Disability Statistics in Canada: A History and Current Results

Disability Statistics in Canada:A History and Current Results

Andrew MacKenzieAndrew MacKenzie

Senior AnalystSenior AnalystStatistics CanadaStatistics Canada

2

Presentation Agenda

Overview of Disability Surveys at Statistics Canada• 1986 & 1991 Health and Activity Limitation Survey (HALS)• 2001 Participation Activity Limitation Survey (PALS)

Conceptual Framework of PALS• ICF & ICF-CY• Question development

Overview of 2001 PALS Data• Disability rates in Canada• Impacts on family and future employment

2006 PALS: Moving Forward• Changes from 2001 PALS• Looking ahead to 2011 PALS

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Overview of Disability Surveys at Statistics Canada

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The Beginning of Disability Statistics in Canada

1986 HALS pioneered development of Canadian disability statistics through survey data

Canada among first to use post-Censal surveys• Locate unique populations from Census information

HALS Target population• children (under 15) and adults (15 years and over) living in

households in the 10 provinces plus the territories

Census filter questions developed to identify population with disabilities• Positive & negative responses included in HALS 1986 & 1991

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The end of HALS

No 1996 disability survey

HALS approach was expensive and inefficient

• Only 10% positive responses in NO sample

New definitions of disability from WHO

• ICF replaces ICIDH

New policy and research interests

• Growth of assistive technology

• Changing programs

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Beginning of PALS

2001 PALS development began in 1997• New Census filter questions developed based on WHO

definition of disability• New content to reflect emerging policy and research interests

2001 PALS Target population• children (under 15) and adults (15 years and over) living in

households in the 10 provinces who reported an activity limitation in the census

2006 PALS development began in 2003• Trend analysis with 2001 PALS• Data collection begins October 30th

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The Conceptual Framework of PALS

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Conceptual Framework of PALS

What is a disability?• Issues for PALS• Public perceptions of disability

Overview of the World Health Organization’s ICF• Development• Concepts & building blocks

Implications of the ICF for PALS• ICF as a guide, not 100%• Developing questions from ICF

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What is a Disability?

Someone who uses a wheelchair all the time? Deaf? Someone who uses a wheelchair some of the time? Depression? Schizophrenia? Dyslexia? Chronic pain? Need a hearing aid? Need glasses?

Three more to chew on:• Obesity?• Homelessness?• HIV/AIDS?

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Opinions of Canadians

Is homeless

Has HIV/AIDS

Is obese

Difficulty with social interactions

Has difficulty climbing stairs

Requires a hearing aid

Has chronic depression

Has difficulty remembering things

Walks with a cane

Has difficulty learning new things

Experiences chronic pain

Has limited vision with glasses or contacts

Has difficulty speaking

Uses a wheelchair some of the time

Is deaf

Uses a wheelchair all the time 95

89

79

78

74

72

69

69

67

67

67

65

49

44

42

312004 Environics Poll, Sponsored by SDC

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World Health Organization (WHO)

The WHO developed a preliminary system concerning consequences of disease in 1972

The first edition of ICIDH was published in 1980; reprinted with additional foreword in 1993

Revision process for ICIDH initiated in 1993

Evaluation, conferences and field trials

Resulted in development of ICF

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ICF as an International Standard

To provide a scientific basis for consequences of health conditions

To establish a common language to improve communications

To permit comparison of data across:• countries

• health care disciplines

• services

• time

To provide a systematic coding scheme for health information systems

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Interaction of Concepts ICF 2001

Health Condition (disorder/disease)

Body function & structure

(Impairment)

Activities(Limitation)

Participation(Restriction)

Environmental Factors

Personal Factors

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WHO Definition of Disability

Disability is defined as:

the unsuccessful interaction between a person with an impairment and an unsupportive environment

Environment has four dimensions:• Physical• Social• Financial• Political

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Building PALS from ICF

PALS follows ICF as a model, but not 100%• Body functions and structures should manifest as activity

limitations and participation restrictions

• Over 1,000 codes, limited patience of respondent

Defining the PALS universe• Select elements to reflect most common disabilities

Pain & memory not included for kids 0-14, chronic conditions and developmental delay (0-4 only) added

Hearing Seeing Communicating

Mobility Agility Pain

Learning Memory Developmental

Emotional / Psychological Unknown

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Example 1. Agility

ICF Code• d540 Dressing

d5400 Putting on clothes d5401 Taking off clothes

PALS Question• B57. Do you have any difficulty dressing and undressing

yourself?

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Example 2. Agility

ICF Code• d520 Caring for body parts• d5204 Caring for toenails

PALS Question• B61. Is it physically difficult for you to cut your own toenails?

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Example 3. Mobility

ICF Code• d415 Maintaining a body position• d4154 Maintaining a standing position

PALS Question• B47. Do you have any difficulty standing in line for more than

20 minutes?

