The United Nations usually estimate that about ten per cent of the population in various countries may be considered disabled. However, there is great variation in the incidence of disabilities in the statistics from different countries. These differences may be caused by different criteria for reporting, degrees of industrialisation, rate of traffic accidents, participation in wars etc., and some of these differences between countries should be taken into account when considering a probable incidence of various disabilities in individual countries. The differences between available statistical surveys, however, cannot readily be explained only by such differences in conditions of life or diseases.
Sandhu and Woods (1990) describe these problems as follows: "There are considerable disparities within the European Community as far as legislative and other measures for the handicapped and elderly are concerned. As this project developed, it became increasingly apparent that within the Community, certain governments had devoted considerable effort and money to developing programmes and identifying the categories of disabled people within their borders, whilst others have been much less active in this area. It is an unfortunate fact that most industrialized countries are still not sure exactly who are the disabled nor what the needs of these people are" (pp. xx-xx).
One of the reasons why it is difficult to make comparisons between countries, and to evaluate the significance of available figures, is that the existing information often has been gathered for purposes other than to demonstrate the needs of people with disabilities. The statistics may not be based on the presence of the specific impairments of functions, but on more general criteria. The figures may be derived from medical statistics, from social groupings (e.g. number of disabled soldiers, people injured in accidents, or disabled civilians), or from other kinds of official statistics.
The purpose of a survey may also influence the figures. For example, if the obtained estimates are to be used as part of an argument for the implementation of legislation, rules, activities etc. for the benefit of the group in question, there may a tendency to define a disability in such a way that as many as possible are included. If, on the other hand, the survey is made by a government as part of a preparation for services, there may be a tendency to define the impairment in such a way that as few as possible are included, so that less extensive and cheaper services can be planned. For example, people living in institutions are often excluded from these statistics.
Furthermore, even if the statistics are based on the number of people with specific impairments within the individual countries, there may not be clear delineation of the nature and extent of those reduced functions which form the basis of the estimate. This uncertainty within individual countries is even more crucial in comparisons between countries. Thus, comparisons may not be useful, due to the different methods of estimation.
Table 6.1 illustrates the difficulties in comparing statistics from different sources. In 1986, the committee for "Transport for Disabled People", appointed by the European Conference of Ministers of Transport, made an analysis of information about prevalence of disabilities from the countries participating in COST 219 and a few other countries. The figures were gathered from different official sources, and the percentage of people with disabilities differed widely, both between countries and between estimates within the same country. Switzerland reported the lowest estimates (1.6 %). Spain reported the highest estimate (25 %). Italy reported both one of the lowest and one of the highest (1.7 and 17 % respectively). A study in Spain (Instituto Nacional de Estadistica, 1987) estimated the proportion of people with disabilities to be thirteen per cent while a Norwegian report (Barth, 1987) suggested an estimate of eighteen per cent.
A special problem is linked to the fact that several studies have demonstrated that the number of people with reduced functions, defined by fairly objective criteria, is considerably larger than the number of people who acknowledge that they are disabled when asked about it. This may be explained in several ways. One reason for not acknowledging a disability may be that the person in question, rightly or not, feels that it is socially discriminating to have a disability. It may be related to a quite common depreciation of people with disabilities. Or it may, for example, be the case that a person with a developmental disability as an adult may feel that the present position is achieved in spite of difficulties and possible resistance from other people, without relating these to the presence of disability.
Denmark 10,0- 12,0
Finland 5,2- 8,3
France 5,0- 8,3
BRD 10,8- 13,1
Ireland 3,3 - 5,0
Italy 1,7- 17,1
Luxemburg 10,0- 11,0
The Netherlands 9,5
Furthermore, it should be noted that even the best statistical information of the number of people with a particular handicap may not always be suitable for an estimate of the need for certain products and services. Both availability and information about products and services will determine their use. If services and products are well known and easy to obtain, more people are likely to use them.
Economic aspects usually play an important part. If adapted equipment is not provided free or cheaply by the State, many people will even fail to use equipment that they need for important daily functions because they cannot afford it, or are afraid to spend money on something they are not sure will function. As a group, people with impairments and disabilities have less economic means than the average of the population.
Lastly, the individual's situation with regard to family life and social conditions, as well as the degree of participation in the common social life and expectations about such participation, may to some extent determine whether a disabled person will attempt to obtain useful products and services.
To obtain a realistic estimate of the number of people with disabilities, it seems necessary to make individual estimates of specifically defined impairments and disabilities, where the definitional criteria are clearly related to the purpose of the survey. This will also make it reasonable to compare statistics, and, if necessary to discuss definitional criteria. The present survey is therefore divided into smaller groups.
Table 6.2 is based on the combined inputs from countries participating in COST 219 (Frederiksen et al., 1989). The figures do not include temporarily disabled people
The above mentioned estimate from Sweden, according to which 12 per cent of the population have limited ability to walk can hardly be compared to the number of people with reduced function of lower limbs. In the Swedish estimate, probably "everyone" with some difficulty in moving are included.
If the individual estimates are used as a basis for the decisions in connection with planning, one should note that an earlier lack of attention to the needs of the groups in question may lead to exclusion from participation in some of the usual activities of the members of the community. Thus, as services become available, estimates may prove too small because people may come to participate in activities they have been excluded from.
If the estimates are used as a basis for adjusting or changing products, one may note that the individual figures may have to be increased to the extent that people with disabilities come to participate more in social life. This increase may vary considerably, and some groups may become significantly larger than they appear to be today.
REDDUCED FUNCTION PERCENTAGE REMARKS
-Partially sighted 2
-Reduced Vision Spanish estimates indicate
that population need optical
-Profoundly deaf 0.1-0.2
-Hard hearing 10.0-15.0
-No speech (*)
-Cannot speak clearly 0.4
-Low volume (*)
Dyslexia 0.5 Estimates of reading dis-
orders are usually higher.
