The Definition of Disability and Statistics Presented by: Andrew J. - - PowerPoint PPT Presentation

The Definition of Disability and Statistics

Presented by: Andrew J. Houtenville, Ph.D. Employment and Disability Institute

Rehabilitation Research and Training Center on Disability Demographics and Statistics

Slide 1

Objective of Today’s Presentation

• Give a flavor of the powerful statistics that can be

generated from national surveys that have disability-related information.

• Highlight the complex of defining disability in the context
• f disability statistics
• Discuss the role the definition of disability plays in

drawing inferences from disability statistics.

• Give a Quiz.

Slide 2

Question 1

• It is not surprising that there is no single definition of

disability among large national surveys and polls. These surveys have different purposes and histories. The population with disabilities is diverse in many ways: types of disabilities, the socio-environment component of disability, and the areas

• f personal and social activities affected by disability. Given

all of this complexity and the normative nature of disability, why is it still important to know the number of people with disabilities? [Hint: What I am thinking of has something to do with money.]

Slide 3

Reporting of a Work Limiting Health Problem or Disability among Persons Ages 25-61

2 4 6 8 10 12 14 16 18

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

(Percentage)

6,000 7,000 8,000 9,000 10,000 11,000 12,000 13,000 14,000 15,000

(Thousands) Percentage Number

Source: Author’s calculations using the Current Population Survey (CPS), 1981-2003.

Slide 4

Reporting of a Work Limiting Health Problem or Disability among Persons Ages 25-61, by State, in 2003

Source: Author’s calculations using the Current Population Survey (CPS), 2003.

2 4 6 8 10 12 14 16 18

NV SD MD NH ND CO NJ VA ID IL MN WI HI TX AZ MO CA UT CT DE FL IA MA NY GA IN OH AK WY NE WA PA DC RI KS NM OK VT MI AR LA NC TN OR ME SC AL MT KY MS WV

(Percentage)

Slide 5

Poverty Rate, by Work Limitation Status (Ages 25-61)

Source: Author’s calculations using the Current Population Survey (CPS), 1981-2003.

4 8 12 16 20 24 28 32

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

(Percentage) Work Limitation No Work Limitation

Slide 6

Receipt of Supplemental Security Income (SSI), by Work Limitation Status (Ages 25-61)

Source: Author’s calculations using the Current Population Survey (CPS), 1981-2003.

4 8 12 16 20 24 28

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

(Percentage) Work Limitation No Work Limitation

Slide 7

Question 2

• OPPS: How many people with disabilities are there in the

United States and what is the definition of disability?

Slide 8

Possible Answer

• 54 million is often cited.

– Corresponds to a prevalence rate of 20.6 percent. – Based on Census Bureau estimates using the 1994 SIPP. – Non-institutionalized, Civilians, the 2000 Census reports about 2 million people living in disability-related institutions. – A “kitchen sink” definition of disability (e.g., one or more ADLs/IADLs; use of a wheelchair, a cane, crutches, or a walker; receipt of federal disability benefits) – Source: http://www.census.gov/prod/3/97pubs/p70-61.pdf

Slide 9

Other Answers

• National Health Interview Survey (NHIS)

– 34 million (or 12 percent of) non-institutionalized civilians of all ages are limited in usual activities due to one or more chronic health conditions in 2002. – Source: www.cdc.gov/nchs/data/series/sr_10/ sr10_220.pdf

• American Community Survey (ACS)

– 41 million (or 13 percent of) non-institutionalized civilians ages 5 and

• lder have a disability in 2002

– Source: www.census.gov/acs/www

• March Current Population Survey (CPS)

– 22 million (or 10 percent of) non-institutionalized civilians ages 16 to 64 reported a work disability in 2002. – Source: www.census.gov/hhes/www/disability.html

Slide 10

Question 3

• What is the best definition of disability

available in Federal surveys? Explain your answer.

– Possible Answer: There is no gold standard. It depends on the reason why you need to define

• disability. You must choose wisely, and

whenever possible, get information in as great a deal and from as many sources as possible.

Slide 11

Example: Disability-Related Questions in the ACS and 2000 Census Long-Form

• Does this person have any of the following long-lasting

conditions:

(a) Blindness, deafness, or a severe vision or hearing impairment? (b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying?

• Because of a physical, mental, or emotional condition

lasting 6 months or more, does this person have any difficulty in doing any of the following activities:

(a) Learning, remembering, or concentrating? (b) Dressing, bathing, or getting around inside the home?

