Seminar on disability By Dr.Santosh Kadle

Disability: Introduction & Concepts
PG Student: Dr. Santosh Kadle
Grant Medical College,Mumbai
GrantGovermentMedicalCollege,Mumbai
1

 Contents of seminar:
 Introduction
 Concept of disability
 Problem statement of disability-
--Worldwide , India , Maharashtra
 Data sources for disability
 Various types of disability, causes of disability
 Certification of disability
2

3
“ 1-7 OCT ” - As Beyond limitations week

“Disabled people are not only the most
deprived human beings in the
developing world, they also the most
neglected.”
----Amartya Sen
4

Disability is the best example of the iceberg phenomenon of disease
5[Source: S. Ganesh Kumar et al, Disability and Rehabilitation Services in India: Issues and Challenges, J Family Med Prim Care. 2012 Jan-Jun]
 Self
reported
cases
 Non reporting
 Improper definition
disability condition
 Less knowledge& skills
in health provider
 Not accessed to services
 Less frequency for
Data collection

 Need of disability evaluation :
Disability evaluation is useful for health care
and policy decisions, in terms of:
 identifying needs
 matching treatments and intervention
 measuring outcomes and effectiveness
 setting priorities
 allocating resources
6
Source: http://www.who.int/topics/disabilities/en/

Barriers faced by Persons with disabilities :
People with disabilities encounter a range of barriers when
they attempt to access health care including the following:
 Prohibitive costs
 Limited availability of services
 Physical barriers
 Inadequate skills and knowledge of health workers
7
[Source: http://www.who.int/topics/disabilities/en/]

Vulnerability of people with disabilities :
• People with disabilities are particularly vulnerable to
deficiencies in health care services.
• Depending on the group and setting, persons with disabilities
may experience greater vulnerability to
1] secondary conditions,
2] co-morbid conditions,
3] age-related conditions,
4] engaging in health risk behaviors and
5] higher rates of premature death.
8[Source: http://www.who.int/topics/disabilities/en/]

According to the International Classification of Impairments,
Disabilities, and Handicap [ICIDH]---
 Impairment is concerned with physical aspects of health,
Disability has to do with the loss of functional capacity
resulting from impaired organ,
Handicap is a measure of the social and cultural
consequences of an impairment or disability.
9
Source: http://www.who.int/topics/disabilities/en/
Concept of Disability:

Disease is a pathological process and its manifestations which
indicate a departure from the state of perfect health.
Impairment is the actual loss or damage of a part of body anatomy
or an aberration of the physiological functions that occurs
consequent to a disease.
Disability is defined as “the inability to carry out certain functions
or activities which are otherwise expected for that age/sex, as a
result of the impairment.”
Handicap is the final disadvantage in life which occurs consequent
to an impairment or disability, which limits the fulfilment of the
role a person is required to play in life.
10

According to the International Classification of functioning,
Disability, and Health [ICF], 2001
Disabilities is an umbrella term, covering impairments, activity
limitations, and participation restrictions.
An impairment is a problem in body function or structure
An activity limitation is a difficulty encountered by an individual
in executing a task or action
A participation restriction is a problem experienced by an
individual in involvement in life situations
11
[Source: http://www.who.int/topics/disabilities/en/]

The Convention of Rights of Persons with Disabilities (UNCRPWD:United
Nation, 2006 w.e.f. 8 May2008)
Shift from a medical social model of disability
In Medical model—
 Individuals with certain physical , intellectual, psychological
and mental conditions (impairment) are regarded as pathologic
or abnormal
It is simply the abnormality conditions themselves that are the
cause of all restrictions of activities
Disability lies in the individuals
Feel pressured to work on ‘their’ restrictions adjusting to their
environment through cures, treatment or rehabilitation.
12

The Convention of Rights of Persons with Disabilities (UNCRPWD:United
Nation, 2006 w.e.f. 8 May2008)
Shift from a medical social model of disability
• In Social model- undue restrictions on behaviour of persons with
impairment are seen to be imposed by: a) dominant social, political,
and economics ideologies; b)cultural and religious perceptions
regarding persons with disabilities; c) paternalism in social welfare
systems; d) discriminations by society; e) the inaccessibility of the
environment and information; and f) the lack of appropriate
institutional and social arrangements
Disability does not lie in individuals, but in the interactions
between individuals and society.
Persons with disabilities are right holders, and are entitled to
advocate for the removal of barriers.
13

