1. High Level Conference European Parliament Brussels Tuesday, 16 th September 2008 EU MHADIE Project Health and Disability Policy Recommendations Somnath Chatterji World Health Organization

2. Outline What is the problem? What did MHADIE do? Where do we go from here?

3. Definition of the problem Lack of a consistent conceptual framework Lack of comparable data Lack of flexibility in data collection Lack of adequate information on determinants of disability

4. MHADIE Objectives Demonstrate utility of ICF model in improving comparability of disability data Develop survey questions for emerging disabilities Examine determinants, e.g., economic status, education, etc.

5. Disability levels

6. Disability by disorder severity

7. Conclusions – levels of disability Feasible appropriate thresholds may be set –sensitivity analyses may be carried out

8. DALYs 2030 – change in ranks compared to 2002

9. DALYs 2030

10. Disability correlates – age Individuals over the age of 65 three times more likely to be disabled Rate of decline with age less in European countries

11. Disability correlates – sex Females more severe problems with functioning Women 1.5 times more likely to be disabled than men Women live longer- implications

12. Disability correlates – education Lack of education associated with worse functioning Compared to those with 10 years of education, the illiterate population is 5 times more likely to be disabled Even a few years of education (primary or secondary school) significantly reduces the likelihood of being disabled

13. Disability correlates – socioeconomic status Individuals in the lowest income quintiles show the worst functioning Poor functioning could result from –living conditions –access to health care services –knowledge and access to preventive interventions

14. Disability correlates – work Those who are working are 3 times less likely to be disabled as compared to those who are unemployed Need for longitudinal data –causes for leaving the work force, –patterns of disability that limit work capacity –barriers in environment that prevent continued participation in the work force

15. Recommendation 1 Data about functioning levels in multiple life areas is essential Small set of impairment questions produce implausible disability prevalence estimates MHADIE results demonstrate feasibility of this approach Produces more comparable results

16. Recommendation 2 Health and Disability surveys should be combined that incorporate a measure of the environment Levels of functioning can be measured as a continuous distribution Independent measurement of the environment allows appropriate targetting of interventions

17. Recommendation 3 Disability data collection efforts should focus on performance as well as individual capacity rather than on a set of a priori diagnostic categories Chronic conditions may be as disabling as 'traditional' disabilities The 'capacity – performance gap' helps identify effective interventions Likely to be a better measure of need

18. Recommendation 4 Future Health and Disability surveys must include an older population Ageing is the major driver of disability trends Older adults have worse functioning Data on the future health of an ageing population will be critical for planning across health and other sectors

19. Recommendation 5 Disparate Health and Disability data collection efforts must be mapped to a common framework ICF survey mapping software has demonstrated feasibility and utility Items and questions in surveys should be mapped onto concepts for post-hoc comparisons