This document discusses disability indicators and measures. It begins by defining key terms like impairment, disability, and handicap. It then discusses various ways to measure and categorize disability prevalence and burden, including: - Disability-Adjusted Life Years (DALYs), which combines years of life lost to premature death and years lived with disability. - Potential Years of Life Lost (PYLL), which measures impact of premature mortality. - The International Classification of Functioning, Disability and Health (ICF) model, which classifies functioning based on body functions, activities, and participation. - Activity Limitation Scores (ALS) and Participation Restriction Scores (PRS), which measure

1. DISABILITY & ITS INDICATORS
Dr SANTOSH KUMAR A
Dept of Community Medicine
J S S M C
Mysore
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2. OVERVIEW
• INTRODUCTION
• DISABILITY CATEGORIES
• PROBLEM STATEMENT
• NEED FOR DISABILITY INDICATORS
• DISABILITY INDICATORS
• DALY, PYLL, ICF MODEL, ADL, IADL
• HALE, QALY
• LEGISLATIONS FOR DISABLED
• REHABILITATION FOR DISABLED
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3. “DEATH RATES FAILS TO TELL
THE ENTIRE STORY”
Dempsey, 1947
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4. DEFINITIONS….
• IMPAIRMENT –
“Any loss or abnormality of psychological,
physiological or anatomical structure or
function”
Eg: loss of foot, defective vision
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5. • DISABILITY
Given by WHO International Classification of
Impairments, Disabilities & Handicaps [ICIDH]
• “Any restriction or lack of ability to perform
an activity in the manner or within range
considered normal for a human being”
• A disability may be temporary or
permanent, reversible or irreversible, &
progressive or regressive
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6. • HANDICAP –
• “A disadvantage for a given individual,
resulting from impairment or a disability,
that limits or prevents the fulfillment of a
role that is normal (depending on age, sex &
social & cultural factors) for that individual”
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7. Main Disability Categories [ICIDH-1980]
• Behavioral disabilities: Awareness, Relations
• Communication disabilities: speaking, Listening, Seeing
• Personal care disabilities: Excretion, personal hygiene,
dressing
• Locomotor disabilities: Ambulatory, Confining
• Body disposition: Domestic, Body movement
• Dexterity disabilities: Daily activity, Manual activity
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8. • Situational dependence: Dependence & endurance,
Environment
• Particular skill disabilities
• Other activity restrictions
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9. PROBLEM STATEMENT
• GLOBAL BURDEN
• Roughly 10-12 percent of the world’s population has a
disability and they are among the poorest of the poor
• 18.6 million (2.9%) were severely disabled & another
79.7 million (12.4%) had moderate long term disability
• Average global prevalence moderate & severe disability
ranges from 5% in children aged 0-14 years, 15% in
adults aged 15-59 and 42% in adults aged 60 years &
older
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10. • Recent estimates 600 million people live with disabilities
of various types due to chronic diseases, injuries,
violence, infectious diseases, malnutrition
• All types of disability are more in low & middle income
countries
• The global average burden of disease across all regions in
2004 was 237 DALYs per 1000 population,
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11. • The most common causes of disability globally are adult-
onset hearing loss and refractive errors.
• Mental disorders such as depression , alcohol use
disorders and psychoses are among the top 20 leading
causes of disability
• Disability due to unintentional injuries, among the
younger population, and cataracts, among the older
population, are far more common.
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14. • “Severe” disability, defined as severity classes VI and VII (the
equivalent of having blindness, Down syndrome, quadriplegia,
severe depression or active psychosis)
• “Moderate and severe” disability, defined as severity classes
III and greater (the equivalent of having angina, arthritis, low
vision or alcohol dependence).
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15. • 500 million healthy life years are lost each year due to
disability associated with health conditions
IN INDIA
• Study conducted from July to Dec 2002, 18.49(1.8%)
million people were disabled
• 11% disabled persons suffered from more than one type
of disability
• Locomotor disability is the commonest, followed by visual
disability & hearing disability
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16. What is an INDICATOR….?
• They are variables which help to measure changes.
• Characteristic of a good indicator
• It should be valid
• Should be reliable
• Should be sensitive
• Should be specific
• Should be feasible
• Should be relevant
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17. Uses of a indicator
• Measure health status of a community
• Compare health status of one country with that of another
• For assessment of health care needs
• Allocation of scarce resources
• Monitoring & evaluation of health services
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18. Need for disability statistics & indicators
• Disability statistics can play a pivotal role in all areas of
policy-making
• For the protection and promotion of the rights and the
dignity of persons with disabilities
• Information about functional status is integral to identify
needs
• Broader social needs of persons with disabilities, such as
provision of assistive technology for use in employment
or education or broader policy and laws.
• For monitoring the quality and outcomes of policies for
persons with disabilities. 18