• In India different definitions of disability conditions have
been introduced for various purposes, essentially following
the medical model and, as such, they have been based on
various criteria of ascertaining abnormality or pathologic
conditions of persons.
• In absence of a conceptual framework based on the social
model in the Indian context, no standardisation for evaluating
disability across methods has been achieved.
• In common parlance, different terms such as disabled,
handicapped, crippled, physically challenged, are used inter-
changeably, indicating noticeably the emphasis on pathologic
conditions .
14

According to The Persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Act, 1995
 "Person with disability" means a person suffering from not less
than 40 % of any disability as certified by a medical authority (any
hospital or institution, specified for the purposes of this Act by
notification by the appropriate Government).
 As per the act "Disability" means -
(i) Blindness; (ii) Low vision; (iii) Leprosy-cured;
(iv) Hearing impairment; (v) Loco motor disability;
(vi) Mental retardation; (vii) Mental illness
15[Source: http://www.socialjistice.nic.in]

 Problem statement :
About 15% of the world's population lives with disability
 2-4% experience significant difficulties in functioning.
The global disability prevalence is higher than previous
WHO estimates, which suggested a figure of around 10%.
This global estimate for disability is on the rise due to
-population ageing
-rapid spread of chronic diseases,
-improvements in the methods to measure disability.
16[Source: http://www.who.int/disabilities/facts]

17[Source: http://www.who.int/disabilities/actionplan/en/]

Three objectives:
 To remove barriers and improve
access to health services
To strengthen and extend
rehabilitation services.
To strengthen data collection and
support research on disability and
related services.
18
Better health for all people with disability
[Source: http://www.who.int/disabilities/actionplan/en/]

Problem statement of disability in India :
• Census 2001 are 2.19 crore and are 2.13 percent of the total
population of the Country. These include persons with visual,
hearing, speech, locomotor and mental disabilities.
• According to the 58th round of National Sample Survey(NSS)of
2002, there were 208 lakh persons with disabilities in 2002 .
• As per Census 2011 are 2.68 crore and are 2.21 percent of the total
population of the Country. These include persons with visual,
hearing, speech, locomotor, mental retardation, mental illness , any
other and multiple disability .
• The Census and the NSS have different sampling design. In both
sources, disability was self-reported.
19[Source: http://www.censusindia.gov.in/disabilitydata]
Sr.No. Year Data source Disabled
population
%
1 2001 Census 2001 2.19 crore 2.13 %
2 2002 NSSO 2002 2.08 crore 2.01 %
3 2011 Census 2011 2.68 crore 2.21 %
The Census and the NSS have different sampling design.
In both sources, disability was self-reported.

NUMBER OF DISABLED POPULATION AND TYPE OF DISABILITY
Population Percentage (%)
Total population 1,028,610,328 100.0
Total disabled population 21,906,769 2.13
Disability rate
( per lakh population)
2,130 --
Type of Disability
(a) In seeing 10,634,881 1.0
(b) In speech 1,640,868 0.2
(c) In hearing 1,261,722 0.1
(d) In movement 6,105,477 0.6
(e) Mental 2,263,821 0.2
[Source: http://www.censusindia.gov.in/2001census/C-series/c-20.html ]
20

NUMBER OF DISABLED POPULATION AND TYPE OF DISABILITY
….. Population Percentage (%)
Total population 1,210,569,573
Total disabled population
26,810,557
2.21
Disability rate
( per lakh population)
2,210
Types of disability…………………………………………y
(a) In seeing 5,032,463
(b) In speech 5,071,007
(c) In hearing 1,998,535
(d) In movement 5,436,604
(e) Mental Retardation 1,505,624
(f) Mental illness 722,826
(g) Any other 4,927,011
(h) Multiple disability 2,116,487
[Source: http://www.censusindia.gov.in/2001census/C-series/c-20.html]
21

56%
44%
Males
Females
[Source: http://www.censusindia.gov.in/2011census/C-series]
22

