Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Standard view
Full view
of .
Look up keyword
Like this
0 of .
Results for:
No results containing your search query
P. 1
Old Age, Disability and Mental Health: Data issues for a post-2015 framework

Old Age, Disability and Mental Health: Data issues for a post-2015 framework

Ratings: (0)|Views: 16|Likes:
HelpAge International and our partners at Sightsavers and ADD International commissioned research into some of the issues in the UN's High-level Panel report on the post-2015 development agenda.

The Overseas Development Institute carried out the research, which examines the High-level Panel's report's call for a "data revolution" and global coordination to improve the quality and availability of data on international development; an essential step to eradicating poverty through the framework that will replace the Millennium Development Goals.
HelpAge International and our partners at Sightsavers and ADD International commissioned research into some of the issues in the UN's High-level Panel report on the post-2015 development agenda.

The Overseas Development Institute carried out the research, which examines the High-level Panel's report's call for a "data revolution" and global coordination to improve the quality and availability of data on international development; an essential step to eradicating poverty through the framework that will replace the Millennium Development Goals.

More info:

Categories:Types, Research
Published by: HelpAge International on Jun 27, 2013
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less





By Emma Samman and Laura K.Rodriguez-Takeuchi
fforts to include inequality in a post-2015agreement are gaining momentum, with onestrand of advocacy urging consideration of the inequalities associated with particular social groups. The Millennium Development Goals(MDGs) included gender-based inequality, withMDG 3 aiming ‘to promote gender equality andempower women’ while the ofcial list of MDGindicators species that ‘all indicators should bedisaggregated by sex and urban/rural as far aspossible’. Issues pertaining to infants and childrenfeatured strongly, but the MDGs overlooked, for themost part, other group-based differences.This Background Note focuses on inequalitiesassociated with old age, disability and mental health.It argues that these should be considered salientsources of group-based difference, given the num-bers of people affected, their marginalisation and vul-nerability, and their relative neglect in internationalagreements to date.This note identies a lack of data as a particular concern, but one that can be addressed through revi-sions to standard household surveys. To this end, thepaper discusses the available data and their limita-tions, constraints to better data collection and effortsneeded to adjust key international survey instru-ments – the World Bank’s Core Welfare Indicator Questionnaire (CWIQ) and Living Standards andMeasurement Survey (LSMS), Macro International’sDemographic and Health Survey (DHS) and theUNICEF Multiple Indicator Cluster Survey (MICS) – tocollect reliable data on these issues. It sets out tech-nical adjustments that would enable these surveys tobroaden their coverage, collect richer information andimprove their identication of these three groups.It concludes by commenting on how measures toaddress the inequalities that affect these groupscould be incorporated within a new post-2015 frame-work agreement.
Why this matters
Inequalities take many forms, some of which havereceived greater policy attention than others. Thoseassociated with old age, disability and mental healthissues did not feature in the MDGs and have beenoften neglected in international agreements to date.This Background Note argues for their inclusion in apost-2015 framework agreement.Obviously, old age, disability and mental healthissues are global in their scale, with salient effectson large numbers of people. But they also haveclose links to vulnerability and a lack of fullmentof human rights. The discrimination experienced bythose who fall into any one of these three groups isimportant to address in itself and is likely to haveconstrained progress towards certain MDGs. For example, in developing countries:
older people may be more susceptible to fatalforms of malaria as a result of age-associatedloss of immune function (Gavazzi et al., 2004)
Over one-third of school aged children remaining out of school have a disability (Peters, 2003)
Mental health issues and poor physical healthcan be mutually reinforcing, with one increasing the likelihood of the other (Das et al., 2007).However, we examine mental health issues
Old age, disability and mentalhealth: data issues or a post-2015 ramework 
The Overseas Development Institute
is the UK’s leading independent think tank on international development and humanitarian issues
ODI Background Notes
provide a summary or snapshot of an issue or of an area of ODI work in progress. This and other ODI BackgroundNotes are available from www.odi.org.uk
