whether the underlying health condition was ‘flu, depression, or back pain”. Training Manual on Disability Statistics (WHO/ ESCAP 2008)

26. Limitations of the ICF approach 5 Focus on disability experience and ignores etiology of health conditions Itmaybeconsiderate a limitation?

27. 5 Identification of the cause of disability may assist policymakers to make decisions about the type of preventive programs appropriate for their country compulsory use of Helmets Health care services Access to Clean water

28. Remaining questions 6 Tendency focus in disability experience, neglecting the causes Could that create problems in the future? Would it reduce the availability of data necessary to evaluate health prevention interventions at population levels?

29. CDC. Prevalence and Most Common Causes of Disability Among Adults in the United States. Morbidity and Mortility Weekly Report (MMWR), available on http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a2.htm#tab2. Retrievedon 04/01/10. 18:02, 2005. DANE Colombia. Censo Nacional de Población. Informe preliminar cifras de población con discapacidad. Bogotá: Departamento Administrativo Nacional de Estadística, 2006. DCDGRD Colombia. Información estadística de la discapacidad. Dirección de Censos y Demografía Grupo de Registros Demográficos. Colombia , 2004. England Department of Health. Health Survey for England 2001. Available on: http://www.archive2.official-documents.co.uk/document/deps/doh/survey01/disa/disa01.htm. Retrieved on 03/01/2008. 21:20, 2001. Hernandez Collado, Héctor. «Encuesta Nicaragüense para Personas con Discapacidad (ENDIS).» 2003. Murray, Christopher, and Alan López. The Global Burden of Diseases, Global Burden of Disease and Injury Series. World Health Organization, Harvard School of Public Health, World Health, 1996. PAHO. La discapacidad en Nicaragua: situación actual y perspectivas.Panamerican Health Organization, 2005. Sánchez, S, M Sanabria, and N Medina. "Nutritional profile of indigenous children under five years old in Paraguay. Indigenous Household Survey 2008." Pediatric Research, 2009: 65:4 (479). Takamine, Yutaka. «Disability Issues in East Asia: Review and Ways.» 2003. Vásquez, Armando. «La discapacidad en América Latina.» En Discapacidad: lo que todos debemos saber, de Alicia Amate y Armando Vásquez, 9-24. Washington: OPS, 2006. WHO. «Health in the Americas 2007. Volume I Regional.» avalaible on www.who.int, 2007. WHO. International Classification of Functioning, Disability and Health. Geneva: World Health Organization, 2001. WHO/ ESCAP. Training Manual on Disability Statistics. World Health Organization / United Nations Economic and Social Commission for Asia and the Pacific Region, 2008. Bibliography