23

1.75
1.80
1.85
1.90
1.95
2.00
2.05
2.10
2.15
2.20
2.25
Total Rural Urban
2.13
2.21
1.93
2.21
2.24
2.17
Percentage
Proportion of Disabled Population by Residence
India : 2001-11
2001 2011
[Source: C-Series, Table C-20, Census of India 2001 and 2011]
24

Source: http://www.censusindia.gov.in/2011census
25

Disabled Population by Type of Disability
India : 2011
Type of Disability Persons Males Females
Total 26,810,557 14,986,202 11,824,355
1] In Seeing 5,032,463 2,638,516 2,393,947
2] In Hearing 5,071,007 2,677,544 2,393,463
3] In Speech 1,998,535 1,122,896 875,639
4] In Movement 5,436,604 3,370,374 2,066,230
5] Mental Retardation 1,505,624 870,708 634,916
6] Mental Illness 722,826 415,732 307,094
7] Any Other 4,927,011 2,727,828 2,199,183
8] Multiple Disability 2,116,487 1,162,604 953,883
26

Disabled Population by Type of Disability (%) India: 2011
In Seeing
18.8 %
In Hearing
18.9 %
In Speech
7.5 %
In Movement
20.3 %
Mental
Retardation
5.6 %
Mental Illness
2.7 %
Any Other
18.4 %
Multiple
Disability
7.9 %
27

Source: http://www.censusindia.gov.in/2011census/C-series/c-20.html
Proportion of Disabled Population
by Type of Disability
India : 2011
1.In Seeing 18.8 17.6 20.2
2.In Hearing 18.9 17.9 20.2
3.In Speech 7.5 7.5 7.4
4.In Movement 20.3 22.5 17.5
5.Mental Retardation 5.6 5.8 5.4
6.Mental Illness 2.7 2.8 2.6
7.Any Other 18.4 18.2 18.6
8.Multiple Disability 7.9 7.8 8.1
28

[Source: C-Series, Table C-20, Census of India 2011]
( % )
0.0
5.0
10.0
15.0
20.0
25.0
18.8 18.2
7.0
21.7
5.5
2.7
17.7
8.5
18.7
20.5
8.5
17.1
5.9
2.8
20.0
6.5
AxisTitle
Axis Title
Disability by Type and Residence, India, 2011
Rural Urban
29

Problem statement of disability in Maharashtra :
.
30[Source: http://www.censusindia.gov.in/disabilitydata]
Sr.No. Year Data source Disabled
population
%
1 2001 Census 2001 1.6 million 1.97 %
2 2002 NSSO 2002 12.37 lakhs 2.89 %
3 2011 Census 2011 29.63 lakhs 2.69 %

Maharashtra : 2011
Total 2963392 1692285 1271107
1] In Seeing 574052 311835 262217
2] In Hearing 473271 264956 208315
3] In Speech 473610 260792 212818
4] In Movement 548418 357348 191070
5] Mental Retardation 160209 90408 69801
6] Mental Illness 58753 32907 25846
7] Any Other 510736 279048 231688
8] Multiple Disability 164343 94991 69352
31

Source: http://www.censusindia.gov.in/2011census/C-series/c-20.html
Maharashtra : 2011
1.In Seeing 19.4 18.4 20.6
2.In Hearing 16.0 15.7 16.4
3.In Speech 16.0 15.4 16.7
4.In Movement 18.5 21.1 15.0
7.Any Other 17.2 16.5 18.2
32

Mumbai : 2011
Total 242343 138652 103691
1] In Seeing 61269 34558 26711
2] In Hearing 57586 32253 25333
3] In Speech 34992 19808 15184
4] In Movement 23117 14731 8386
5] Mental Retardation 10460 6200 4260
6] Mental Illness 3741 2102 1639
7] Any Other 42271 23796 18475
8] Multiple Disability 8907 5204 3703
33

Mumbai : 2011
1.In Seeing 25.3 24.9 25.8
2.In Hearing 23.8 23.3 24.4
3.In Speech 14.4 14.3 14.6
4.In Movement 9.5 10.6 8.1
7.Any Other 17.4 17.2 17.8
34

 Types of disability:
1] Visual disability
2] Hearing disability
3] Speech disability
4] Locomotor disability
5] Mental disability
6] Mental illness
7] Multiple disability
35