Slide 12

Prevalence of Disability among Persons Ages 25-61, by Type, 2002 American Community Survey

Source: Calculations by Robert Weathers, Cornell University, using the 2002 American Community Survey.

2.7 7.5 4.0 1.9 4.1 7.6 13.7 4 8 12 16 20 24 28 32 36 40

Sensory Physical Mental Self-Care Go-Outside Work One or More

(Percentage)

(CPS 7.8) Slide 13

Conceptual Definition of Disability—Nagi

Pathology Impairment Functional Limitation Disability Environment

Slide 14

Prevalence of Disability among Persons Ages 25-61, by Type, 2002 American Community Survey

Source: Calculations by Robert Weathers, Cornell University, using the 2002 American Community Survey.

2.7 7.5 4.0 1.9 4.1 7.6 13.7 4 8 12 16 20 24 28 32 36 40

Sensory Physical Mental Self-Care Go-Outside Work One or More

(Percentage)

Nagi “Impairment” Nagi “Functional Limitation” Nagi “Disability”

Slide 15

Question 4

• How many people who reported being

“blind in both eyes” DID NOT report a health condition or impairment that limited the kind or amount of work they could do.

– Possible Answer: About 31 percent.

Slide 16

Prevalence of Reporting Specific Impairments Among Working Age Persons (NHIS, pooled 1983-96)

74.5 0.09 Cerebral Palsy 38.0 69.0% Share Reporting Work Limitation 0.37 Deaf in Both Ears 0.15% Blind in Both Eyes Prevalence Rate Group

Slide 17

Employment Rate Among Working Age Men who Report Disability, Using Alternative Disability Definitions from the NHIS and CPS, 1981-2000

10 20 30 40 50 60 70 80 90

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year Percentage

NHIS-Impairment CPS-Work Limitation NHIS-Work Limitation

Slide 18

Question 5

• While I am here ... The unemployment rate

is around 5 to 6 percent. What is the unemployment rate among people with disabilities?

– Possible Answer: About 20 percent, depending

• n the definition of disability.

Slide 19

Question 6

• The unemployment rate is the percentage of the labor force who

are employed. The labor force is defined as those are employed

• r have actively looked for work in the last four weeks. Why

wouldn’t the unemployment rate be a good measure to identify the lack of employment among working age people with disabilities? [Hint: Who would be left out of the labor force?] – Possible Answer: It drops people who have not "actively looked for work in the past four weeks", thus it would miss people with disabilities that are discouraged in the job search process, and it would also miss people on DI and SSI—a population we know increase dramatically in the 1990s.

Slide 20

Conceptual Definition of Disability—ICF/WHO

Health Condition Impairment Participation Restriction Activity Limitation Disability

Slide 21 Slide 21

Question 7

• The Nagi frameworks acknowledge the role of the environment

in the transformation of “pathologies/impairments” into “functional limitations/ disabilities”. The ICF is attempting to codify and quantify the environmental components of “disability”. Suppose you suggested to a health insurance company that it use the ICF rather than their current health based classification system (ICD-10). What do you think would be the response of the health insurance company? What would a workers compensation insurance company say?

Slide 22

Question 8

• In what way does the Social Security Administration (SSA)

explicitly incorporate the role of the environment in their disability determination process? [Hint: It is not very explicit or expansive.]

–

Possible Answer: Whether there exists a job in the national economy for which the applicant can do with a reasonable degree of retaining.

Slide 23

Question 9

• Suppose the Social Security Administration (SSA) codified

the entire ICF within their disability determination process. What implications do you think this would have for SSA policy and recent efforts of SSA to return to work?

–

Possible Answer: It might motivate SSA to work to address environmental barriers to employment and other activities.

Slide 24

Question 10

• What currently causes labor lawyers

(representing both people with disabilities and employers) a great deal of uncertainty?

–

Possible Answer: Based on my discussions with a few labor lawyers -- the lack of a clear definition of disability.

Slide 25

Andrew J. Houtenville, Ph.D., Senior Research Associate Employment and Disability Institute School of Industrial & Labor Relations Cornell University Room 331, Ives Hall Ithaca, New York 14853-3901 USA Telephone: (607) 255-5702 TTY/TDD: (607) 255-2891 Fax: (607) 255-2763 E-mail: ajh29@cornell.edu http://www.ilr.cornell.edu/RRTC/ http://www.disabilitystatistics.org

Contact Information

Slide 26