A.l The absence of overall statistics about the number of people with disabilities in Ireland and the lack of research into specific areas of disability has been commented upon repeatedly in this report.
A.2 There are several difficulties involved in compiling accurate statistics about the number of people with disabilities. These include the definition of disability: whether it is based on a medical definition or, the definition favoured by the Commission, based on a social definition which sees disability as something that arises from society's failure to adapt itself to the different ways in which people with impairments accomplish activities. Another difficulty is that disability is a relative concept and therefore requires a cut-off point as to the degree of severity of disability (however defined) which would be included or excluded.
A.3 In addition, it is difficult in practice to distinguish between sickness or illness, on the one hand, and disability on the other hand and this means that for many purposes the two categories are combined. In general, sickness or ill-health are regarded as temporary while disability is thought of as being more permanent but for many purposes the two categories are combined.
A.4 The perception of a disability and its extent, whether by a person with a disability him/herself or another, also depends on a complex and inter-related combination of considerations including the following:
A.5 In relation to (c), for example, there is a considerable overlap between "people with disabilities" and "the elderly": whether particular older people are considered as having disabilities depends on a lot of factors, including subjective ones. This subjectivity applies whether disability is defined by experts, medical or otherwise, or by people with disabilities themselves.
A.6 Even when definitions and cut-off points are agreed, the problem remains of estimating the numbers of persons in the categories corresponding to the definitions. This would require a major survey of the population.
A.7 The Commission asked the Economic and Social Research Institute to assist it by collating existing quantitative data on disability which might enable it to arrive at some overall estimates. The ESRI's report suggested that the prevalence and incidence of disabilities could be estimated from existing data in three ways:
by reference to statistics on disability-related income support schemes; on the basis of data from the Census and from the Labour Force Survey on people who are outside the labour force for reasons of permanent sickness on disability; from the results of sample surveys in which people themselves estimate
A.8 The ESRI report analysed these different data bases in some detail. The estimates arrived at on the basis of these three methods, and the disadvantages of each method from the point of view of arriving at a reliable overall figure, are set out in Table 1, at sections 1 to 3 overleaf.
A.9 The area of mental handicap, or intellectual disability, is the only area of disability in which comprehensive statistics are collected systematically on a census basis for administrative purposes. The Department of Health established a computerised national mental handicap database in 1995 and the first statistics became available in 1995. These show, in general terms, that there are approximately 26,000 persons with intellectual disabilities, from mild disability to profound disability, known to the Health Boards of whom over 6,000 are children under 15 years of age (Mulcahy, Mulvany and Timmons, 1996).
Methods of Estimation
Estimated Numbers and/or percentages
Limitations of Method
|1. Statistics on disability-related income support schemes||106,000 long-term recipients (1994) of Department of Social Payments & DPMA (4.9% of population aged 15-64)||
1. People in the labour force, whether employed or unemployed, not included.
2. Non-insured people who do
not pass DPMA family mean-test not included, e.g. many married women.
3. People over 65 and children not included.
Most people in residential care not included.
2. The Census and Labour Force Survey (LFS)
The Census is based on self- reporting
LFS is a sample survey done
80,000 "unable to work due to sickness or disability" (Census, 1991)
66,000, as above, (Labour Force Survey, 1995)
1. Underestimates disability among older middle aged people who are more likely to describe themselves are "retired".
2. Underestimates disability among women, especially married women, who are more likely to describe themselves as "engaged in home duties".
3. Children not included
|3. Surveys of people estimating their own disabilities.||
(a) 11.3% of all age-groups experienced restrictions of activities due to illness, injury or emotional/mental health problems (Living in Ireland Survey, 1994)
(b) 15.4% of over-65s could not do at least one "daily activity"(ERSRI Survey of over-65s, 1993)
1. Underestimates disability which is thought by people to be a part of growing old.
2. Underestimates extent of mental illness.
3. People in residential care not included.
4. Children not included.
|4. European Averages (Eurostat, 1995, Disabled Persons, Statistical Data, Second Edition)||
(a) c. 12% of total population disabled
(b) 6-8% of people aged under 60 disabled
(c) 4-5% of people aged under 60 receiving disability-related payments.
