Who library Cataloguing-in-Publication Data World report on disability 2011




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277

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Estadística and Inter-American Development Bank, 2002 (http://www.iadb.org/sds/SOC/publication/gen_6191_4149_s.
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49. Census of India. New Delhi, Office of the Registrar General (http://www.censusindia.net, accessed 3 February 2010).

50. Report of baseline health research. Jakarta, National Institute of Health Research and Development, Ministry of Health, 2008.

51. General results of Iran census 2006: population and housing. Tehran, National Statistics Office, Statistical Centre of Iran, 2006.

52. Census 2006: principal socio-economic results. Dublin, Central Statistics Office, 2006 (http://www.cso.ie/census/census2006re-

sults/PSER/PSER_Tables%2031-38.pdf, accessed 3 February 2010).

53. National disability survey. Dublin, Central Statistics Office, 2008 (http://www.cso.ie/releasespublications/documents/

other_releases/nationaldisability/National%20Disability%20Survey%202006%20First%20Results%20full%20report.pdf,

accessed 3 February 2010).

54. Bartley M. Measurement of disability data: Jamaica’s experience with censuses and surveys [Estadísticas de discapacidad en el

Cono Sur]. Buenos Aires, Inter-American Development Bank, 2005 (http://tinyurl.com/ylgft9x, accessed 3 February 2010).

55. Annual report on government measures for persosn with disabilities. Tokyo, Cabinet Office, 2005 (http://www8.cao.go.jp/

shougai/english/annualreport/2005/h17_report.pdf, accessed 3 February 2010).

56. A note on disability issues in the Middle East and North Africa. Washington, World Bank, 2005 (http://siteresources.worldbank.

org/DISABILITY/Resources/Regions/MENA/MENADisabilities.doc, accessed 3 February 2010).

57. Disability data from the annual report of the Ministry of Health and the Republican Medical Information Centre: Health of the

population and functioning of health facilities in 2008. Bishkek, Ministry of Health, 2009. Population data from: Main social and
demographic characteristics of population and number of housing units. Bishkek, National Statistical Committee of the Kyrgyz
Republic, 2009.

58. National human development report: Lebanon 2001-2002. Beirut, United Nations Development Programme, 2002.

59. National needs assessment survey of the injured and disabled. Monrovia, Centers for the Rehabilitation of the Injured and

Disabled, 1997.

60. Statistikos Departmentas [web site]. (http://db1.stat.gov.lt/statbank/default.asp?w=1680, accessed 3 February 2010).

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62. Loeb ME, Eide AE. Living conditions among people with activity limitations in Malawi: a national representative study. Trondheim,

SINTEF, 2004 (http://www.safod.org/Images/LCMalawi.pdf, accessed 3 February 2010).

63. Country profile: Malaysia. Bangkok, Asia-Pacific Development Center on Disability, 2006 (http://www.apcdfoundation.org/

countryprofile/malaysia/index.html, accessed 25 March 2010). [Note: “Prevalence data” refers to registered persons with

disabilities.]

64. National Statistics Office of Malta [web site]. (http://www.nso.gov.mt, accessed 3 February 2010).

65. Census 1999. Majuro, Republic of the Marshall Islands Census, 1999 (http://www.pacificweb.org/DOCS/rmi/pdf/99census.

pdf, accessed 6 March 2010).

66. Central Statistics Office. Republic of Mauritius [web site]. (http://www.gov.mu/portal/goc/cso/census_1.htm, accessed 3

February 2010).

67. Lerma RV. Generating disability data in Mexico [Estadística sobre personas con discapacidad en Centroamérica]. Managua,

Inter-American Development Bank, 2004 (http://tinyurl.com/ylgft9x, accessed 3 February 2010).

68. Bases de datos en formato de cubo dinámico. Mexico City, Sistema Nacional de Información en Salud, 2008 (http://dgis.salud.

gob.mx/cubos.html, accessed 3 February 2010).