1] Visual disability:
Definition – as per PWD act1995,
"Blindness" refers to a condition where a person suffers from any of
the following conditions,
 Total absence of sight.
 Visual acuity not exceeding 6/60 or 20/200 (Snellen) in the better
eye with correcting lenses;
 Limitation of the field of vision subtending an angle of 20 degree
or worse;
"Person with low vision" means a person with impairment of visual
functioning even after treatment or standard refractive correction
but who uses or is potentially capable of using vision for the
planning or execution of a task with appropriate assistive device;
36

1] Visual disability:
• As per Census 2001.
Seeing disability: A person who cannot see at all (has no perception of light) or
has blurred vision even with the help of spectacles. A person with proper vision
only in one eye was also treated as visually disabled.
A person may have blurred vision and had no occasion to test whether her/his
eyesight would improve by using spectacles - such persons were treated as
visually disabled.
• As per NSSO 2002-
For the survey, visually disabled included (a) those who did not have any light
perception - both eyes taken together and (b) those who had light perception but
could not correctly count fingers of hand (with spectacles/ contact lenses if he/ she
used spectacles/ contact lenses) from a distance of 3 metres (or 10 feet) in good
day light with both eyes open.
Night blindness was not considered as visual
37

Visual disability:
• Common causes of blindness and visual impairments:
-cataract (81%)
- refractive errors (7%)
-glaucoma (2%)
- corneal ulcer , opacity (3%)
-trachoma (0.2%)
-other (6.76%)
[ xerophthalmia , conjunctivitis ,retinal detachment ,
astigmatism, nystagmus ,optic atrophy , retinitis
pigmentosa ]
38

2] Hearing disability:
As per PWD act 1995,
"Hearing impairment" means loss of sixty decibels or more in the
better ear in the conversational range of' frequencies.
As per Census 2001,
“A person who cannot hear at all (deaf), or can hear only loud
sounds was considered to have hearing disability. If a person cannot
hear through one ear but her/his other ear is functioning normally ,
she/ he was still considered to have hearing disability.
A person who is able to hear using hearing aid, was not considered
as disabled under this category.
As per Census 2011,
Persons using hearing aid have been treated as disabled .
39

Hearing disability:
Causes- old age , occupational, post infections- csom , injury ,
congenital
Severity of hearing disability-
profound- could not hear at all or could only hear loud sounds
severe - could hear only shouted words or could hear only if the
speaker was sitting in the front.
moderate - disability was neither profound nor severe. usually ask
to repeat the words spoken by the speaker or would like to see the
face of the speaker while he/she spoke or would feel difficulty in
conducting conversations.
mild - has difficulty in hearing but it does not interfere in day
today conversation
40

3] Speech disability:
As per Census 2001,
“ A person who is dumb or whose speech is not understood by a
listener of normal comprehension and hearing, was considered to
have speech disability.”
Persons who stammer but whose speech is comprehensible were
not classified as disabled by speech.
As per Census 2011 ,
“persons who speak in single words and are not able to speak in
sentences” was specifically mentioned to be treated as speech
disabled.
41

4] Locomotor disability:
Loco motor disability" means disability of the bones, joints muscles
leading to substantial restriction of the movement of the limbs or
any form of cerebral palsy.
• As per Census 2001,
Movement Disability: A person, who lacks limbs or is unable to use
the limbs normally, was considered to have movement disability.
-If any part of the body is deformed
-A person, who cannot move herself/himself without the aid of
another person or without the aid of stick,
- A person who is unable to move or lift or pick up any small
article placed near her/him .
- A person who may not be able to move normally because of
problems of joints like arthritis and has to invariably limp while
moving.
42

4] Locomotor disability:
Specific mention of the following was made in the definition for
Census 2011:
1. Paralytic persons
2. Those who crawl
3. Those who are able to walk with the help of aid
4. Have acute and permanent problems of joints/muscles
5. Have stiffness or tightness in movement or have loose, involuntary
movements or tremors of the body or have fragile bones
6. Have difficulty balancing and coordinating body movement
7. Have loss of sensation in body due to paralysis, Leprosy etc.
8. Have deformity of body like hunch back or are dwarf.
43