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Example 4. Communicating

ICF Code• d330 Speaking

PALS Question• B29. Because of a condition or health problem, do you have

any difficulty speaking?

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Example 5. Pain

ICF Code• b280 Sensation of pain

PALS Question• B73. Do you have any pain or discomfort that is ALWAYS

present?• B74. Do you have PERIODS of pain or discomfort that

REOCCUR from time to time?

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More Questions From the ICF:

Build a safety net to identify less common disabilities• Do you have any difficulty hearing, seeing, communicating,

walking, climbing stairs, bending, learning or doing any similar activities?

– Yes, sometimes– Yes, often– No

• Does a physical condition or mental condition or health problem reduce the amount or the kind of activity you can do:

At home? At work? In other activities, for example transportation or leisure?

– Yes, sometimes– Yes, often– No

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Disability Statistics from PALS 2001

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Disability Rates in Canada by Gender

0

10

20

30

40

50

60

0-4 5-9 10-14

15-24

25-34

35-44

45-54

55-64

65-74

75+

MaleFemale

Source: 2001 PALS. Excludes Territories, Reserves and Institutions

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Disability Rates by Province & Gender, Age 0-9

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

NF PEI NB NS QC ONT MAN SK AB BC

Boys

Girls


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Non-Physical Disability Rates by Province, Age 5-9

0

0.2

0.4

0.6

0.8

1

1.2

1.4

ATL QC ONT MAN SK AB BC

Develop

Learning

Emotion


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Rates of Disability Types by Gender, Age 0-9

0 20 40 60 80

Hearing

Seeing

Communication

Mobility

Dexterity

Developmental

Learning

Emotional

Chronic

Delay*

Unknown

Boys

Girls


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Multiple Disabilities for Children with Learning, Developmental or Emotional Disabilities, Age 5-9

0 20 40 60 80

Hearing

Seeing

Communication

Mobility

Dexterity

Chronic

Boys

Girls


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Severity of Disability for Non-Physical Disability Types, Age 5-9

0

5

10

15

20

25

30

35

40

45

Learning Develop Emotion

Mild

Moderate

Severe

Very Severe


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Children whose parents require help, 2001

45

16

40

31 29

39

0

10

20

30

40

50

Parents receive allhelp needed

Parents receive help,but need additional

help

Parent receive nohelp, but need some

Mild to moderate severity Severe to very severe


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Impacts of Non-Physical Conditions on the Family’s Employment, Age 5-9

0 10 20 30 40 50 60

Declined aJob

QuitWorking

ChangedWork Hours

RefusedPromotion

Fewer Hours

Mild

Moderate

Severe

Very Severe


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What Does the Future Hold? Labour Market Characteristics of Adults

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Employment Status – Canadians Aged 15 to 64

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Disability No Disability

Employed

Unemployed

Not in the LabourForce


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Unemployment Rate By Severity

02468

101214161820

Non Disab Mild Moderate Severe

Total

Men

Women


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Disability types in the Labour Force, Ages 15-64

0 20 40 60 80 100

Hearing

Seeing

Communicating

Mobility

Agility

Pain

Learning

Memory

Developmental

Emotional

Male

Female


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Differences in Average Employment Income – All Employed With Disability

0

10

20

30

40

50

60

70

80

90

15-24 25-34 35-54 55-64

Mild

Moderate

Severe


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PALS 2006: Moving Forward

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PALS 2006

PALS 2006 will be collected between October 2006 and January 2007

Target population• children (under 15) and adults (15 years and over) living in

households in the 10 provinces and 3 territories who reported an activity limitation in the census

Sample of 35,000 adults, 8,000 children from the YES sample in the 2006 Census

The content will allow for time series comparisons

Results will be available by Winter 2007-08

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Changes to Adult PALS from 2001

Addition of the Health Utility Index

Improved questions on care received and needed

Improved questions on aids and assistive devices

– repairs, replacement, cost

New content on workplace training

Addition of an internet module

New content on discrimination and societal

perception of disability

Improved content on local transportation

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Changes to Children’s PALS

Addition of the Health Utility Index

Improved questions on care received and needed

Improved questions on aids and assistive devices

– repairs, replacement, cost

New content on bullying

Improved content on child care options and

limitations

New content on the impact on the parent and the

family

Improved content on special education services

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PALS 2011: Looking Ahead

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PALS 2011

Better understanding of false positives• Short-term illnesses or injuries?

Further research into “Quebec Effect”• Language vs. culture

Examine Census filter questions and PALS screening questions for non-physical disabilities

Improve alignment of PALS 2011 with International Standards such as ICF• Not a perfect match with ICF• Revisions to ICF currently underway

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Questions?

For further information, please contact:

Andrew MacKenzie

Senior Analyst, PALS Survey

Statistics Canada

(613) 951-2544

[email protected]

Thank you for your attention!

Documents

Disability Statistics in Canada: A History and Current Results