278

Technical appendix A


69. The YLD estimate for 2004 is reported for Serbia and Montenegro.

70. Enquête nationale sur le handicap. Rabat, Secrétariat d’Etat chargé de la Famille, de l’Enfance et des Personnes Handicapées,

2006 (http://www.alciweb.org/websefsas/index.htm, accessed 10 March 2010).

71. Disability. Maputo, Instituto Nacional de Estatística (http://www.ine.gov.mz/Ingles/censos_dir/recenseamento_geral/

deficiencia, accessed 3 February 2010).

72. Eide HE, Kamaleri Y. Health research, living conditions among people with disabilities in Mozambique: a national repre-

sentative study. Oslo, SINTEF, 2009 (http://www.sintef.no/upload/Helse/Levekår%20og%20tjenester/LC%20Report%20

Mozambique%20-%202nd%20revision.pdf, accessed 4 April 2010).

73. Department of Statistics. Malaysia [web site]. (http://www.statistics.gov.my, accessed 3 February 2010).

74. Namibia 2001: population and housing census. Windhoek, National Planning Commission (http://www.npc.gov.na/census/

index.htm, accessed 3 February 2010).

75. Eide AH, van Rooy G, Loeb ME. Living conditions among people with activity limitations in Namibia: a representative, national

study. Oslo, SINTEF, 2003 (http://www.safod.org/Images/LCNamibia.pdf, accessed 3 February 2010).

76. Table 22: Population by type of disability, age groups and sex for regions. Kathmandu, National Planning Commission Secretariat,

Central Bureau of Statistics (http://www.cbs.gov.np/Population/National%20Report%202001/tab22.htm, accessed 3

February 2010).

77. Disability counts 2001. Wellington, Statistics New Zealand, 2002 (http://www2.stats.govt.nz/domino/external/pasfull/

pasfull.nsf/0/4c2567ef00247c6acc256e6e006bcf1f/$FILE/DCounts01.pdf, accessed 3 February 2010).

78. Paguaga ND. Statistics on persons with disabilities [Estadística sobre personas con discapacidad en Centroamérica]. Managua,

Inter-American Development Bank, 2004 (http://tinyurl.com/ylgft9x, accessed 3 February 2010).

79. Number of recipients of social welfare by case (various years). Muscat, National Statistics, 2006 (http://www.moneoman.gov.

om/stat_book/2006/fscommand/SYB_2006_CD/social/social_4-20.htm, accessed 3 February 2010).

80. Population census organization. Islamabad, Statistics Division, 2004 (http://www.statpak.gov.pk/depts/fbs/publications/

compendium_gender2004/gender_final.pdf, accessed 10 March 2010).

81. Quesada LE. Statistics on persons with disabilities [Estadística sobre personas con discapacidad en Centroamérica]. Managua,

Inter-American Development Bank, 2004 (http://tinyurl.com/ylgft9x, accessed 3 February 2010).

82. Barrios O. Regional harmonization of the definition of disability [Armonización regional de la definición de discapacidad].

Buenos Aires, Inter-American Development Bank, 2005 (http://tinyurl.com/ylgft9x, accessed 3 February 2010).

83. Census 2007. Lima, National Statistics Office, 2008 (http://www.inei.gob.pe/, accessed 25 March 2010). [Note: data correspond

to percentage of surveyed homes with a person with disability.]

84. Araujo GR. Various statistics on disability in Peru [Datos de discapacidad en la región Andina]. Lima, Inter-American

Development Bank, 2005 (http://tinyurl.com/ylgft9x, accessed 3 February 2010).

85. A special release based on the results of Census 2000. Manila, National Statistics Office, 2005 (http://www.census.gov.ph/data/

sectordata/sr05150tx.html, accessed 10 March 2010).

86. Central Statistical Office [web site]. (http://www.stat.gov.pl, accessed 4 February 2010).

87. Instituto Nacional de Estatística [web site] (http://www.ine.pt, accessed 4 February 2010).

88. Statistics annual book. Bucharest, Ministry of Health, 2008.

89. The Caribbean (Studies and Perspectives Series, No. 7). Port of Spain, United Nations Economic Commission for Latin America

and the Caribbean, Statistics and Social Development Unit, 2008.