May 2013
shaping policy for development
Background Note
separately as they are not always disabling andbecause the discourse on disabilities oftenneglects people with mental health issues.A post-2015 development agreement that is trulyconcerned with inequality in its many forms shouldtake these issues into account. One clear obstacleis the widespread lack of nationally-representativeand internationally-comparable data – a challengearising from denitional or technical issues (whatto measure and/or how), operational issues (e.g.,resource or capacity constraints), attitudinal issues(relating to stigma) and/or lack of demand from datausers. A greater understanding is needed of theseconstraints and how they might be overcome. Our focus here is on the former.
Size, vulnerability and the internationalocus to date on old age, disability andmental health
The marginalisation of older people and those withdisabilities or mental health issues is fuelled by pre-vailing attitudes, stigma, environmental barriers,
 difculties in accessing social services, and lackof voice and participation, all of which combine torender these groups ‘invisible’ (Cain, 2012). Theyare disadvantaged in many contexts, particularlywhere relevant policies and safety nets are absent,and their disadvantages tend to overlap in distinctways, as well as with more often-studied sources of inequality such as gender and place of residence.We review the evidence on the size and vulnerabilityof each group and their treatment to date in inter-national accords, before outlining ways in which theinequalities they face appear to overlap.
Older people
The global population is ageing. People aged 60years and above – the international denitionof older people used by the UN (UNDESA, 2004)– account for 11% of the global population. Thisshare is expected to double to 22%, or 2 billionpeople, by 2050 (UNDESA statistics, cited in UNFPAand HelpAge International, 2012). Globally, thereare already more older people than children under the age of ve and they are expected to out-stripthe number of youth aged 15 years and under by2050. The fastest growth is happening in devel-oping countries, with profound implications notonly for older people themselves, but also for their households, their social and community infrastruc-ture, and for social policy.Recent studies in developing countries have foundthat households with older heads or members tendto be poorer than other households (Masset andWhite, 2004; Kakwani and Subbarao, 2007). Ageing may mean that people become less able to work andhave fewer opportunities to do so, while policies andprogrammes designed to enhance livelihoods oftenexclude older people from activities that require highlevels of labour capacity and mobility.Despite their more limited opportunities for work,only one-fth of older people worldwide have pen-sions and coverage is even lower in developing countries (UNFPA and HelpAge International, 2012),although studies point to their feasibility in evenlow-income settings (Hagemejer and Behrendt,2009). At present, some 340 million older peopleare living without any secure income and, if currenttrends continue, this number will rise to 1.2 billionby 2050 (Meissner, 2010).A recent study in Bulgaria, Ghana, Nicaragua,Viet Nam and the state of Andhra Pradesh in Indiareported that between 15% and 30% of older peoplelived alone or with no adult of working age (Massetand White, 2004). And in many countries where chil-dren have been orphaned by HIV and AIDS or con-ict, or where parents have migrated, older peopleare taking on a heavy burden of caring for children(Kakwani and Subbarao, 2005). As with other formsof the ‘care economy’, this is not monitored (letalone rewarded) systematically.No international convention exists as yet on therights of older peoples although there are growing calls for such a convention, given the extent andprevalence of age discrimination and a recognisedgap in protection. The 2002 Madrid InternationalPlan on Ageing was the rst to make explicit con-nections between ageing, development aims andhuman rights. It remains the only global agree-ment that commits governments to integrate issuesrelated to ageing into economic and social develop-ment policies and into meeting the MDGs. However,the MDGs ‘completely ignore the ageing of socie-ties and poverty in old age’ (UNFPA and HelpAgeInternational, 2012).
Disability is not a rare event. Leading estimates fromthe World Health Organization’s World Health Survey(WHO, 2011a) and Global Burden of Disease report(WHO, 2008), both using 2002-2004 data, suggestthat between 15% and 20% of the population world-wide live with some form of disability, including those resulting from mental health issues, and that2% to 4% of people have a severe disability.On balance, disability is linked to a higher prob-ability of being poor (Groce et al., 2011).
In manysettings, people with a disability are less likely
Background Note