19. Purpose of disability statistics &
indicators
• To assist in the development and evaluation of
programmes and policies for service provision
• To monitor the level of functioning in the population
• To assess equalization of opportunities.
• Early detection, early intervention and education
• Training and employment, including self-employment
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20. • Poverty alleviation through capacity-building, social
security and sustainable livelihood programmes
• Including people with disabilities in economic
development activities, therefore, is key to achieving the
UN Millennium Development Goals
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21. DISABILITY RATES
• Based on notion that health implies full range of daily
activities
• Commonly used disability rates
• Event type indicators –
a. Number of days of restricted activity
b. bed disability days
c. Work loss days/school loss days within a
specified period
Person type indicators –
a. Limitation of mobility
b. Limitation of activity
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22. DISABILITY ADJUSTED LIFE YEARS (DALY)
• Created by WHO, World bank & Harvard university
• Measure of burden of disease & effectiveness of
interventions in a defined population
• It express years of life lost to premature death & years
lived with disability adjusted for the severity of the
disability
• It is equal to the sum of the number of years of life lost in
a population (YLL) and the number of years lived with
disability of known severity
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23. • YLL (years of life lost):
Losses from premature death, defined as difference
between the actual age at death & life expectancy at that
age in a low mortality population
• YLD(Years lived with disability):
Loss of healthy life years resulting from disability
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DALY = YLL + YLD

24. Disadvantages of DALY
• In estimation of YLL, non consideration of competing
causes may be a concern in case of developing countries
where general mortality is relatively high
• Estimation of YLD requires estimation of incidence,
duration & disability weights & this requires extensive
resources.
• DALYs do not reflect the change in people’s functional
status or well-being if they receive rehabilitation services,
assistive devices.
• DALYs only reflect the presence of a medical condition
that is associated with certain functional limitations

25. TO MEASURE DALY….
It requires two things
• Life table of that country, to measure days lost from
premature death
• Loss of healthy life years resulting from disability &
disease
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26. USES OF DALY
• To assist in setting health services priorities
• Targeting health interventions
• Measuring results of health interventions
• Compare health status of different countries
• To identify the disadvantaged group
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27. • The three leading causes of DALYs in 2030 are projected
to be unipolar depressive disorders, ischaemic heart
disease and road traffic accidents.
• global average burden of disease across all regions in
2004 was 237 DALYs per 1000 population, 60% was due
to premature death
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28. • World wide, 1.49 billion DALYs were lost in 2002,
• 36% of total loss were as a result of disease & injury in
children less than 15 years & 50% in adults 15-59 years
Potential Years of Life Lost (PYLL):
• It is a measure of the impact of premature mortality on
the population.
• PYLL is the sum of the years that people dying would
have lived, had they experienced a normal life
expectancy, usually determined at 65 years.
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29. The ICF and the Social Model of Disability
• Disability arises out of the interaction between functional
limitations and an unaccommodating environment
• People are not identified as having a disability based
upon a medical condition, as in DALYS,
• Classified according to a detailed description of their
functioning within various domains:
Body Function and Structure
Activities
Participation.
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30. Body structure and function
• Most closely related to the medical model as it refers to
the physiological and psychological functions of body
systems.
• Body structures are defined by the ICF as “anatomic parts of
the body such as organs, limbs and their components.”
Activity
• Activities pertain to a wide range of deliberate actions
performed by an individual, such as walking or climbing
stairs.
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31. • Participation
• Refers to activities that are integral to economic and
social life and the social roles that accomplish that life
• Ex - being able to attend school or hold a job.
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32. ICF Model
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33. Activity Limitation Score (ALS) and the Participation
Restriction Score (PRS)
• In ALS basic activities are measured without benefit of
assistive devices of any kind
• PRS measures complex activities according to how the
individual performs in their usual environment
• Total of 40 activities of which 18 basic & 22 complex
• Each individual item is scored on a 5 point scale
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38. • The ALS and PRS were scaled from 0 through 100.
• Weights are constructed for each domain so that the
maximum score for each of the 4 ALS domains is 25 and
the maximum score for each of the 5 PRS domains is 20
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39. The advantages of the ALS and PRS score to other
indicators referred to above, are that they:
 Allow for the variability in functional capacity of people
with the same medical diagnoses
 Can measure improvements in functionality that result
from interventions that do not change an underlying
diagnosis
 Separate out activity limitations from participation
restrictions
 Reduce the degree of counting particular activity
limitations more than once
 Weight different domains equally 39

