Alana Officer

The World report on ageing and health: a policy framework for healthy ageing

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

Socioeconomic Inequality in Disability Among Adults: A Multicountry Study Using the World Health Survey

OBJECTIVESnWe compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups.nnnMETHODSnData on 218,737 respondents participating in the World Health Survey 2002-2004 were analyzed. A composite disability score (0-100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality.nnnRESULTSnMedian age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries.nnnCONCLUSIONSnIntegrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.

Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey

IntroductionWomen represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women.MethodsWorld Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics.ResultsPrevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants.ConclusionsThere is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.

Counting disability: global and national estimation

Purpose: How many people with disabilities are in the world? How is disability defined? How can we measure disability in an accurate and comparable way? These are some of the key questions which the recently published World Bank/WHO World Report on Disability (WRD) addresses. Method: Multiple data sources and methods were used by WHO and the World Bank to estimate a global figure, with the ICF as the underlying data standard. Key international data sources were the World Health Survey of 2002–2004 and the 2004 updates from the Global Burden of Disease study. The World Report on Disability also includes a compilation of country-reported prevalence from census and surveys. This paper presents and discusses key findings of the Irish National Disability Survey (2006) to illustrate the value of the ICF framework for disability statistics and most especially the environmental factors component. Results: The World Report estimates that globally one billion people or 15% of the world’s population experience disabilities. Between 110–190 million people (2% of the world’s population) experience severe or extreme difficulties in functioning. Definitions and measures of disability vary widely across countries. The Irish Disability Survey shows the substantial impact of environmental factors on people’s functioning. For example, attitudes, and the presence or absence of facilitating equipment, support services, flexible working arrangements and transport significantly affect participation of people with disabilities in Irish society. Conclusions: To improve the quality of disability information, the World Report recommends the use of a common definition and concepts of disability based on WHO’s International Classification of Functioning Disability and Health (ICF). Furthermore, disability measurement needs to apply a multidimensional approach, in particular, measuring disability in terms of the level of difficulty a person is experiencing in multiple areas of life, rather than head counting severe impairment types in a dichotomous way. Environmental factors have significant effects on individual functioning and should be considered as an integral part in disability measurement. Implications for Rehabilitation Rehabilitation practitioners and researchers can be part of the international work towards an epidemiology of functioning and disability, by using a common language and frame of reference – the ICF – and by gathering and sharing information and statistics as recommended by the World Report on Disability. Better comparability between clinical or case based data and population data will also enable analyses which serve to improve the health of populations globally. Environmental factors – physical, social and attitudinal – must be recorded or measured as part of the context which influences the experience and level of functioning and can offer useful information to guide positive interventions.

The World Report on Ageing and Health

Lead Authors Anthony Woolf, Bone and Joint Research Group, Royal Cornwall Hospital, UK; Chair, Global Alliance for Musculoskeletal Health Lyn March, Institute of Bone and Joint Research, University of Sydney, Australia; Chair, Global Alliance for Musculoskeletal Health Surveillance & Information Task Force; Member, International Coordinating Committee Alana Officer, Senior Health Advisor, Department of Ageing and Life Course, WHO International Core Writing Group Marita J Cross*, Institute of Bone and Joint Research, University of Sydney, Australia. Andrew M Briggs*, School of Physiotherapy & Exercise Science, Curtin University, Australia; Arthritis and Osteoporosis Victoria, Australia. Damian Hoy, Global Alliance for Musculoskeletal Health Surveillance & Information Task Force, Secretariat of the Pacific Community. Lidia Sanchez-Riera, Centre on Aging and Mobility, University of Zürich and City Hospital Waid Zurich, Switzerland. Fiona Blyth, Concord Clinical School, University of Sydney, Australia

ISCoS–WHO collaboration. International Perspectives of Spinal Cord Injury (IPSCI) report

Objective:The objective of this study was to describe the projects, the International Spinal Cord Society (ISCoS) has in cooperation with the World Health Organization (WHO) for the benefit of individuals with spinal cord injury (SCI) worldwide.Setting:InternationalMethods:Collaboration between ISCoS and WHO can be divided into (A) building capacity for better SCI education and prevention programs; (B) improving classification systems for use of data in SCI research, the International Classification of External Cause of Injury (ICECI), the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF); and (C) improving the evidence base for SCI through the report, International Perspectives on Spinal Cord Injury (IPSCI). The objectives of the IPSCI report are first to summarize information on SCI, in particular the science and epidemiology, the services, interventions and policies that are relevant and ‘the lived experience’ of persons with SCI across the full spectrum of life and throughout the world; second, to document all aspects of the science and experience of SCI to identify gaps between what exists and what is required; and third to make recommendations based on this evidence, with a clear perception of feasible goals and targets, that are consistent with the aspirations and goals of inclusion and full participation as expressed in the UN Convention of the Rights of Persons with Disabilities.Future cooperation:ISCoS and WHO will continue to join forces in areas where they can make the greatest difference, especially in prevention and educational issues worldwide.

