World Report on Disability

WORLD REPORT ON DISABILITY

WHO Library Cataloguing-in-Publication Data

World report on disability 2011.

1.Disabled persons - statistics and numerical data. 2.Disabled persons - rehabilitation. 3.Delivery of health care. 4.Disabled children. 5.Education, Special. 6.Employment, Supported. 7.Health policy. I.World Health Organization.

ISBN 978 92 4 156418 2 ISBN 978 92 4 068521 5 (PDF) ISBN 978 92 4 068636 6 (ePUB) ISBN 978 92 4 068637 3 (Daisy)

(NLM classification: HV 1553)

? World Health Organization 2011

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Printed in Malta

Contents

Foreword

Preface

Acknowledgements

List of contributors

Introduction

Understanding disability What is disability? Environment The diversity of disability Prevention Disability and human rights Disability and development

Disability ? a global picture Measuring disability Prevalence of disability ? difficulties in functioning Country-reported disability prevalence Global estimates of disability prevalence Health conditions Trends in health conditions associated with disability Demographics Older persons Children The environment Health conditions are affected by environmental factors Disability and poverty Developed countries Developing countries Needs for services and assistance

ix

xi

xiii

xv

xxi

1 3 4 7 8 9 10

19 21 24 25 25 32 32 34 34 36 37 37 39 39 39 40

iii

Costs of disability

42

Direct costs of disability

43

Indirect costs

44

Conclusion and recommendations

44

Adopt the ICF

45

Improve national disability statistics

45

Improve the comparability of data

46

Develop appropriate tools and fill the research gaps

46

General health care

55

Understanding the health of people with disabilities

57

Primary health conditions

57

Risk of developing secondary conditions

58

Risk of developing co-morbid conditions

59

Greater vulnerability to age-related conditions

59

Increased rates of health risk behaviours

59

Greater risk of being exposed to violence

59

Higher risk of unintentional injury

60

Higher risk of premature death

60

Needs and unmet needs

60

Addressing barriers to health care

62

Reforming policy and legislation

65

Addressing barriers to financing and affordability

66

Addressing barriers to service delivery

70

Addressing human resource barriers

77

Filling gaps in data and research

80

Conclusion and recommendations

81

Policy and legislation

82

Financing and affordability

82

Service delivery

82

Human resources

83

Data and research

83

Rehabilitation

93

Understanding rehabilitation

95

Rehabilitation measures and outcomes

95

Rehabilitation medicine

97

Therapy

100

Assistive technologies

101

Rehabilitation settings

101

Needs and unmet needs

102

Addressing barriers to rehabilitation

103

Reforming policies, laws, and delivery systems

104

National rehabilitation plans and improved collaboration

105

Developing funding mechanisms for rehabilitation

106

iv

Increasing human resources for rehabilitation

108

Expanding education and training

110

Training existing health-care personnel in rehabilitation

111

Building training capacity

112

Curricula content

112

Recruiting and retaining rehabilitation personnel

112

Expanding and decentralizing service delivery

114

Coordinated multidisciplinary rehabilitation

114

Community-delivered services

114

Increasing the use and affordability of technology

117

Assistive devices

117

Telerehabilitation

118

Expanding research and evidence-based practice

119

Information and good practice guidelines

120

Research, data, and information

121

Conclusion and recommendations

121

Policies and regulatory mechanisms

122

Financing

122

Human resources

122

Service delivery

122

Technology

123

Research and evidence-based practicF

123

Assistance and support

135

Understanding assistance and support

138

When are assistance and support required?

139

Needs and unmet needs

139

Social and demographic factors affecting demand and supply

140

Consequences for caregivers of unmet need for formal support services

141

Provision of assistance and support

142

Barriers to assistance and support

144

Lack of funding

144

Lack of adequate human resources

144

Inappropriate policies and institutional frameworks

145

Inadequate and unresponsive services

145

Poor service coordination

145

Awareness, attitudes, and abuse

147

Addressing the barriers to assistance and support

147

Achieving successful deinstitutionalization

147

Creating a framework for commissioning effective support services

149

Funding services

149

Assessing individual needs

150

Regulating providers

151

Supporting public-private-voluntary services

151

v

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