90. Country profile: Samoa. Bangkok, Asia-Pacific Development Center on Disability, 2006 (http://www.apcdfoundation.org/

countryprofile/samoa/index.html, accessed 25 March 2010). [Note: “Prevalence data” refers to people aged 15 years and

older.]

91. Country profile on disability: Kingdom of Saudi Arabia. Washington, World Bank and JICA Planning and Evaluation Department,

2002 (http://siteresources.worldbank.org/DISABILITY/Resources/Regions/MENA/JICA_Saudi_Arabia.pdf, accessed 4

February 2010).

92. From official statistics provided by the Ministry of Health to the WHO regional office. Note: data only valid for age group

16-64 years and only in relation to disabilities recorded in the occupational statistics.

93. The YLD estimate for 2004 is reported for Serbia and Montenegro.

94. 2004 population and housing census: mortality and disability. Freetown, Statistics Sierra Leone and UNFPA, 2006 (http://www.

sierra-leone.org/Census/Mortality and Disability.pdf, accessed 4 February 2010).

95. Prevalence of disability in South Africa, Census 2001. Pretoria, Statistics South Africa, 2005 (http://www.statssa.gov.za/

PublicationsHTML/Report-03-02-44/html/Report-03-02-44.html, accessed 4 February 2010).

96. Department of Health Facts and Statistics [web site]. (http://www.doh.gov.za/facts/index.html, accessed 4 February 2010).


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97. Instituto Nacional de Estadística, [web site] (http://www.ine.es/en/inebmenu/mnu_salud_en.htm, accessed 4 February

2010).

98. Census of population and housing 2001: disabled persons by type and disability, age and sex. Colombo, National Statistics Office,

2001 (http://www.statistics.gov.lk/PopHouSat/PDF/Disability/p11d2%20Disabled%20persons%20by%20Age%20and%20

Sex.pdf, accessed 4 February 2010).

99. Hunte A. Disability studies in Suriname [Datos de discapacidad en el Caribe]. Kingston, Inter-American Development Bank,

2005 (http://tinyurl.com/ylgft9x, accessed 4 February 2010).

100. National Statistics Office of Switzerland [web site]. (http://www.bfs.admin.ch/bfs/portal/fr/index/themen/20/06.html,

accessed 4 February 2010).

101. From official statistics provided to the WHO regional office. Note: data refer to working-age population.

102. National Statistics Office of Thailand [web site]. (http://portal.nso.go.th/otherWS-world-context-root/index.jsp, accessed 4

February 2010).

103. National disability identification survey. Nuku’alofa, Tonga Department of Statistics, 2006 (http://www.spc.int/prism/Country/

to/Stats/pdfs/Disability/NDIS06.pdf, accessed 4 February 2010).

104. Schmid K, Vézina S, Ebbeson L. Disability in the Caribbean. A study of four countries: a socio-demographic analysis of the

disabled. UNECLAC Statistics and Social Development Unit, 2008 (http://www.eclac.org/publicaciones/xml/2/33522/L.134.

pdf, accessed 4 February 2010).

105. Turkey disability survey. Ankara, Turkish Statistical Institute, 2002 (http://www.turkstat.gov.tr/VeriBilgi.do?tb_id=5&ust_id=1,

accessed 4 February 2010).

106. Census 2002. Kampala, Uganda Bureau of Statistics (http://www.ubos.org/index.php?st=pagerelations2&id=16&p=rela

ted%20pages%202:2002Census%20Results, accessed 10 March 2010).

107. Uganda national household survey 2005-2006: report on the socio-economic module. Kampala, Uganda Bureau of Statistics,

2006 (http://www.ubos.org/onlinefiles/uploads/ubos/pdf%20documents/UNHSReport20052006.pdf, accessed 4 April

2010).

108. United Kingdom National Statistics [web site]. (http://www.statistics.gov.uk, accessed 4 February 2010).

109. Tanzania disability survey 2008. Dar es Salaam, National Bureau of Statistics, 2008. (http://www.nbs.go.tz/index.

php?option=com_phocadownload&view=category&id=71:dissability&Itemid=106#, accessed 10 March 2010).