40. Activities of Daily Living (ADL):
• Measures six basic functions (moving between rooms,
using the lavatory, washing and bathing, dressing and
undressing, getting in and out of bed, and feeding
oneself)
• Score of A - independent in every item
• B - dependent in one item
• C - dependent in two items
• D - dependent in three items
• E - dependent in four items
• F - dependent in five items
• G - dependent in all functions
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41. Instrumental Activities of Daily Living (IADL):
• IADL-scale measures more complex functions like
Using the telephone, getting to places beyond walking
distance
grocery shopping, preparing meals, doing housework
or handyman work, doing laundry, taking
medications, managing money
The score ranges from
• 8 - able to perform all functions to
• 0 - cannot perform any function
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42. Functional Independence Measure
 It includes 13 motor & 5 cognitive measures rated on a
seven level scale
 It provides an estimate of the expected reduced
functional capacity
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43. • Sullivans Index
• Expectation of life free of disability
• Obtained by subtracting from the life expectancy the
probable duration of bed disability & inability to perform
major activities
• Its considered as one of the most advanced indicators
currently available
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44. Health adjusted life expectancy (HALE)
• Based on life expectancy at birth & includes an
adjustment for time spent in poor health
• Number of years in full health that a newborn can expect
to live based on current rates of ill health & mortality
Quality adjusted life year (QALY)
• Years of healthy life afforded by different treatments of a
condition
• Adjustments are based on subjective judgements
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45. LEGISLATIONS FOR THE
DISABLED
• Rehabilitation council of India (RCI) Act, 1992
• The persons with Disabilities (Equal opportunities,
Protection of rights & full participation) Act, 1995
• The National trust for welfare of persons with Autism,
Cerebral palsy, Mental retardation & multiple Disabilities
Act, 1999
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46. Rehabilitation council of India (RCI) Act, 1992
• Came into force from 31st july, 1993
• Main objectives
Regulate training policies & programs in the field of
rehabilitation of persons with disabilities
To prescribe minimum standards of education &
training in the field of rehabilitation
To regulate these standards in all training institutions
uniformly through out the country
To maintain central rehabilitation register
To encourage rehabilitation education & research
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47. The persons with Disabilities (Equal opportunities,
Protection of rights & full participation) Act, 1995
• Came into force on Feb 7, 1996
• Provisions of act
• Prevention & early detection of disabilities
• Right to free education till 18 years
• 3% reservation in Govt jobs
• Disabled friendly designed public places & transport
• Research & man power development
• Social security (special insurance schemes for disabled
employees)
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48. WELFARE SCHEMES FOR DISABLED
• Exemptions & assistance:
• Travelling –
• Ministry if railways gives 75% concession on travel
fare
• Indian airlines allows 50% concession fare to blind on
all domestic flights
• Postage exemption-
• Payment of postages for blind literature packets is
exempted
• Telecommunication preference-
• Telephone facility to blind persons on 50% of normal
rental & priority basis
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49. • Conveyance allowance –
• Handicapped government employee to get conveyance
allowance at 5% basic pay
• For disabled children –
• Special schools for children with severe disability
• Scholarships on monthly basis for disabled student for
a maximum period of 6 years after class 12
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50. REHABILITATION
• Defined as
“ The combined & coordinated use of medical,
social, educational & vocational measures for
training & retraining the individual to the highest
possible level of functional ability”
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51. • Types of rehabilitation:
 Medical rehabilitation – restoration of function
 Vocational rehabilitation – restoration of capacity
to earn livelihood
Social rehabilitation – restoration of family &
social relationships
Psychological rehabilitation – restoration of
personal dignity & confidence
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52. Bibliography
• Park text book of Preventive & Social Medicine
• Oxford text book of public health
• Concepts of epidemiology, Raj gopal
• Text book of P& SM, O. P. Ghai
• Text book of P&SM, Sunderlal
• www.who.int/icf
• www.cdc.gov/ncbddd/dh
• www.disabilityresources.org
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THANK YOU…