The rates of disability vary from one country to another depending on:
• the structure of the population by age;
• methodological differences concerning the definition and method of identifying persons with a disability;
• technological and industrial characteristics of countries and their experiences of war
A.l0 Another approach to estimating the numbers of people with disabilities in Ireland is to rely on estimates arrived at in other countries, including the UK, where comprehensive surveys have been done. However, differences between Ireland and these other countries in terms of demographic structure, historical experience, economic conditions, and public attitudes make such an exercise hazardous.
A.ll Fortunately, a volume became available in 1995 which collates statistics on disability from the twelve EU Member State (as they were before the last accessions). Grammenos (1995) in his Disabled Persons: Statistical Data, published by the Statistical Office of the European Communities presents detailed tables based on censuses, surveys and administrative data (ie, social security data) in each country. Ireland is included but, generally speaking, there are more comprehensive data bases for most other countries. Most of this report is devoted to tabular data from individual countries but it identifies (pp. 324 - 327) patterns across countries which enables it to arrive at some general conclusions about the prevalence of disability in EU countries. The main estimates are in the fourth section of Table 1.
A.12 The most striking finding is that the "analysis of the percentage of disabled persons by age group revealed a stable and uniform relationship in the Member States". Disability is related to age: "the rate of disability rises from 1% for the very young to around 90% for the very elderly". The data also shows that the rate of disability is higher among women than among men, which can be partly explained by their greater longevity. Another unsurprising result is that "as the degree of disability increases, the number of persons [affected] declines": in other words fewer people have more significant (serious) disabilities; more people have less significant (serious) disabilities. The distribution by degree of disability is the same for men and women.
A.13 In relation to types of disability, the conclusions in the report, which are approximate, are as follows:
One might say that persons with an intellectual or psychiatric impairment account for 5 to 15% [of all people with disabilities], with a sensory impairment for 10 to 18% and a physical impairment for 50 - 80%. Locomotor impairments predominate among this latter.
A.14 The Commission attached some importance to these general conclusions since they represent the results of data collection in eleven other countries as well as Ireland. There is no reason to think that these general conclusions do not apply to Ireland too, although all the relevant data is not available for Ireland.
A.15 The Commission concluded that one can, on the basis of the data presented in Table 1, arrive at reasonably reliable estimates of the numbers of people with disabilities in Ireland. This has been done by trying to fit the figures in Table 1 together like pieces of a jigsaw. In fact, the pieces overlap instead of fitting neatly together and it becomes a question of presenting rounded overall figures that are:
A.16 Where these data still allow for variations in estimates, the Commission tended to adopt conservative ones. Overall rounded estimates are presented in Table 2 below on the basis that these figures, despite their limitations, give a reasonably accurate picture. It notionally covers different types and degrees of disability and includes both people in the labour force and people outside the labour force who are usually categorised as "engaged in home duties" or "retired".
TABLE 2: THE PREVALENCE OF DISABILITY IN IRELAND
|Age Group||No. in Population (2)||% with Disabilities||No. with disabilities (3)|
A.17 The estimated overall number of people with disabilities, at 360,000, represents 10% of the population as compared with an average of 12% for EU countries (Grammenos, 1995, p. 325; see Table 1). It is interesting to note that recent surveys in Northern Ireland estimated that 17.4% of the adult population had disabilities (McCoy and Smith, 1992) as were 3.5% of the child population (Smith et aI., 1992). Our own estimates suggest that half of all people with disabilities are aged 60 and over.
A.18 It is worth nothing that only a small minority of people with disabilities are in residential care although, as we have said in the body of our Report, they are likely to be most disadvantaged. For example, available official statistics indicate that about 500 children with mental handicap or intellectual disability are in residential care, there are about 34,000 adults in residential care, including hostels and "community residences", i.e. 7,000 persons with mental handicap, 12,000 with mental illness and 15,000, mainly older people, with various levels of dependency, in residential facilities for the elderly.