Slide
1 International
Classification of Functioning, Disability and
Health (ICF)
Overview of the ICF
framework and its utility for disability statistics
Nenad Kostanjsek
Department of Measurement and Health Information
Systems
World Health Organization
www.who.int/classification/icf
Slide
2 Overview
- Overview of ICF framework
and its utility for disability statistics
1.1 Disability data: need and characteristics
1.2 How does ICF help in disability statistics?
1.3 Exercise
- Structure of ICF and
its use in disability statistics
2.1 ICF taxonomy
2.2 Using ICF in disability surveys –
Design and Implementation choices
2.3 Examples from using ICF in health
and disability statistics
2.4 Exercise
Slide
3 Why
do we need disability data?
Disability is a major problem
- Disability accounts
for 500 Mio healthy live year lost p.a.
- High disability burden
in developing countries
Years lost due to Disability (YLDs 2002)
Afghanistan: 14.6 years (male) 15.5 years
(female)
Laos: 10.1 years (male) 12.8 years (female)
compared to
Japan: 5.5 years (male) 6.0 female
Slide
4 Why do we need
disability data? Health Sector Information gap
- Service needs
- Utilization patterns
- Outcomes
- Costs-effectiveness
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5 Why do we need
disability data? Social Sector Information gap
- Lost productivity and
Disability: how big a problem?
- Return-to-work policy:
do they work?
- Anti-discrimination
law: what effect do they have?
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6 Why do we need
disability data?
Future direction
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7 What is Disability
Data?
Disability can be a…
- life long experience
- late life concern
- episode in life
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8 What is Disability
Data?
Case Example: Forrest Gump
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9 What is Disability
Data?
Case Example: Forrest Gump
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10 What is Disability
Data?
Multi-Dimensional
- Information about functioning
of basic body parts or organs IMPAIRMENT
- Information about capacity
of person to do basic or complex actions ACTIVITY
- Information about extent
of person’s participation in society
PARTICIPATION
- Information about the
impact of person’s ENVIRONMENT
Slide
11 What is Disability
Data?
Information on extend, type and impact of disability
- How many people are affected
by different types of disabilities?
- Which impact has disability
on peoples live?
- What key environmental
factors influencing that impact?
Slide
12 What is Disability
Data?
Disability vs. Health Measurement
"Light evening
homework"
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13 What is Disability
Data?
Disability vs. Health Measurement
| |
DISABILITY |
No |
Yes |
| Health problem |
No |
|
|
| Yes |
|
|
- Case 1: Blind person
- Case 2: Person with flu
– cannot work for 10 days
- Case 3: Heavy smoker
– risk to develop lung cancer
- Case 4: Person with epilepsy
– not allowed to drive
- Case 5: HIV positive
person (a- symptomatic) – work denied
- Case 6: Person living
in polluted environment - risk to develop
respiratory problems
- Case 7: Coronary Infarct
- cannot walk +200 meters
- Case 8: Paraplegic person
- using wheelchair to move around
- Case 9: Person with one
eye loss – no driving licences
- Case 10: Ex-Depression
patient – difficulties in engaging in
community activities
Slide
14 What is Disability
Data?
Disability vs. Health Measurement
| |
DISABILITY |
No |
Yes |
| Health problem |
No |
Potential risk
Protection
Promotion
e.g. environmental pollution
|
|
| Yes |
Tempo. functional problems
associated with infectious or chronic
health conditions
|
Perm. functional problems
associated with infectious or chronic
health conditions
e.g. HIV/AIDS, Epilepsy,
Schizophrenia, Mental retardation
|
Slide
15 How does ICF
help in disability statistics
Slide
16 Market failures
in disability information
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17 Production
of disability information: tool coverage by
level
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18 Implications
of NOT using a common & comprehensive
language
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19 Problem of
Comparability in International Health Data
| - Mortality statistics |
3 x |
| - Health Survey data |
6 – 8 x |
| - Disability Survey data |
40 – 300 x |
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20 Implications
of NOT using a common & comprehensive language
- Information lack on:
- identifying people
with disabilities most in need
- functioning problems
that matter most for people
- effective interventions
strategies for
- assistance
- treatment
- rehabilitation
- prevention
- Weak monitoring and
evaluation of policies e.g. equalisation of
opportunities
- Duplication of effort
Slide
21 What difference
do classifications make in collecting disability
data?
- Aggregation of data
- Integration of disparate
data sets
- cross-cultural language
- cross-sectoral usage
- international standard
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22 What difference
does the ICF model make in collecting
disability data?
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23 ICF Model:
multi-dimensional not uni-dimensional
Body Functions
&
Structures
|
Activities
&
Participation
|
Environmental Factors |
IMPAIRMENT of
Functions & Structure |
CAPACITY/ PERFORMANCE PROBLEM
|
Barriers
Facilitators |
Medical treatment
|
Rehab, back to work programme, education |
Destigma. campaign
Support informal care |
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24 ICF Model:
universal not minority
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25 ICF Model:
universal not minority Disabled?
WHO Photo Contest
“Images of Health and Disability 200
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26 ICF Model:
universal not minority Disabled?
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27 ICF Model:
universal not minority Disabled?