Valuing Older People: Time for a Global Campaign to Combat Ageism

Today, for the first time in history, most people can expect to live into their sixties and beyond. By 2050, the worlds population aged 60 years and older is expected to double to nearly 2 billion people, 80% of whom will live in low-and middle-income countries. The health of older people is unfortunately not keeping up with increasing longevity. The World report on ageing and health highlights great diversity in health and functioning in older age and marked health inequities in this group. (1) There is little evidence to suggest that people today are experiencing older age in better health than previous generations. (1) Pervasive misconceptions, negative attitudes and assumptions about older people are serious barriers to developing good public policy on ageing and health. Negative attitudes and stereotypes about older adults as frail, out of touch, burdensome or dependent are ubiquitous. A recent analysis carried out by the World Health Organization (WHO) using world values survey data of 83034 adults from 57 countries found low respect for older adults. (2) Sixty percent of participants reported that older adults are not well respected, with respondents from higher income countries being more likely to report so. Stereotyping and discrimination against individuals or groups on the basis of their age is called ageism. (1) Unlike other forms of discrimination, including sexism and racism, ageism is socially acceptable, strongly institutionalised, largely undetected and unchallenged. (3,4) Ageism limits the questions that are asked and the way problems are conceptualized. Recent analysis suggests that ageism influences the development of global health policy and targets. (5) The authors highlight that age limits placed on global goals to prevent and control noncommunicable diseases and the use of premature mortality thresholds, including in the sustainable development goals (SDGs), may be used to discriminate against older adults in the allocation of health resources and data collection. (5) Changing public discourse around population ageing, which largely depicts older people as burdens on public spending and economic growth, can help to capitalise on the great human capacity that older people represent. Although most older people will eventually experience multiple health problems, older age is not the most significant driver of health care costs and does not imply dependence. For example, in a period of unprecedented population ageing in the United States of America (1940-1990) ageing contributed to around 2% of the increase in health expenditures, compared to 51% related to technology innovation in medical practice. (6) Older adults make significant social and economic contributions to their societies. In the United Kingdom of Great Britain and Northern Ireland, the contributions older people made through taxation, consumer spending and other economically valuable activities were worth nearly 40 billion pounds sterling ([dollar]), more than expenditure on them through pensions, welfare and health care combined. …

Socio-demographic patterns of disability among older adult populations of low-income and middle-income countries: results from World Health Survey

ObjectiveOur objective was to quantify disability prevalence among older adults of low- and middle-income countries, and measure socio-demographic distribution of disability.MethodsWorld Health Survey data included 53,447 adults aged 50 or older from 43 low- and middle-income countries. Disability was a binary classification, based on a composite score derived from self-reported functional difficulties. Socio-demographic variables included sex, age, marital status, area of residence, education level, and household economic status. A multivariate Poisson regression model with robust variance was used to assess associations between disability and socio-demographic variables.ResultsOverall, 33.3xa0% (95xa0% CI 32.2–34.4xa0%) of older adults reported disability. Disability was 1.5 times more common in females, and was positively associated with increasing age. Divorced/separated/widowed respondents reported higher disability rates in all but one study country, and education and wealth levels were inversely associated with disability rates. Urban residence tended to be advantageous over rural. Country-level datasets showed disparate patterns.ConclusionsEffective approaches aimed at disability prevention and improved disability management are warranted, including the inclusion of equity considerations in monitoring and evaluation activities.