5] & 6] Mental Disability
• As per Census 2001,
Mental disability: A person who lacks comprehension
appropriate to her/his age was categorised as mentally disabled.
Mentally retarded and insane persons were treated as mentally
disabled.
• As per NSSO 2002-
• Mental disability: Persons who had difficulty in understanding
routine instructions, who could not carry out their activities
like others of similar age or exhibited behaviours like talking to
self, laughing/ crying, staring, violence, fear and suspicion
without reason were considered as mentally disabled for the
purpose of survey.
44

5]Mental Retardation
• New category introduced at Census 2011.
• Mental retardation" means a condition of arrested or
incomplete development of mind of a person which is
specially characterized by sub normality of intelligence.
• % of disability in MR [As per GOI,13 June 2001]
• ]
• ]
45
Sr.No Type of mental retardation % of disability
1 Mild Mental Retardation 50 %
2 Moderate Mental Retardation 75%
3 Severe Mental Retardation 90%
4 Profound Mental Retardation 100%

6] Mental illness
 New category introduced at Census 2011.
 Mental Illness was covered under the category of
Mental disability at Census 2001
46

7] Any other disability:
New category introduced at Census 2011 to ensure
complete coverage.
 This option enabled respondents to report those
disabilities which are not listed in the question.
In such cases, where informant was not sure about the
type of disability this option of reporting disability as ‘Any
Other’ was available to her/him.
47

8] Multiple disability:
New category introduced at Census 2011.
The question has been designed to record as many
as three types of disabilities from which the
individual was reported to be suffering.
48

 Data sources for disability:
 Census Data-1872-1931,1981,2001,2011
 NSSO Rounds-1981,1991,2002
 Hospital Data
 Special Survey by NGO, Govt.
 Literature
 Research studies
49

 Historical Perspective of disability in Census :
In Census 2011, information on eight types of disability has been collected
In Census 2001, information on five types of disability was collected
The question was dropped in Census 1991
In Census 1981, information on three types of disability was collected
The question on disability was not canvassed in the Censuses from 1941 to 1971
The question on disability was canvassed in all the Censuses since 1872 to 1931
50

 National sample survey [NSSO]:
Sr.N
o
National
sample
survey
Round of NSS Time of survey Disability Included
Prior to 1981, NSS surveys were restricted to only the physically handicapped
persons.
1 First 36 th round July-Dec 1981 visual , communication
(i.e. hearing and/ or
speech) and loco-motor.
2 Second 47 th round July-Dec 1991 visual , communication
(i.e. hearing and/ or
speech) and loco-motor.
3 Third 58 th round July-Dec 2002 visual , hearing, speech
, loco-motor & mental
disability
51

 Present Dataset –Census 2011
 The present set of results pertains to data collected in the
Census 2011 on disability.
 Information on disability of individuals was collected during
the Population Enumeration phase of Census 2011 through
‘Household Schedule’ . Similar information was collected
during 2001 census also.
 Information for individuals residing in ‘Normal’, ‘Institutional’
and ‘Houseless’ households was collected.
 The table C-20- ‘Disabled by age-group and type of disability’
has been generated on the basis of processing 100% Census
Schedules.
52

 Features of Disability Question, 2011
 Has a filter question to ascertain disability status.
 Attempts to collect information on eight types of disabilities as
against five in Census 2001.
 Designed to cover most of the disabilities listed in the “Persons
with Disabilities Act, 1995” and “The National Trust Act, 1999”.
 The placement of the question on disability in the Census
Schedule was changed. The question was brought forward at Q-9
at Census 2011. This was the question No. 15 at the Census
2001.
53

 Questions Canvassed in Census 2011
Codes
54

 Disability certificate guidelines:
As per the persons with Disabilities Act, 1995, seven disabilities
are applicable :
(1) Blindness
(2) Low vision
(3) Leprosy-cured
(4) Hearing impairment
(5) Loco motor disability
(6) Mental retardation
(7) Mental illness
55

 Disability certificate guidelines:
• A Medical Board of three doctors including one
specialist from Medical Department examines the
disabled person and issues the disability certificate in
case of 40% or more percentage disability.
• The Medical Board after due examination give a
permanent disability certificate in cases of such
permanent disabilities where there are no chances of
variation in the degree of disability.
56

Challenges In Issuing Certificate:
 Duplications
 Identification of real persons with Disabilities
 Difficult for the authorities to reach the beneficiaries
 Lack of awareness among the Medical professionals
 Element of subjectivity
 Pressure from politically motivated groups
57

