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WHO World Report on Disability: A review
Disability and Health Journal 4 (2011) 141e142 www.disabilityandhealthjnl.com
Review Article
WHO World Report on Disability: A review Gloria L. Krahn, Ph.D., M.P.H. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Abstract The World Health Organization in collaboration with the World Bank developed the World Report on Disability to inform governments of countries about the importance of disability, analyze scientific information, and provide recommendations for action at the national and international levels. The report is remarkably readable, comprehensive, and concise. There are recurrent themes of the connection between disability and poverty, and within disability groups, the relatively greater vulnerability of women, children, and persons with mental health disabilities. Chapter content includes an overview of disability, global view addressing measurement and prevalence, general health care, rehabilitation, assistance and supports, enabling environments, education, work and employment, and recommendations for moving forward. The report successfully illustrates a great need for improved data, policies, and programs, while describing promising practices that can inform policy makers in addressing these needs. This report is highly recommended reading for anyone interested in a global view on disability and should be required reading for any students in disability and public health. Published by Elsevier Inc. Keywords: Disability; WHO; World; ICF
The much-anticipated World Report on Disability was released by the World Health Organization in June 2011 [1], and it is comprehensive, current, and highly informative. It was developed at the request of the World Health Assembly in collaboration with the World Bank to provide ‘‘a comprehensive description of the importance of disability,’’ and analysis of ‘‘best available scientific information,’’ and ‘‘recommendations for action at national and international levels.‘‘ Based on the International Classification of Functioning, Disability and Health (ICF) framework and grounded in the values of the Convention of the Rights of Persons with Disabilities, it was guided in every stage of its development by people with disabilities. Expectations were high, and the editorial and advisory committees along with the more than 370 contributors to this report can celebrate a document that successfully meets these expectations. Given the enormity of its scopeda report on the global status of disability based on best science availabledthe report is remarkably readable, comprehensive, and concise. There are recurrent themes of the connection between disability and poverty and, within disability groups, the relatively greater vulnerability of women, children, and Financial disclosure: The author has no conflicts of interest and no financial interests in this work. Corresponding author: 1600 Clifton Road NE, MS E88. E-mail address: [email protected] (G.L. Krahn) 1936-6574/$ - see front matter Published by Elsevier Inc. doi:10.1016/j.dhjo.2011.05.001
persons with mental health disabilities. The benefit of strong editing is evident in its clear writing style, common voice, and terminology, with consistent use of scenarios, examples, and text-boxes across chapters. Each chapter’s reference list reads like a Who’s Who in disability research, yet the science is synthesized into understandable findings. The authors make extensive use of tables in a format that allows comparisons between low-income and high-income countries, between women and men, and across age categories. The 5 technical appendices are a valuable resource in providing more detailed information. Some readers may see the report as glossing over differences in an effort to provide summary statements but there is generally good balance between synthesis and specificity of information. It appears this was an effort of distilling complexity into a form that approaches simplicity. The report is organized into 9 chapters that begin with an overview of disability, followed by 7 chapters that address different primary life areas, concluding with a chapter on recommendations for moving forward. Chapter 1, ‘‘Understanding Disability,’’ deftly introduces complex and contested topics on how disability is regarded, and it does so with such clarity and grounding in the ICF that the uninformed reader would not suspect the history of vigorous debate that surrounds these concepts. This chapter also introduces themes of disability’s relation to poverty, the importance of the environment, the diversity of disability, disability as a human rights issue, and
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G.L. Krahn / Disability and Health Journal 4 (2011) 141e142
community-based rehabilitationdthemes that are echoed throughout. The second chapter, ‘‘DisabilitydA Global Picture,’’ largely addresses measurement and prevalence of disability in countries around the world. It summarizes data that are drawn primarily from two major surveys, the World Health Surveyd2001-2004 and the WHO Global Burden of Disease Studyd2004 update. This chapter moves through the complexity of multiple differences in measurement to provide summary findings about the global magnitude of disability. It provides results of multiple country-specific surveys that lend contextual meaning to the global findings. The chapter ‘‘General Health Care’’ summarizes a wealth of information regarding understanding increased risk for poor health (secondary and comorbid conditions, agerelated conditions, health risk behaviors, violence, injury), unmet needs (including services for health promotion, sexual, oral, and mental health), barriers to care (policy, financing, distribution, attitudes and communication), strategies for improving care, and recommendations. The sheer volume of information presented on general health care will make this chapter an important resource. Less resourceabundant is the chapter ‘‘Rehabilitation,’’ which relates the shortcomings of inadequate data, measures, and policies. It does, however, make a clear case for increased attention to developing rehabilitation capacity across countries, expanding and decentralizing services within countries, and expanding the evidence-base and implementation of care. ‘‘Assistance and Support’’ communicates the critical importance of planning and financing for communitybased, person-centric services in order to support participation for persons with disabilities. A succinct overview of a rich literature on definitions, needs, and barriers across multiple countries is followed by a useful framework for commissioning effective support services that has been informed by ongoing research. The chapter ‘‘Enabling Environments’’ provides a brief overview on physical accessibility and transportation with useful examples from developing countries. It then dedicates about half its length to accessibility of information communication technology (ICT). While this enthusiastic focus on ICT addresses an important and emerging environment, the result is that the chapter largely neglects other important environmental topics such as societal attitudes, emergency preparedness, and aspects of environments demonstrated to promote health and participation.
