Daniel Mont

Measuring health and disability

Disability-adjusted life years (DALYs)—a frequent indicator for assessment of the relative eff ects of public-health interventions—explicitly incorporate disability. This Viewpoint will argue, however, that the notion of disability embodied in DALYs does not accord with that in WHO’s International Classifi cation of Functioning, Disability, and Health (ICF). Underlying this inconsistency is the basic issue of what is meant by health and disability. The result is that DALYs are a poor indicator of the eff ect of public-health interventions that improve the lives of people with disabilities. An argument can be made that DALYs are better suited for assessment of the eff ect of programmes and policies aimed at prevention of disabilities, but even in this case their approach to measurement of disability needs to be enhanced. Disability and health are diffi cult concepts to defi ne and measure. In fact, the appropriate defi nition of disability depends on the reason behind its measurement. Thus, when monitoring or assessing public-health interventions, having a clear defi nition of disability is very important. Before the advent of DALYs (and the earlier but related idea of quality-adjusted life years [QALYs]), health-outcome measures typically relied on mortality (an exception was the method of disability-free life expectancy and its complement, the number of years lived with a disability).

The Economic Lives of People with Disabilities in Vietnam

Through a series of focus group discussions conducted in northern and central Vietnam, this study gives voice to the lived economic experience of families with disabilities and how they manage the economic challenges associated with disability. The dynamic of low and unstable income combined with on-going health care and other disability-related costs gives rise to a range of coping mechanisms (borrowing, reducing and foregoing expenditures, drawing upon savings and substituting labour) that helps to maintain living standards in the short-run yet threatens the longer-term welfare of both the individual with disability and their household. Current social protection programs were reported as not accessible to all and while addressing some immediate economic costs of disability, do not successfully meet current needs nor accommodate wider barriers to availing benefits.

Economic impacts of international migration and remittances on household welfare in Vietnam

Purpose - The purpose of this paper is to examine the impact of international remittances on different household welfare indicators including child education, assets, durable goods, and reservation wages of other working age household members. It examines how international remittances are spent for production and consumption by receiving households. Design/methodology/approach - This paper uses fixed-effect regressions to estimate the impact of international remittances on household spending in Vietnam using Vietnam Household Living Standard Surveys 2006 and 2008. Findings - It is found that most of international remittances are spent on housing and land, debt repayment and saving. A small proportion of remittances are used to buy durable goods. Remittances are not spent in production as well as living consumptions. The effect of international remittances on consumption-based poverty is very limited. Originality/value - The findings from this paper suggest that current international remittances are not an effective measure for poverty reduction in the short-run in Vietnam.

Does Parental Disability Matter to Child Education? Evidence from Vietnam

This paper examines the effect of parental disability on school enrollment and educational performance for children in the 2006 Vietnam Household Living Standards Survey. Results from instrumental-variables regressions indicate that children of parents with a disability have a lower enrollment rate in primary and secondary school of about 8 percentage points: 73 percent compared with 81 percent. However, the association of parental disability with educational performance is small and not statistically significant. The conclusion of the paper is that to achieve the Millennium Development Goal of universal primary school as well as increased coverage of secondary education, the government should have policies and programs that either directly support the education of children with disabled parents and/or have policies that support disabled adults, thus lessening the incentive for their children not to attend school.

The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach

Accessing health services at an early age is important to future health and life outcomes. Yet, little is currently known on the role of health insurance in facilitating access to care for children. Exploiting a regression discontinuity design made possible through a policy to provide health insurance to pre-school aged children in Vietnam, this paper evaluates the impact of health insurance on the health care utilization outcomes of children at the eligibility threshold of six years. Using three rounds of the Vietnam Household Living Standards Survey, the study finds a positive impact on inpatient and outpatient visits and no significant impact on expenditures per visit at public facilities. We find moderately high use of private outpatient services and no evidence of a switch from private to covered public facilities under insurance. Results suggest that adopting public health insurance programs for children under age 6 may be an important vehicle to improving service utilization in a low- and middle-income country context. Challenges remain in providing adequate protections from the costs and other barriers to care.

Can Households Cope with Health Shocks in Vietnam

Abstract This paper investigates the economic impact of health shocks on working‐age adults in Vietnam during 2004–2008, using a fixed effects specification. Health shocks cover disability and morbidity and are measured by ‘days unable to carry out regular activity’, ‘days in bed due to illness/injury’, and ‘hospitalization’. Overall, Vietnamese households are able to smooth total non‐health expenditures in the short run in the face of a significant rise in out‐of‐pocket health expenditures. However, this is accomplished through vulnerability‐enhancing mechanisms, especially in rural areas, including increased loans and asset sales and decreased education expenditures. Female‐headed and rural households are found to be the least able to protect consumption. Results highlight the need to extend and deepen social protection and universal health coverage.

Extra costs of living with a disability: A review and agenda for research

BACKGROUNDnThere has been a growing interest in disability and poverty on the international research and policy stages. Poverty assessments for persons with disabilities may be affected by the experience of extra costs associated with a disability.nnnOBJECTIVEnThis article provides a systematized review of the global literature on the direct costs associated with living with a disability at the individual or household level.nnnMETHODSnWe searched three databases for peer-reviewed journal articles that estimated extra costs associated with disability: Econlit, SocIndex and PubMed.nnnRESULTSnWe found 20 such studies conducted in 10 countries. These studies were predominantly from high-income countries. Although studies were heterogeneous (e.g., in terms of disability measures and cost methodologies), estimated costs were sizeable and some patterns were consistent across studies. Costs varied according to the severity of disability, life cycle and household composition. Highest costs were observed among persons with severe disabilities, and among persons with disabilities living alone or in small sized households.nnnCONCLUSIONSnMore quantitative evidence is needed using rigorous methods, for instance evidence based on longitudinal data and as part of policy evaluations. More internationally comparable data on disability is required for the quantitative evidence to develop, especially in low- and middle-income countries where studies are scarce. Qualitative and participatory research is also needed, especially to investigate unmet needs, and the consequences of extra costs.

Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition

The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5-9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10-14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15-19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.

Prevalence of HIV infection among people with disabilities: a population-based observational study in Yaoundé, Cameroon (HandiVIH).

BACKGROUNDnIn resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities.nnnMETHODSnIn this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities.nnnFINDINGSnBetween Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaoundé, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9-5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0-8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6-5·6 for sexual violence and 12·3, 4·4-34·6 for sex work). Analyses were done in men and women.nnnINTERPRETATIONnThe higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population.nnnFUNDINGnAgence nationale de recherches sur le sida et les hépatites virales (ANRS-Inserm) and the 5% Initiative.

HandiVIH—A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations

Introduction In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. Methods and analysis The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaoundé (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents’ life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled peoples organisations is collected separately. Ethics and dissemination This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. Trial registration number NCT02192658.