Everyone may have disability
Continuum
Multi-dimensional |
Certain impairment groups
Categorical
Uni-dimensional
|
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28 ICF Model:
Context inclusive not person alone
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29 ICF Model:
Integrative not medical or social model
- PERSONAL problem &
SOCIAL problem
- medical care &
social integration
- individual treatment &
social action
- professional help &
individual & collective responsibility
- personal &
environmental adjustment manipulation
- behaviour &
attitude
- care &
human rights
- health care policy &
politics
- individual adaptation
& social change
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30 ICF Model:
Interactive not linear progressive
p
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31 Unidirectional
Flow of Concepts ICIDH 1980
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32 ICF Model:
Etiological neutral not driven by causality
- Loss of limb
landmines = diabetes = thalidomide
- Missed days at usual activities
flu = depression = back pain = angina
- Stigma
leprosy = schizophrenia = epilepsy = HIV
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33 ICF Model:
Complementary with ICD
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34 ICF Field
Testing
- 7 years 1994-2001
- 61 countries
- ICF drafts translated
into / tested in 27 languages
- 38 National Consensus
Conferences
- 7 International Consensus
Conf.
- 2000 Live Case evaluations
- 3500 Case Summary evaluations
Slide
35 ICF developed
and applicable across cultures
- Sharing the same
concept (conceptual equivalence
- Sharing the same categories
(functional equivalence)
- Translatability
- Usability
- International Comparisons
Slide
36
- ICF Model: Endorsed by
the World Health Assembly
- Endorse and publish ICF
- Use the ICF in Member
States in:
- research
- surveillance
- reporting
- Joint use with ICD
- Operational subsets:
- surveys
- clinical encounters
- Periodic revision
Slide
37 What difference
does the ICF model make in collecting
disability data?
| Multi-dimensional |
not |
uni-dimensional |
| Universal |
not |
minority approach |
| Integrative |
not |
medical or social |
| Context inclusive (person & environment) |
not |
person alone |
| Etiological neutral |
not |
driven by causality |
| Interactive |
not |
linear progressive |
| Cultural applicability |
not |
western concepts |
| Continuum with Health |
not |
Categorical |
Slide
38 The statistical
benefits of ICF
- Common language
- Inclusive and comprehensive
domain coverage
- no need to decide upfront
of who counts as disabled and who does not
(a-priori definition)
- choices for threshold
can be explicitly stated at point of analysis
(posteriori definition)
- measurement can be tailored
to suit the purpose
- Linking health and disability
measurement
Slide
39 Further information:
Slide
40 1. Exercise
"Disability definitions and ICF Model"
Discuss and evaluate the following disability
definitions and disability survey questions
in light of the ICF definition and understanding
of disability.
Respond to the following question:
- On which ICF components
(impairments, activity limitations, participation
restriction) is the definition/filter question
focusing?
- What other characteristics
has the definition/ filter question (e.g.
mentioning of severity, time, cause, environmental
factors etc.)?
- To what extent is the definition/filter
question in line with the ICF definition and
understanding of disability.
Slide 41
1. Exercise: "Disability
definitions and ICF Model"
Disability definition No.1
"Any case of blindness,
deafness and muteness, deafness
(only), loss of arm, leg or both,
deformity of right / left hand
/ foot and full paralysis is known
as disability."
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Teaching Points: |
Slide 42
1. Exercise:
"Disability definitions and ICF Model"
Disability definition No.2
"Disability refers
to the physical or organic handicap
of a person due to natural deformity
or deficient functioning of any
limb resulting from accident,
disease, etc. It includes blind,
deaf and dumb, crippled mentally
retarded and insane."
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Teaching Points: |
Slide 43
1. Exercise:
"Disability definitions and ICF Model"
Disability definition No.3
"Totally blind, totally
deaf and /or dumb persons and
persons with a disability in one
or more legs or arms were regarded
as physically disabled."
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Teaching Points: |
Slide 44
1. Exercise:
"Disability definitions and ICF Model"
Disability definition No. 4
"A restriction or lack
(resulting from an impairment)
of ability to perform an activity
in the manner or within the range
considered normal for a human
being. It describes a functional
limitation or activity restriction
caused by impairment, Disabilities
are description of disturbances
in functioning at the level of
the person. Examples of disabilities
are difficulties in seeing, speaking,
moving, climbing stairs, grasping,
reaching, bathing eating and toileting."
Teaching points:
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Teaching Points: |
Slide 45
1. Exercise:
"Disability definitions and ICF Model"
Disability Filter questions,
No.1
"Does any of the household
members have a health problem
or a disability that limits his/her
capabilities? If yes, what kind
of disability does (name) have?
Mental, hearing, vision, movement,
speech, mental and hearing, mental
and vision, mental and movement,
mental, hearing and vision, total
disability (all the above), others."
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Teaching Points: |
Slide 46
1. Exercise:
"Disability definitions and ICF Model"
Disability Filter questions
No. 2
"Is there any member
of this family who is disabled?
If yes, what is the type of disability?
Physical disability, disabled
in seeing, disabled in hearing,
mental disability, multiple disability,
other disability, chronic disease."
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Teaching Points: |
Slide 47
1. Exercise:
"Disability definitions and ICF Model"
Disability Filter questions
No. 3
Does anyone in your household
ever have any difficulty in doing
day to day activities because
of a physical, mental or emotional
(or other health) condition?
Has this difficulty lasted, or
is it expected to last 6 months
or more?
If YES to 1.1 and 1.2, how would
you describe your difficulty?
Does anyone in your household
need assistance to do day to day
activities?
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Teaching Points: |
Slide 48
1. Exercise:
"Disability definitions and ICF Model"
Disability Filter questions,
No.4
"Does anyone in your
household have any difficulty
hearing, seeing, communicating,
walking, climbing stairs, bending,
learning or doing any similar
activities? This person could
be yourself, or a child or an
adult of any age who is living
in your household.
Does a physical condition or mental
health condition or health problem
reduce the amount or the kind
of activity you, or anyone in
your household, can do:
At home?
At work or at school?
In other activities, for
example transportation or leisure?
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Teaching Points: |
Slide 49
Thank you!
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