In Maharashtra:
• In SADM- (Software for Assessment of Disability-
Maharashtra) online issuance of disability certificates,-mainly
five (i) Visual impairment (ii) Hearing impairment (iii)
Physical/Locomotor (iv) Mental retardation (v) Mental illness
• In Maharashtra, the issuance of Disability certificates is the
responsibility of PHD (Public Health Department) and DMER
(Department of Medical Education and Research).
• For this the three departments-PHD,DMER& SJSAD(Social
Justice and Special Assistance Department) came together and
helped the IT department in developing this software.
58
[Source: http://sadm.maharashtra.gov.in/sadm ]

59

60

61

62

63

Benefits of SADM
Element of subjectivity and discretion is minimal
 Unique ID
 Duplication check
Centralized database of all Disabled
Centralized database of Doctors/Specialists in the state
 Linkage to Aadhaar (UID Number of the application)
 Transparency and Tracking
Real Time Reports Govt. & NGO’s can avail the data
 Public Domain
64

Governments positive initiative:
Special department –Department of empowerment of persons
with disability from 2012.
Accessible India Campaign- “Sugamya Bharat Abhiyan” 2015
“To make India-Differently Abled-Friendly”
65

Sugamya Bharat Abhiyan
• The Minister of Social Justice and Empowerment on 24
sept 2015 launched Accessible India campaign
• To make public buildings, public transportation, signage
accessible to Persons with Disabilities.
• The Centre will identify more than 50 buildings in 50 major
cities
• Four cities from Maharashtra including Mumbai, Pune,
Nagpur, and Nashik will figure in the list of cities for the
Accessible India campaign
66

International year for disability: 1981
International day for disability: 3, December
67

Way forward :
Scope to improve in defining the concepts of disability
Positive signs from government with good initiatives
Scope in research studies on disability and use for policy
making.
Change should be “Benefits Approach” to “Right's Approach”
Universal accessibility to health care services.
Disability friendly environment creation like transport and
other public facilities.
68

“The problem is not
how to wipe out the
differences but how
to unite with the
differences intact”.
– Rabindranath Tagore
69

References:
1] IAS Topper Ira Singhal: Success story revealed.indiatoday.in.New Delhi. July
6,2015 available on http://indiatoday.intoday.in/education/story/ias-topper-ira-
singhal/1/449482.html
2] Blind IAS candidate Ajit fulfills his Dream. Careers 360,Educational Hub.09
May2014,available on http://www.motivation.careers360.com/node/14929
3] S. Ganesh Kumar et al, Disability and Rehabilitation Services in India: Issues
and Challenges, J Family Med Prim Care. 2012 Jan-Jun; 1(1): 69–73.
4] World Report on Disability. Geneva: WHO; 2011. World Health Organization
downloaded from http://www.who.int/disabilities/world_report /2011/en/
5] Census of India 2011. Data on disability. Office of the Registrar General and
Census Commissioner, India. Available from : http://www.censusindia.n
6] World Health Organization. International Classification of Functioning ,
Disability and Health 2001. Available from http://www.who.int/classification/icf/en
70

References:
7]Persons with disability act,1995 from
https://sadm.Maharashtra.gov.in/sadm/GRs/PWD%20 Act.pdf downloaded on 10
sept2015
8] Disability status in India,58 th NSSO report, downloaded from
http://www.socialjustice.nic.in/aboutdivision3.php on 10 sept2015
9] The Disabled: Health and Human Rights downloaded from
http://www,cehat.org/humanrights/lenichchoudhari.pdf on 10 sept 2015
10]Information on Accessible India Campaign, Press information bureau ,Govt. of
India, available on https://pibindia.wordpress.com/2015/08/17/accessible-india-
campaign-sugamya-bharat-abhiyaan-to-make-india-disabled-friendly/
11] Public buildings in Mumbai, key Indian cities to be made disabled friendly, article
in The Hindu date 26 sept 2015 available on
http://http://www.thehindu.com/news/cities/mumbai/public-buildings-in-mumbai-key-
indian-cities-to-be-made-disabled-friendly/article7692547.ece
71

72

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Seminar on disability By Dr.Santosh Kadle

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