The ‘‘Education’’ chapter begins with the premise that education contributes to human capital formation, and that exclusion of children with disabilities carries high social and economic costs. It then provides clear and compelling data demonstrating deficits related to attendance and academic achievement for children with varying disabilities. The discussion on inclusive education illustrates an instance where science and values are not in alignment, and the report would have benefited from having a brief acknowledgement of that divergence. But overall, this is a richly informative chapter that maintains focus while summarizing a wealth of information across many countries and contexts. ‘‘Work and Employment’’ begins with the clear message that work and employment rates for persons with disabilities are too low and need to be raised. It provides a brief overview of labor markets, describing strategies and illustrations of how to address barriers. These strategies include laws and regulations, tailored interventions, vocational rehabilitation, self-employment, social protections, and attitudes. The chapter tackles the complex topic of disability benefit systems and the experiences of different countries in reducing disincentives to work while still providing adequate safety-net protections. The concluding chapter summarizes the current status of disability in the world and provides nine categories of recommendations from across the multiple life domains: enable access to mainstream policies, systems and services; invest in specific programs and services for people with disabilities; adopt a national disability strategy and plan of action; involve people with disabilities; improve human resource capacity; provide adequate funding and improve affordability; increase public awareness and understanding; improve disability data; strengthen and support research on disability . The report successfully illustrates a great need for improved data, policies and programs, while describing promising practices that can inform policy makers in addressing these needs. Globally harnessing the political will to implement these recommendations is the immediate challenge facing us. We can only hope that a similarly named report a decade hence will document real improvement in the lives of people with disabilities in countries around the world. Reference [1] World report on disability, 2011. World Health Organization. Available at: www.who.int. Accessed June 2011.
Review Article
WHO World Report on Disability: A review Gloria L. Krahn, Ph.D., M.P.H. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Abstract The World Health Organization in collaboration with the World Bank developed the World Report on Disability to inform governments of countries about the importance of disability, analyze scientific information, and provide recommendations for action at the national and international levels. The report is remarkably readable, comprehensive, and concise. There are recurrent themes of the connection between disability and poverty, and within disability groups, the relatively greater vulnerability of women, children, and persons with mental health disabilities. Chapter content includes an overview of disability, global view addressing measurement and prevalence, general health care, rehabilitation, assistance and supports, enabling environments, education, work and employment, and recommendations for moving forward. The report successfully illustrates a great need for improved data, policies, and programs, while describing promising practices that can inform policy makers in addressing these needs. This report is highly recommended reading for anyone interested in a global view on disability and should be required reading for any students in disability and public health. Published by Elsevier Inc. Keywords: Disability; WHO; World; ICF
The much-anticipated World Report on Disability was released by the World Health Organization in June 2011 [1], and it is comprehensive, current, and highly informative. It was developed at the request of the World Health Assembly in collaboration with the World Bank to provide ‘‘a comprehensive description of the importance of disability,’’ and analysis of ‘‘best available scientific information,’’ and ‘‘recommendations for action at national and international levels.‘‘ Based on the International Classification of Functioning, Disability and Health (ICF) framework and grounded in the values of the Convention of the Rights of Persons with Disabilities, it was guided in every stage of its development by people with disabilities. Expectations were high, and the editorial and advisory committees along with the more than 370 contributors to this report can celebrate a document that successfully meets these expectations. Given the enormity of its scopeda report on the global status of disability based on best science availabledthe report is remarkably readable, comprehensive, and concise. There are recurrent themes of the connection between disability and poverty and, within disability groups, the relatively greater vulnerability of women, children, and Financial disclosure: The author has no conflicts of interest and no financial interests in this work. Corresponding author: 1600 Clifton Road NE, MS E88. E-mail address: [email protected] (G.L. Krahn) 1936-6574/$ - see front matter Published by Elsevier Inc. doi:10.1016/j.dhjo.2011.05.001