to obtain an education – a result of constraints toaccess, as well as stigma and a lack of support –and face reduced employment opportunities andearnings. Other household members may have togive up their jobs to care for them. Typically, peoplewith disabilities have higher health-care costs, andmay also face social and political marginalisation(Groce et al., 2011).The poor, in turn, are more likely to be malnour-ished, in low-quality employment, subject to dif-cult living conditions and to be exposed to environ-mental hazards, all of which increase the likelihoodof disability. Several meta-studies and individualcountry studies support this relationship.
An analysis of 15 developing countries foundthat, in the majority, ‘people with disabilities,on average, experience multiple deprivations athigher rates and in higher breadth, depth andseverity than people without disabilities’ (Mitraet al., 2013).
In 13 developing countries, school-age childrenwith disabilities were less likely to be enrolled inschool (Filmer, 2008).
Households with a member with a disability were20% more likely to be poor in Tanzania (Massetand White, 2004) and 38% more likely to be poor in Uganda (Hoogeveen, 2005).
In India, children with disabilities were over ve times more likely to be out of school, whileemployment rates for people with disabilitieswere some 60% lower, on average (WorldBank, 2007).At a national level, the relationship between dis-ability and poverty varies greatly according to theavailability of health care, nutrition programmes,disability benets and accessible schooling, high-lighting the importance of policy (Mitra et al., 2013).The 2006
Convention on the Rights of Personswith Disabilities
marked an advance in the recog-nition of the rights of those with disabilities, butUnited Nations Member States need to do more toimplement its commitments by adopting measuresto ensure equality before the law, as well as non-discrimination in access to economic and socialrights. UN General Assembly Resolutions in 2008and 2010 have reinforced the need for a stronger focus on disability and have highlighted the wayin which those with disabilities are invisible instatistics. People with disabilities are not includedexplicitly in any of the MDG targets and indicators.The 2010 and 2011 MDG Reports acknowledgedthe needs of this specic group, but they were wasmissing from the MDG Report for 2012.
Mental health
Mental health disorders account for 13% of theworld’s Global Burden of Disease (WHO, 2008),affecting some 450 million people, or more thansix in every 100 people. Severe depression affectsaround 99 million people; the share of affectedpeople has risen since 1990 and WHO predictsthat it will affect more people than any other healthproblem by 2030 (WHO, 2008). In some countries,mental health issues are becoming increasinglyimportant, relative to traditional health concerns.In Nepal, for example, suicide is now the leading single cause of death among women of reproductiveage (accounting for 16% of deaths), while causesrelated to pregnancy and childbirth have fallen tothird place (Suvedi et al., 2009).Although evidence on the relationship betweenmental health issues and poverty is less consistent(Das et al., 2007), it has strong links to certain fac-tors that heighten the probability of being sociallyexcluded, such as lack of education, food insecu-rity, poor housing, low socio-economic status andnancial stress (Lund et al., 2010). Changes in lifecircumstances brought on by, for example, illness,ageing, being widowed or in poor health and other adverse events, such as war, may also contribute(Das et al., 2007; Do and Iyer, 2009).Mental health ‘remains a largely ignored issue inglobal health, and its complete absence from theMDGs reinforces the position that mental healthhas little role to play in major development-relatedhealth agendas’ (Miranda and Patel, 2005). Thereis vast and unmet need for mental health treatment,particularly in developing countries. In Colombia,Lebanon and Mexico, an estimated 76% to 85%of people with severe mental health issues donot receive treatment. Even in high-income coun-tries, unmet need is estimated at between 35%and 50% of people with severe conditions (WHOWorld Mental Health Survey Consortium, 2004).Resources are part of the problem: one-third of theworld’s countries do not have any health-budgetallocation at all for mental health, while in one-fth of the countries that do, the allocation is lessthan 1% of the total health budget (Mental Healthand Poverty Project, 2010).The extent to which these and other sources of inequality overlap and reinforce one another mayheighten exclusion and disadvantage. For example,older people are much more likely to experience dis-ability – indeed, 38% of older people worldwide havea disability (Groce et al., 2011; WHO, 2011a), andolder people with disabilities are more likely to bemulti-dimensionally poor (Filmer, 2008). Dementia isprojected to rise as populations age, and will affect

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->