110. Census 2000. Washington, United States Census Bureau (http://www.census.gov/main/www/cen2000.html, accessed 6

March 2010).

111. American community survey 2007. Washington, United States Census Bureau (http://www.census.gov/acs/, accessed 4

February 2010). [Note: Prevalence data are valid for people aged 5 years and older.]

112. Damonte AM. Regional harmonization of the definition of disability [Armonización regional de la definición de discapacidad].

Buenos Aires, Inter-American Development Bank, 2005 (http://tinyurl.com/ylgft9x, accessed 4 February 2010).

113. Vanuatu: disability country profile. Suva, Pacific Islands Forum Secretariat, 2009 (http://www.forumsec.org/pages.cfm/

strategic-partnerships-coordination/disability/, accessed 2 June 2009).

114. León A. Venezuela: characterization of people with disability, Census 2001 [Datos de discapacidad en la región Andina]. Lima,

Inter-American Development Bank, 2005 (http://tinyurl.com/ylgft9x, accessed 4 February 2010).

115. Central Statistical Organization [web site]. (http://www.cso-yemen.org/publication/census/second_report_demogra-

phy_attached.pdf, accessed 4 February 2010).

116. Eide AH, Loeb ME, eds. Living conditions among people with activity limitations in Zambia: a national representative study. Oslo,

SINTEF, 2006 (http://www.sintef.no/upload/Helse/Levekår%20og%20tjenester/ZambiaLCweb.pdf, accessed 7 December

2009).

117. Eide AH et al. Living conditions among people with activity limitations in Zimbabwe: a representative regional survey. Oslo,

SINTEF, 2003 (http://www.safod.org/Images/LCZimbabwe.pdf, accessed 4 February 2010).


280

Technical appendix B


Overview of global and regional initiatives on disability statistics

There are numerous databases (including web sites) and studies of various
international and national organizations that have compiled disability sta-
tistics (1-9).

To illustrate some of the current initiatives to improve disability statis-
tics, the work of five organizations is described here. They are:
■ The United Nations Washington Group on Disability Statistics.
■ The United Nations Economic and Social Commission for Asia and the
Pacific (UNESCAP).

■ The WHO Regional Office for the Americas/Pan American Health
Organization (PAHO).

■ The European Statistical System (ESS).

■ The United Nations Economic Commission for Europe (UNECE).

The United Nations Washington Group on Disability Statistics

The Washington Group was set up by the United Nations Statistical Commission
in 2001 as an international, consultative group of experts to facilitate the meas-
urement of disability and the comparison of data on disability across countries

(10). At present, 77 National Statistical Offices are represented in the Washington Group, as well as seven international organizations, six organizations that represents people with disabilities, the United Nations Statistics Division, and three other United Nations-affiliated bodies.

As described in Chapter 2, the Washington Group created a short set of
six questions for use in censuses and surveys, following the Fundamental
Principles of Official Statistics and consistent with the International
Classification of Functioning, Disability and Health (ICF) (11). These ques-
tions, when used in combination with other census data, assess the degree
of participation of people with disabilities in education, employment, and
social life - and can be used to inform policy on equalization of opportu-
nities. The United Nations Principles and Recommendations for Population
and Housing Censuses incorporates the approach taken by the Washington
Group (12).


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The recommended Washington Group
short set of questions thus aims to identify the
majority of the population with difficulties in
functioning in six core domains of function-
ing (seeing, hearing, mobility, cognition, self-
care, communication); difficulties that have
the potential to limit independent living or
social integration if appropriate accommoda-
tion is not made. The Washington Group short
set of census questions underwent a series of
cognitive and field tests in 15 countries before
being finalized (13).

A second priority was to recommend
one or more extended sets of survey items to
measure the different aspects of disability, or
principles for their design, that could be used
as components of population surveys or as sup-
plements to special surveys. The extended set
of questions has undergone cognitive testing in

10 countries, with further field-testing taking place in five countries in Asia and the Pacific -
in collaboration with the UNESCAP Statistical Division - and one in Europe.