persons with mental health disabilities. The benefit of strong editing is evident in its clear writing style, common voice, and terminology, with consistent use of scenarios, examples, and text-boxes across chapters. Each chapter’s reference list reads like a Who’s Who in disability research, yet the science is synthesized into understandable findings. The authors make extensive use of tables in a format that allows comparisons between low-income and high-income countries, between women and men, and across age categories. The 5 technical appendices are a valuable resource in providing more detailed information. Some readers may see the report as glossing over differences in an effort to provide summary statements but there is generally good balance between synthesis and specificity of information. It appears this was an effort of distilling complexity into a form that approaches simplicity. The report is organized into 9 chapters that begin with an overview of disability, followed by 7 chapters that address different primary life areas, concluding with a chapter on recommendations for moving forward. Chapter 1, ‘‘Understanding Disability,’’ deftly introduces complex and contested topics on how disability is regarded, and it does so with such clarity and grounding in the ICF that the uninformed reader would not suspect the history of vigorous debate that surrounds these concepts. This chapter also introduces themes of disability’s relation to poverty, the importance of the environment, the diversity of disability, disability as a human rights issue, and
142
G.L. Krahn / Disability and Health Journal 4 (2011) 141e142
community-based rehabilitationdthemes that are echoed throughout. The second chapter, ‘‘DisabilitydA Global Picture,’’ largely addresses measurement and prevalence of disability in countries around the world. It summarizes data that are drawn primarily from two major surveys, the World Health Surveyd2001-2004 and the WHO Global Burden of Disease Studyd2004 update. This chapter moves through the complexity of multiple differences in measurement to provide summary findings about the global magnitude of disability. It provides results of multiple country-specific surveys that lend contextual meaning to the global findings. The chapter ‘‘General Health Care’’ summarizes a wealth of information regarding understanding increased risk for poor health (secondary and comorbid conditions, agerelated conditions, health risk behaviors, violence, injury), unmet needs (including services for health promotion, sexual, oral, and mental health), barriers to care (policy, financing, distribution, attitudes and communication), strategies for improving care, and recommendations. The sheer volume of information presented on general health care will make this chapter an important resource. Less resourceabundant is the chapter ‘‘Rehabilitation,’’ which relates the shortcomings of inadequate data, measures, and policies. It does, however, make a clear case for increased attention to developing rehabilitation capacity across countries, expanding and decentralizing services within countries, and expanding the evidence-base and implementation of care. ‘‘Assistance and Support’’ communicates the critical importance of planning and financing for communitybased, person-centric services in order to support participation for persons with disabilities. A succinct overview of a rich literature on definitions, needs, and barriers across multiple countries is followed by a useful framework for commissioning effective support services that has been informed by ongoing research. The chapter ‘‘Enabling Environments’’ provides a brief overview on physical accessibility and transportation with useful examples from developing countries. It then dedicates about half its length to accessibility of information communication technology (ICT). While this enthusiastic focus on ICT addresses an important and emerging environment, the result is that the chapter largely neglects other important environmental topics such as societal attitudes, emergency preparedness, and aspects of environments demonstrated to promote health and participation.
The ‘‘Education’’ chapter begins with the premise that education contributes to human capital formation, and that exclusion of children with disabilities carries high social and economic costs. It then provides clear and compelling data demonstrating deficits related to attendance and academic achievement for children with varying disabilities. The discussion on inclusive education illustrates an instance where science and values are not in alignment, and the report would have benefited from having a brief acknowledgement of that divergence. But overall, this is a richly informative chapter that maintains focus while summarizing a wealth of information across many countries and contexts. ‘‘Work and Employment’’ begins with the clear message that work and employment rates for persons with disabilities are too low and need to be raised. It provides a brief overview of labor markets, describing strategies and illustrations of how to address barriers. These strategies include laws and regulations, tailored interventions, vocational rehabilitation, self-employment, social protections, and attitudes. The chapter tackles the complex topic of disability benefit systems and the experiences of different countries in reducing disincentives to work while still providing adequate safety-net protections. The concluding chapter summarizes the current status of disability in the world and provides nine categories of recommendations from across the multiple life domains: enable access to mainstream policies, systems and services; invest in specific programs and services for people with disabilities; adopt a national disability strategy and plan of action; involve people with disabilities; improve human resource capacity; provide adequate funding and improve affordability; increase public awareness and understanding; improve disability data; strengthen and support research on disability . The report successfully illustrates a great need for improved data, policies and programs, while describing promising practices that can inform policy makers in addressing these needs. Globally harnessing the political will to implement these recommendations is the immediate challenge facing us. We can only hope that a similarly named report a decade hence will document real improvement in the lives of people with disabilities in countries around the world. Reference [1] World report on disability, 2011. World Health Organization. Available at: www.who.int. Accessed June 2011.