The present estimate only
include severe cases.
Impairment of language
Reduced function of lower limbs
-Can only walk with aid 6.0-7.0 In Sweden it is estimated
that 12 % of the population
have limited walking
Reduced function of upper limbs
-Cannot use arms (*)
-Cannot use fingers 0.2
-Cannot use one arm 0.2
-No ability to lift or
push and difficulty
in above 3.0-4.0
Reduced coordination of movement
-No ability of accurate
handling 2.0 2.0
-Short people (*)
(*) No estimate available
A study of thirteen European countries shows - as expected - that the categorisation of a person as disabled varies from country to country, for example:
20 per cent of mental capacity (Belgium)
30 per cent physical capacity (Belgium, Luxembourg)
50 per cent of mental or physical capacity (Denmark)
In most countries, categorisation is not dependent solely upon the actual impairment itself, but is assessed along with the consequences for employment and social independence. In Germany, for example, a disability is assessed on the basis of a reduction of 30 per cent or 50 per cent of earning capacity due to physical or mental disorders. Obviously, these percentages are determined by the degree of severity of the impairment and how it is classified, for example slight, medium or severe. Unfortunately, there is no consistent classification of impairment within Europe; classification methods are not standardized and are therefore open to interpretation.
In view of these problems, there is an urgent need for community action which, by establishing provisions applicable to all the countries in Europe, will eliminate these disparities and present a more united front in the quest for accurate statistical information which is so often used to formulate policies and address political issues.
TYPE OF LOWER UPPER VISUAL HEARING MENTAL PERCENT
HANDICAP LIMBS LIMBS POPULATION
UK 7.9 2.6 3.0 4.7 2.8 11.6
Belgium 3.1 1.03 2.4 2.4 3.4 11.1
Netherlands 5.3 1.8 1.1 2.0 2.3 11.9
Italy 6.9 2.3 4.0 1.7 2.6 12.1
Germany 6.0 2.0 2.3 3.1 2.5 13.1
France 5.1 1.7 1.8 2.4 1.9 10.2
Sweden 7.8 2.6 1.3 5.5 1.9 12.0
Ireland 5.8 1.9 2.0 2.8 2.3 11.6
Greece 5.3 1.8 1.7 2.4 2.0 10.0
Denmark 5.7 1.9 2.0 2.7 2.3 12.0
Portugal 5.7 1.9 2.0 2.7 2.3 11.4
Luxemburg 5.8 1.9 1.9 2.6 2.2 11.0
Spain 5.8 1.9 2.0 2.7 2.3 10.0
According to table 6.3, the total number of people with reduced functions is estimated to be at approximately the same level in the various countries, in proportion to the size of each population. However, there are differences in connection with the individual kinds of impairments, which cannot be readily explained. The differences are likely to be a result of the uncertainty with regard to definitions (degree of disability) and collection of data. This concerns, for example, the number of people with reduced function of lower limbs (3.1 per cent of the population in Belgium - 7.8 per cent in Sweden), visual impairment (4 per cent in Italy and 1.1 per cent in the Netherlands) and hearing impairment (1.7 per cent in Italy and 5.5 per cent in Sweden).
The estimated number of people with hearing impairment are considerable lower than in table 4.2 (the Cost 219 estimate). This is not surprising, since Cost 219 was focusing only on a reduction of the hearing function. In relation to the figures in table 4.1 (ECEMT's publication), the numbers appear more homogenous.
In Table 6.1, the number of disabled people varied between 5.0 per cent of the population (Ireland) to 25.0 per cent in Spain. However, it is not corrections of statistical investigations which have changed the figures, but more likely a re-estimate of the existing material. The difference between Tables 4.1 and 4.3 clearly show the need for systematisation and coordination in the field.
A considerable number of disabled people have more than one form of impairments. For example, of 1 000 people who are deaf-blind (Barth, 1987):
120 are totally deaf and blind;
500 have residual sight and hearing;
300 are mobility impaired;
100 have diabetes;
50 have asthma/allergy ;
100 are intellectually impaired ;
450 have symptoms typical of old age;
650 have to be described as severely handicapped besides being deaf-blind about;
750 are more than 66 years old ; and,
500 people are over 80 years old.
Table 6.4 gives an overview over the various combinations. The table illustrates that there is a considerable number of people who have a particular impairment and in addition to this also have other forms of reduced function.
MOBILITY IMP. VISUAL IMP. HEARING IMP.
COMBINED HANDICAP NUMBER NUMBER NUMBER
Mobility impairment 1000 700 530
Visual impairment 150 1000 160
Hearing impairment 230 380 1000
Rheumatics 320 220 200
Epileptics 20 30 10
Heart diseases 270 150 170
In this chapter, several statistical surveys have been reviewed in order to obtain the most relevant estimates of the number of disabled people. The material available shows a need for passing of uniform criteria for delineation of the various forms of reduced functions, that is, of the term "disability". A uniform understanding will be a requirement for the use of these statistics for national and international plans. Investigations should be based on the criteria put forward, and related to investigations of "social aspects", for instance, relations between employment, activities etc.References:
Frederiksen, J. Martin, M. Puig de la Bellacasa, R. & von Tetzchner, S. (1989). Use of telecommunication: The needs of people with disabilities. Madrid: Fundesco.
Sandhu, J. & Wood, T. (1990). Demography and market sector. Analysis of people with special needs in thirteen European countries. Newcastle: Newcastle Polytechnic.
Svensson, E. (1989). Hur mUnga? Bromma: Handikappinstitutet. 1989).
Barth, E. (1989). Funksjonshemmet i Norge. Oslo: FFO.