The Washington Group is also involved in building capacity in developing countries to collect data on disability, for example by training government statisticians on disability measurement methodology. In addition, it has produced a series of papers that:

■ describe its work for disabled peoples’
organizations (14);

■ can assist national statistical offices (15);
■ show how disability is interpreted using the

short set of six questions (16);

■ give examples of how the short set of ques-
tions can be used to monitor the United

Nations Convention on the Rights of Persons with Disabilities (CRPD) (17).

United Nations Economic and Social
Commission for Asia and the Pacific

The UNESCAP has been working to improve
disability measurement and statistics in line
with the Biwako "Millennium Framework
for Action towards an Inclusive, Barrier-Free


282

and Rights-Based Society". They have imple-
mented a joint ESCAP/WHO disability project
(2004-06) - based on the ICF - to improve the
availability, quality, comparability, and policy
relevance of disability statistics in the region.

An ongoing project entitled - Improvement
of Disability Measurement and Statistics in
Support of the Biwako Millennium Framework
and Regional Census Programme - funded
by the United Nations Development Account
builds on the momentum generated by the
earlier project. The project - implemented by
the UNESCAP’s Statistics Division in close
collaboration with internal and external part-
ners including the United Nations Statistics
Division, the Washington Group, World Health
Organization (WHO), and selected national
statistical offices in the region (18) - is designed
to be linked to other global initiatives involving
disability data collection through population
censuses and surveys such as the Washington
Group. The project combines several compo-
nents including:

■ country pilot tests of standard question sets;
■ targeted training of statistical experts and

health professionals;

■ country advisory services;

■ development of knowledge management
tools and the establishment of a regional

network of national disability statistics experts working within governments, to facilitate cross-country cooperation.

The Pan American Health Organization

In Latin America and the Caribbean, PAHO
has established a strategic initiative to improve
and standardize disability data through the
application of the ICF. The initiative takes the
form of a network of governmental and non-
governmental organizations involved in the
collection and use of disability data. It serves
two broad purposes. At country level, the focus
is on building capacity and providing technical
assistance for disability information systems.
At the regional level, the initiative promotes




Technical appendix B



the sharing of knowledge and best practice and the development of standard measurement and operational guidelines (19).

The European Statistical System

Over the past decade, ESS has undertaken
a project in the European Union to achieve
comparable statistics on health and disability
through surveys (20). As a result, a consist-
ent framework of household and individual
surveys measuring health and disability is
now being implemented within the European
Union. Common questions on disability have
been integrated into the various European-wide
surveys. Several general questions, for instance,
have been included on activity restrictions in
the European Union-Statistics on Income and
Living Conditions (EU-SILC) surveys which
replaced the European Community Household
Panel. The EU-SILC includes a "disability"
question on "longstanding limitations in activ-
ities due to a health problem" (known as the
Global Activity Limitation Indicator - GALI -
question) that is used in the calculation of the
Healthy Life Years structural indicator. Special
surveys, such as the European Health Interview
Survey (EHIS), and the European Survey on
Health and Social Integration (ESHSI) - have
also been developed. The EHIS in its first round
(2008-10) included questions on domains of
functioning including seeing, hearing, walk-
ing, self-care, and domestic life. The ESHSI
addresses additional domains of functioning as
well as environmental factors including mobil-
ity, transport, accessibility to buildings, educa-
tion and training, employment, internet use,
social contact and support, leisure pursuits,
economic life, attitudes, and behaviour.

Variables and questions for these different surveys all are linked to the ICF structure.

Each of these surveys also contains the
European Union’s core set of social variables,
which allows for a breakdown by socioeconomic
factors. Importance has been attached to trans-
lating the common questions into the various


languages of the European Union, to testing the
questions and to using a common implementa-
tion schedule and methodology. Results from a
special survey, the European Health Interview
Survey, will gradually become available in the
coming years. The ESHSI is planned for imple-
mentation in 2012.