Rehabilitation of the injured child

Several recent surveys have highlighted the significant risks of disability experienced by injured children.1 While the distinction is inadequately captured in most databases, disability results from the interaction between the injured child and their environment, and encompasses impairments in body functions and structures as well as limitations in activities and participation.2 The major impact on the lives of injured children is typically compounded by the adverse psychosocial and financial consequences for their families.3 The “injury poverty trap” is an inevitable outcome for many low-income households.1 n nRehabilitation is a process designed to assist the injured child, who is experiencing or likely to experience disability, to achieve and maintain optimal functioning in interaction with their environment. By addressing evolving needs and building on the strengths and resources of the child and their family, early initiation of rehabilitation can reduce acute health care costs and prevent disability.2 In addition to the goals of trauma rehabilitation programmes in general (e.g. facilitating recovery of pre-injury health), child-oriented programmes must also actively consider: the physical and psychosocial developmental needs of children, increasing levels of autonomy with regard to care and decision-making as they transition through adolescence; as well as their relationships with families, peers, schools and vocational settings. n nFor many injured children living with disabilities, assistive devices (e.g. crutches, wheelchairs, prostheses and computer aids) can play a vital role enabling mobility, education and social engagement.4 Adequate provision of assistive devices usually requires trained professionals such as prosthetic and orthotic technicians, occupational therapists and physical therapists. However, a wheelchair cannot facilitate access to an inaccessible school. Changes are also required in the child’s environment if they are to use technologies effectively (e.g. availability of ramps and accessible toilets). n nThe 2008 Convention on the Rights of Persons with Disabilities is the first legally binding treaty that reaffirms that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms.5 The Convention underscores the need for interdisciplinary collaborative efforts at local, national and global levels to enhance the quality of life of children with disabilities, promote their rights and protect their dignity. n nIt is estimated, however, that only 3% of individuals who need rehabilitation, globally, receive any kind of support,6 the reasons for this include inadequate primary care, a lack of trained personnel, prohibitive costs, limited availability of transport and difficulties in accessing health-related rehabilitation. A study undertaken in Ghana, India, Mexico and Viet Nam found that human resources for rehabilitation were less-developed than for acute care, with specialized services such as speech pathology virtually absent while physiotherapy services were more likely to be available.7 Donated or mass-produced assistive devices can pose particular difficulties as they are often not child-sized, customized or provided with appropriate support services. n nRehabilitation services for children may be funded through a variety of sources including government budgets, health and social insurance, external funding, private sources, including nongovernmental arrangements, and out-of-pocket payments. Of the 114 countries providing data to the global survey on government action in 2005,8 only 73 countries (64%) allocated budgets for rehabilitation services. In 66 (58%) of countries surveyed, no government funding was allocated to make the physical environment accessible to persons with disabilities, and 43 countries (38%) provided no support for children with disabilities with regard to assistive devices and support services. In a representative national survey in India, two-thirds of recipients of assistive devices paid for their devices themselves.9 Third payer and insurance schemes in high-income countries can also influence the type, amount and extent of rehabilitation services for injured children.3 n nIn the context of these constraints and unmet needs, some promising strategies designed to maximize the availability and outreach of rehabilitation services have emerged. These include more flexible and community-based services (e.g. home and school-based programmes), and training of primary health care workers, family members or community rehabilitation workers in core elements of rehabilitation. Community-based rehabilitation aims to utilize resources available in the prevailing social context while motivating communities to work with persons with disabilities to identify and remove barriers to participation and inclusion.10 Rehabilitation professionals in several south east European countries are collaborating with associations of persons with disabilities to develop alternative rehabilitation services based on holistic and individualized approaches.11 n nWHO is currently implementing its Disability and rehabilitation action plan 2006–2011, which provides the impetus to bring about change in key areas including strengthening community-based and medical rehabilitation (and access to it), improving data collection and supporting policy development in accordance with the principles of the Convention on the Rights of Persons with Disabilities.12 While much remains to be learned about the effectiveness of these approaches, they signal the potential to actualize the full and meaningful participation of young people who experience disability following an injury. ■

Stakeholders’ perceptions of rehabilitation services for individuals living with disability: a survey study

BackgroundThe World Health Organization (WHO) was tasked with developing health system guidelines for the implementation of rehabilitation services. Stakeholders’ perceptions are an essential factor to take into account in the guideline development process.The aim of this study was to assess stakeholders’ perceived feasibility and acceptability of eighteen rehabilitation services and the values they attach to ten rehabilitation outcomes.MethodsWe disseminated an online self-administered questionnaire through a number of international and regional organizations from the different WHO regions. Eligible individuals included persons with disability, caregivers of persons with disability, health professionals, administrators and policy makers. The answer options consisted of a 9-point Likert scale.ResultsTwo hundred fifty three stakeholders participated. The majority of participants were health professional (64 %). In terms of outcomes, ‘Increasing access’ and ‘Optimizing utilization’ were the top service outcomes rated as critical (i.e., 7, 8 or 9 on the Likert scale) by >70 % of respondents. ‘Fewer hospital admissions’, ‘Decreased burden of care’ and ‘Increasing longevity’ were the services rated as least critical (57 %, 63 % and 58 % respectively).In terms of services, ‘Community based rehabilitation’ and ‘Home based rehabilitation’ were found to be both definitely feasible and acceptable (75 % and 74 % respectively). ‘Integrated and decentralized rehabilitation services’ was found to be less feasible than acceptable according to stakeholders (61 % and 71 % respectively). As for ‘Task shifting’, most stakeholders did not appear to find task shifting as either definitely feasible or definitely acceptable (63 % and 64 % respectively).ConclusionThe majority of stakeholder’s perceived ‘Increasing access’ and ‘Optimizing utilization’ as most critical amongst rehabilitation outcomes. The feasibility of the ‘Integrated and decentralized rehabilitation services’ was perceived to be less than their acceptability. The majority of stakeholders found ‘Task shifting’ as neither feasible nor acceptable.