Consolidated Reply: Recommendations of the Expert Group Meeting on developing supplementary targets and indicators on social inclusion, population, gender equality and health promotion to strengthen the MDG process

25 March 2008
Prepared by the Moderators Team

Original Query: Srinivas Tata, UNESCAP Thailand

The Expert Group Meeting on developing supplementary targets and indicators on social inclusion, population, gender equality and health promotion to strengthen the MDG process discussed key issues related to MDG achievement in the ESCAP region was held on 13-15 November, 2007.

For the benefit of new participants of this discussion group, a brief recapitulation is provided below:

This meeting was held as part of the project being implemented by ESCAP along with all regional commissions, in order to develop supplementary targets and indicators on social inclusion, population, gender equality and health promotion to strengthen the MDG process (which are areas hitherto perceived to be not well covered by existing MDG targets and indicators). This project thus draws its inspiration from the Millennium Declaration rather than the gaols and targets.

The details of the project are available in a brochure which can be downloaded: http://www.unescap.org/esid/hds/development_account/images/DA_brochure_final.pdf

The details of the expert group meeting and papers are available at: http://www.unescap.org/esid/hds/development_account/schedule_of_meetings.asp#egm07

The recommendations of the meeting are at the following link: http://www.unescap.org/esid/hds/development_account/ConsolidatedDraft-finalVersion.pdf

All participants are requested to provide their inputs on the implementation of the recommendations, especially the suggested indicators and . We would particularly like to have your suggestions on areas of further research and study under the project. The suggested areas in the EGM are below:

SUGGESTED AREAS OF RESEARCH AND FURTHER STUDY

1. Research the key challenges and the socio-economic, cultural and political implications of population ageing by studying:
   
   1. the rising demand for health services
   2. growing requirement for long-term care
   3. declining family support
   4. increasing needs for social support and income and social security
   5. labour force participation of the elderly including in the informal sector
   6. the situation of older persons living alone
2. Conduct longitudinal research on the quality of life of older persons and the support systems available to them in order to track elderly well-being and enhance the evidence-base for policy making on ageing issues.
3. Research on the situation of persons with disabilities throughout the life cycle, in particular, with respect to poverty, their access to information, communication and technology, support services and environmental accessibility.
4. Research on sub-groups within the population of persons with disabilities, such as persons with intellectual disabilities, deaf persons, women with disabilities, and those in rural and remote areas.
5. Research the situation of socially vulnerable and disadvantaged groups in the context of MDGs, paying particular attention to the challenges of social inclusion and effective strategies to reduce vulnerability and promote inclusion.
6. Study the long-term sustainability of programmes funded by governments and other donors in respect of socially vulnerable and disadvantaged groups.
7. Document best practices and lessons learned with regard to the planning, implementation and assessment of policies, strategies and programmes for achieving the MDGs.
8. Document the differentials in MDG achievement in detail between social and geographical groupings, including sub-national entities, and variations between general population and among vulnerable groups, along with determinants of such disparities.
9. Study and document links between fertility and poverty (short to medium term) and relate these links to their direct and indirect impact on health and education outcomes and in turn the effect on productivity and incomes.
10. Suggestions for institutionalization of new target and indicators arrived at this project. Men’s sexual and reproductive health is also an important area of study. Needs of adolescents and young people also need to be studied further.
11. Study on further evolution of health coverage, needs of ageing populations and health promotion indicators (in association with WHO). The need to go beyond sectoral interventions towards comprehensive health system strengthening.

We look forward to your inputs in the matter.

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Srinivas Tata
Social Affairs Officer
Health and Development Section
Emerging Social Issues Division UNESCAP,
UN Building Ratchadamnern Nok Avenue Bangkok-10200
Tel: 02-288-1592 e-mail: tatas@un.org

Consolidated Reply : Summary of Responses on Expert Group Meeting recommendations report

The recommendations report of the Expert Group Meeting on developing supplementary targets and indicators on social inclusion, population, gender equality and health promotion to strengthen the MDGs (Bangkok, 13-15 November 2007) had been circulated to the e-discussion group for feedback.

The recommendations of the report will be considered and discussed during a UN interregional workshop to share regional findings on strengthening social inclusion, gender equality and health promotion in the MDGs planned later this year for the project. Consideration will also be made as to how the recommendations can feed into and advance indicator work in these areas of the MDGs through various UN bodies, mechanisms and forums.

The following are key highlights of the resulting e-discussion on the report.

Implement the MDGs taking into consideration subgroups and disaggregated analysis:

• It is important to ensure the MDGs are implemented taking into consideration disaggregation by various subgroups. Disaggregated analysis by these various groups is needed and should be integrated in all research activities.
• Disabled women and the disabled were cited as an example of an important subgroup. Other important subgroupings cited include older persons, youth and geographical factors such as remote (rural/outer island)
• Women do not comprise one heterogeneous group. There are many subgroups of women based on ethnicity, disability, class, religion, minority status, women from different socioeconomic classes, etc.
• Examples of areas where disaggregated analysis would be very informative: studies on the use of contraceptives, prevalence of NCDs and other health risk factors.