United Nations Economic Commission for Europe - Budapest Initiative

on Measuring Health Status

In 2004, under the aegis of UNECE, a Joint Steering Group and Task Force on Measuring Health Status was set up with the UNECE, the Statistical Office of the European Union (EUROSTAT) and WHO. The Task Force has been known as the Budapest Initiative since its first meeting in Budapest in 2005 (21).

The main purpose of the Budapest Initiative
was to develop a new common instrument,
based on the ICF, to measure health state suit-
able for inclusion in interview surveys. The
objectives were to obtain basic information
on population health which can also be used
to describe trends in health over time within
a country, across subgroups of the population
and across countries within the framework of
official national statistical systems. Health state
measures functional ability in terms of capacity

- and not other aspects of health such as deter-
minants and risk factors, disease states, use of
health care, and environmental barriers and
facilitators (21, 22). This information is useful
for both the profiling of health of different pop-
ulations, and also for subsequent development
of summary indices of population health such
as those used by the Global Burden of Disease.
The Budapest Initiative questions cover vision,
hearing, walking and mobility, cognition,
affect (anxiety and depression), and pain - and
use different response categories relevant to the
particular domain (23).

The Budapest initiative also works to coor-
dinate with existing groups and build on exist-
ing work carried out by the ESS, the World


283

World report on disability



Health Survey, the joint United States of America and Canada survey and the Washington Group. For example, the Washington Group and the Budapest Initiative - with support

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Papers Series M, No. 67/Rev.2) (http://unstats.un.org/unsd/demographic/sources/census/docs/P&R_Rev2.pdf).

13. Washington Group on Disability Statistics. In: Statistical Commission forty-first session, 23-26 February 2010. New York,

United Nations Economic and Social Council, 2010 (E/CN.3/2010/20) (http://unstats.un.org/unsd/statcom/doc10/2010-
20-WashingtonGroup-E.pdf, accessed 29 December 2010).

14. Disability information from censuses. Hyattsville, Washington Group on Disability Statistics, 2008 (http://www.cdc.gov/

nchs/data/washington_group/meeting8/DPO_report.pdf, accessed 9 December 2009).

15. Development of an internationally comparable disability measure for censuses. Hyattsville, Washington Group on Disability

Statistics, 2008 (http://www.cdc.gov/nchs/data/washington_group/meeting8/NSO_report.pdf, accessed 9 December

2009).

16. Understanding and interpreting disability as measured using the WG short set of questions. Hyattsville, Washington Group

on Disability Statistics, 2009 (http://www.cdc.gov/nchs/data/washington_group/meeting8/interpreting_disability.pdf,
accessed 9 December 2009).

17. Monitoring the United Nations (UN) Convention on the Rights of Persons with Disabilities. Hyattsville, Washington Group on

Disability Statistics, 2008 (http://www.cdc.gov/nchs/data/washington_group/meeting8/UN_convention.htm, accessed

9 December 2009).

18. Improvement of disability measurement and statistics in support of Biwako Millennium Framework and Regional Census

Programme. Bangkok, United Nations Economic and Social Commission for Asia and the Pacific, 2010 (http://www.unes-
cap.org/stat/disability/index.asp#recent_activities, accessed 29 December 2010).

19. Vásquez A, Zepeda M. An overview on the state of art of prevalence studies on disability in the Americas using the International

Classification of Functioning, Disability and Health (ICF): conceptual orientations and operational guidelines with regard to the application of the ICF in population studies and projects of intervention. Santiago, Programa Regional de Rehabilitación, Pan American Health Organization, 2008.


284

Technical appendix B


20. EUROSTAT. Your key to European statistics. Luxembourg, European Commission, n.d. (http://epp.eurostat.ec.europa.eu,
accessed 9 December 2009).

21. Health state survey module: Budapest Initiative: mark 1. In: Fifty-fifth plenary session, Conference of European Statisticians,
Geneva, 11-13 June 2007. Geneva, United Nations Economic Commission for Europe, 2007 (ECE/CES/2007/6) (http://www.
unece.org/stats/documents/ece/ces/2007/6.e.pdf, accessed 29 December 2010).