• A key challenge to data collection on disabled persons is unclear definitions on who is disabled and what constitutes a disability. Recent Somoan experience with 2006 Population and Housing Census illustrated this.
• Definitions for the disabled vary across countries based on different criteria. Establishing uniform definitions on the disabled is complex and not easy to find consensus on.
• The concept of disabled has developed and evolved over time. The following were reported during the discussion as some examples of its historical development:
  
  1. Original traditional concept of disability: based on defining disability on the basis of one's physiological, intellectual or psychiatric conditions considered "abnormal" by doctors and professional eyes.
  2. Rise of civil rights consciousness among persons with different disabilities draws people's attentions to the lack of enabling environment for disabled and societal and environmental flaws (ie. Inaccessible infrastructure for the disabled, lack of information, lack of devices, attitudinal bias against persons with disabilities, rigid notion of what is "normal.").
  3. Current concept of disabled: increasing global consensus that disability is not a static attribute of an individual but a dynamic condition which results from an interaction between one's condition and environment. This is reflected in the Convention on the Rights of Persons with Disabilities which was adopted in 2006 and is now being ratified by many countries. Disability is also approached from a wider perspective paying attention to the societal, environmental, attitudinal and institutional barriers.
  4. An underlying notion is that the disabled’s impairments coupled with various barriers hinder the disabled’s “full and effective participation in society on an equal basis with others”.
• Different countries have different criteria for defining the disabled. Definitions for the disabled are set out in a number of countries’ ordinances and laws [see detailed discussion for official definitions in Hong Kong and Korea].
• Some factors affecting how countries establish definitions for who are disabled are:
  
  1. What is the definition to be used for? For example, to decide who is eligible for public assistance, services and/or cash.
  2. To allocate resources efficiently for those “who really need assistance” when limited resources are available.
  3. Classification of a person as disabled is contingent on certification by medical doctor or other pre-conditions in a number of countries.
  4. To reduce disability fraud (people fraudently report to be disabled to gain disability benefits) which was reported to be a problem in some countries.

• To implement the MDGs, the extent of poverty experienced by "persons with disabilities" can be measured on the basis of disabled/impaired people defined by social welfare related laws or by anti-discrimination law. Further clarification on this measurement could be useful.
• The issue of social disability was raised. Many people experience impairment/disability due to discrimination based on gender, race and caste, ethnicity. Is there scope for incorporating this element in current definitions of the disabled?
• Should disability be defined on the basis of physical impairment only, or on the basis of an individual’s ability to not live or to live a normal life? Should someone with a physical impairment, but still living an active, normal life be considered disabled?
• On the issue of the elderly, should those experiencing blindness, hearing loss or osteoporosis usually characteristic of old age be considered disabled, though many of them remain active?

Current and key works on disability statistics

The International Classification of Functioning, Disability and Health (ICF) provides a key framework for statisticians and policy makers for disability statistics.

The UN’s General Assembly resolution 62/127 highlights the need to reinforce the disability perspective in the MDGs. A report on this issue will be considered during the 63rd session of the General Assembly in autumn 2008.

Countries and national statistical offices developing their statistical capacity building in disability statistics may be interested in the UN’s 2010 Programme on Population and Housing Censuses which includes recommended tabulations on “human functioning” relating to disabilities.

Draft census recommendations can be accessed at: http://unstats.un.org/unsd/demographic/sources/census/2010_PHC/default.htm.

The Washington Group and ESCAP are working on creating a workable set of questions for the census and survey to capture persons with disabilities and their socioeconomic status.

Announcements and upcoming meetings

A Regional Workshop on Promoting Disability Data Collection through Population and Housing Census is scheduled from 8-10 April 2008 in Bangkok, Thailand. The workshop is being organized by the UN Economic and Social Commission for Asia and the Pacific. For more information on the workshop, contact Ms. Aiko Akiyama, UNESCAP Subprogramme on Disabilities, telephone: (66-2) 288-2315, email: akiyama@un.org

The Washington Group will be meeting on disability statistics in Manila, Philippines. (2008 date and exact venue is still to be determined).

Recommended resources cited during discussion

interRAI
This organization is a collaborative network of researchers in over 20 countries committed to improving health care for persons who are elderly, frail, or disabled. It makes available comprehensive disability assessment tools, as well as ADL and other criteria to assess disability. Hearing and Visual problems are also included in this tool. Offficial website is: www.interRAI.org.

UN Economic and Social Commission for Asia and the Pacific, Statistics Division
Draft Technical Manual on Disability Statistics (2006). Proceedings; Fourth Workshop for Improving Disability Statistics and Measurement, Bangkok, Thailand, 20-22 June 2006. Access at: http://www.unescap.org/stat/meet/widsm4/index.asp. The UN’s 2010 Programme on Population and Housing Censuses includes recommended tabulations on “human functioning” relating to disabilities. Draft census recommendations are available at: http://unstats.un.org/unsd/demographic/sources/census/2010_PHC/default.htm.

Thank you to the following members for their contributions:

Aiko Akiyama, Alfred, Anjana Bhushan, Clint Rapley, Ghulam Nabi Nizamani, Kim Robertson, Marie Sicat, Malaefono Faafeu Taaloga, Maya Thomas, Dr Nugroho Abikusno, MD, MSc (nut), DrPH, Osama Rajkhan, Ramaiah, Dr Sharifa Begum, and Thaworn Sakunphanit.

For full responses of the consolidated reply, please download the attached file.