22. Health as a multi-dimensional construct and cross-population comparability. In: Conference of European Statisticians,
Joint UNCE/WHO/Eurostat meeting on the measurement of health status, Budapest, Hungary, 14-16 November 2005. United
Nations Economic Commission for Europe, 2005 (Working Paper No. 1) (http://www.unece.org/stats/documents/ece/ces/
ge.13/2005/wp.1.e.pdf, accessed 29 December 2010).

23. Revised terms of reference of UNECE/WHO/EUROSTAT steering group and task force on measuring health status. In:
Conference of European Statisticians, First Meeting of the 2009/2010 Bureau, Washington, D.C., 15-16 October 2009. Geneva,
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ments/ece/ces/bur/2009/mtg1/11.e.pdf, accessed 29 December 2010).


285

Technical appendix C


Design and implementation of the World Health Survey

The World Health Survey was implemented in 70 countries. The sample
sizes ranged from 700 in Luxembourg to 38 746 in Mexico. The respond-
ents were men and women older than 18 years living in private households.
All samples were drawn from a current national frame using a multistage
cluster design so as to allow each household and individual respondent to
be assigned a known nonzero probability of selection, with the following
exceptions: in China and India, the surveys were carried out in selected
provinces and states; in the Comoros, the Republic of the Congo, and Côte
d’Ivoire, the surveys were restricted to regions where over 80% of the popu-
lation resided; in Mexico, the sample was intended to provide subnational
estimates at the state level. The face-to-face interviews were carried out by
trained interviewers. The individual response rates (calculated as the ratio
of completed interviews among selected respondents in the sample, and
excluding ineligible respondents from the denominator) ranged from 63%
in Israel to 99% in the Philippines.

The health module in the World Health Survey was closely synchronized
with the revision of the International Classification of Functioning, Disability
and Health (ICF). The aim was not to capture individual impairments, but to
provide a cross-sectional snapshot of functioning among the respondents in
the different country surveys that could be aggregated to the population level.
Respondents were not asked about health conditions or about the duration of
their limitation in functioning.

To develop a World Health Survey module for health state description,
an item pool was constructed and the psychometric properties of each ques-
tion documented (1). Qualitative research identified the core constructs in
different countries. The questionnaire was tested extensively before the start
of the main study. The pilot testing was carried out initially in three coun-
tries in United Republic of Tanzania, the Philippines and Colombia and
subsequently used in World Health Organization’s (WHO) MultiCountry
Survey Study in 71 surveys in 61 countries. Of these surveys, 14 were car-
ried out using an extensive face-to-face interview of respondents covering


287

World report on disability



21 domains of health with sample size of more
than 88 000 respondents (1). The World Health
Survey survey instrument was then developed
in several languages and further refined using
cognitive interviews and cultural applicability
tests. Rigorous translation protocols devised
by panels of bilingual experts, focused back-
translations, and in-depth linguistic analy-
ses were used to ensure culturally relevant
questions. Between February and April 2002,
revised modules for health state descrip-
tion were further tested in China, Myanmar,
Pakistan, Sri Lanka, Turkey, and the United
Arab Emirates.

Short and long versions of the survey
instrument were then developed. The survey
instrument asked about difficulties over
the last 30 days in functioning in eight life
domains: mobility, self care, pain and dis-
comfort, cognition, interpersonal activities,
vision, sleep and energy, and affect. For each
domain, two questions of varying difficulty
were asked in the long version of the surveys,
while a single question was asked in the short
version. The questions in the World Health
Survey in the different domains were very
similar or identical to questions that had been
asked in national and international surveys
on health and disability. They spanned the
levels of functioning within a given domain
and focused as far as possible on the intrinsic
capacities of individuals in that domain. In
the case of mobility, for example, respondents
were asked about difficulties with moving
around and difficulties with vigorous activi-
ties. In the case of vision, they were asked
about difficulties with near and distant vision.
The response scale for each item was identical
on a 5 point scale ranging from no difficulty
(a score of 1) to extreme difficulty or cannot
do (a score of 5). The prevalence of difficulties
in functioning was estimated across sex, age,
place of residence and wealth quintiles.


288

Analysis of the World Health Survey, including derivation of threshold for disability


Data from 69 countries were used in the analy-
ses for this Report. Data from Australia were
excluded as the survey was carried out partly as
a drop-and-collect survey and partly as a tele-
phone interview and it was not possible to com-
bine these estimates due to unknown biases.
Data were weighted for 59 of the 69 surveys based
on complete sampling information. Individual
country estimates are presented in Appendix A
excluding those countries that were unweighted:
Austria, Belgium, Denmark, Germany, Greece,
Italy, Netherlands, and the United Kingdom of
Great Britain and Northern Ireland (all short
version surveys) and Guatemala and Slovenia
(both long version surveys) or where the sur-
veys were not nationally representative: China,
the Comoros, the Republic of the Congo, and
Côte d’Ivoire. The survey in India was carried
out in six states, these estimates were weighted
to provide national estimates and the results
have been included in Appendix A. Pooled
prevalence estimates were calculated from
weighted and age-standardized data from 59 of
the 69 countries

While the sample sizes in each country in the survey vary, for the purposes of the pooled estimates the post-stratified weights were used with no specific adjustment to the individual survey sample size. The United Nations population database was used for post-stratification correction of the sample weights and for the sex standardization. For age standardization, the WHO world stand-
ard population was used (2).

Detailed information on the quality metrics
of each survey in terms of representativeness,
response rates, item non-response and person
non-response are available from the World




Technical appendix C


Table C.1. Proportion of respondents reporting different levels of difficulty on 16 World Health
Survey domains of functioning

None Mild Moderate Severe Extreme

Mobility

Moving around 64.8 16.5 11.4 5.9 1.3

Vigorous activity 50.7 16.0 13.3 10.3 9.7

Self-care

Self-care 79.8 10.7 5.9 2.6 1.0

Appearance, grooming 80.4 10.7 6.0 2.2 0.9

Pain

Bodily aches and pains 45.2 26.3 16.8 9.5 2.2

Bodily discomfort 49.2 24.9 16.1 8.0 1.8

Cognition

Concentrating, remembering 61.5 20.0 11.8 5.5 1.3

Learning 65.6 17.3 9.8 4.7 2.5

Interpersonal relationships

Participation in community 76.8 13.1 6.6 2.4 1.2

Dealing with conflicts 74.4 14.4 6.7 3.0 1.5

Vision

Distance vision 75.4 11.6 7.1 4.3 1.6

Near vision 76.3 11.9 7.0 3.8 1.0

Sleep and energy

Falling asleep 60.9 18.9 10.0 6.6 1.6

Feeling rested 57.2 22.1 13.1 6.2 1.4

Affect

Feeling depressed 56.1 22.5 12.9 6.6 2.0

Worry, anxiety 51.2 22.9 14.0 8.3 3.6


Health Survey web site: http://www.who.int/ healthinfo/survey/whsresults/en/index.html

Respondents reporting
different levels of difficulty

Data on 16 items are available from 53 countries, with the remaining 16 countries providing data on eight items. Table C.1 shows the proportion of respondents who responded in each category.

A much larger proportion of respondents
reported severe (10.3%) or extreme (9.7%) dif-
ficulties with vigorous activities than in the
areas of self-care and interpersonal relation-
ships. Once vigorous activities are excluded,


8.4% of respondents reported having extreme
difficulties or being unable to function in at
least one area of functioning. Furthermore,

3.3% of respondents reported extreme dif-
ficulties in functioning in two or more areas
and 1.7% reported extreme difficulties in
functioning in three or more areas. Difficulties
with self-care and interpersonal relation-
ships, which includes participation in com-
munity and dealing with conf licts, were the
least common, while difficulties with mobil-
ity and pain were among the most commonly
reported. Across all domains, difficulties in
functioning were more common in older age
groups and among women.


289
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