Interregional Consultative Expert Meeting
on disability-sensitive policy design and evaluation
for sustainable livelihoods for all in the twenty-first century

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Disability-Sensitive Policy Design And Evaluation For Sustainable Livelihoods For All In The Twenty-First Century: Hong Kong Experience in a Changing Regional Context

Joseph Kwok

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SECTION TWO
ENUMERATING PEOPLE WITH DISABILITIES IN HONG KONG

Hong Kong has three major sets of statistics on people with disabilities, namely: statistics of the Central Registry for Rehabilitation, statistics of the Rehabilitation Program Plan, and statistics from General Household Surveys. The first two are compiled and managed by the Health and Welfare Bureau and the last one by the Census and Statistics Department.

CENTRAL REGISTRY FOR REHABILITATION

The Central Registry for Rehabilitation (CRR) was set up in 1983 by a government policy bureau to collect and compile information on people with disabilities for purposes of planning and delivery of rehabilitation services and research. CRR covers eight categories of disabilities, same as those recognizes by RPP.

The CRR collects information on people with disabilities on a voluntary basis through relevant government departments and NGOs upon their first contact with a disabled client. To simplify disability certification and to encourage public acceptance, CRR issues a registration card to CRR registrants. The registration card is accepted by increasing number of schemes/organizations, both in private and NGO sectors, as an identity proof for price concessions and privileged services.

In spite of the efforts to encourage registration, the reliability of the CRR data set has always been a major problem. First, the 1992 Green Paper openly admitted the problem of under-reporting (Working Party on Rehabilitation Policies and Services, 1992). Second, the information contained in the Central Registry for Rehabilitation has been found to be seriously out-dated. In a territory-wide research, telephone inquiries were conducted on a sample of registrants to find out whether they could be reached. It was reported that over 70% of the names given had either moved away, died or could not be located (Working Group on Research for International Year of the Family, 1994, p.31).

Still, CRR statistics is being used as a major reference for purposes of policy and services development.

As of March 2001, there were 121,966 registrants in CRR. Among them, 108,958 (89.4%) had single disability, 11,124 (9.1%) had two types of disability, and 1,884 (1.5%) had more than 2 types of disabilities. The distribution of registrants by number of registrations and type of disabilities is given below.

Table 2.1              Distribution of registrations by number of registrations by and types of disabilities

Source: Central Registry for Rehabilitation, 2001.

Note: People with multiple disabilities are registered under more than one type of disability.

Table 2.2              Number of registrations by age group and by sex

Source: Central Registry for Rehabilitation, 2001.

Note: People with multiple disabilities are registered under more than one type of disability.

The General Household Survey Institutional Survey Of Census And Statistics Department

The Census and Statistics Department collected selected disability prevalence rates during the 1976 Population By-census and the 1981 Population Census. Because of the limitations caused by enumerators’ lack of experiences, respondents’ unwillingness to provide information, complexity of the exercise and difficulties in definition and identification, the information collected was believed to suffer from serious under-reporting. As a remedy, the Census and Statistics Department (CSD) incorporated a territory-wide survey on persons with disabilities and chronic diseases, as a special topic enquiry, into its regular General Household Survey (GHS) (Census and Statistics Department, 2001).

The survey method

The GHS is a sample survey conducted by CSD on a regular basis primarily to collect data on concerning labour force, plus a supplementary part on special topics required by other departments and policy bureaux. The GHS sample covers all Hong Kong land-based non-institutional population.

The special topic survey of the GHS collected data from PWDs living in domestic households extended over the entire year of 2000 in order to obtain a sufficiently large sample of people of different disabilities. The final random sample size was 44,000 households (about 2% of all households in Hong Kong), with a response rate of 90%.

A separate institutional survey was conducted in the same year, covering those resided in social welfare institutions, long-stay care hospitals and rehabilitation centers. A two-stage stratified disproportionate sampling design was employed. The final random sample size was 70 institutions and about 1,400 respondents, with a response rate of 90%.

In both types of survey, well-trained and experienced interviewers were employed to conduct face-to-face interviews. The following data were collected: (a) type disability, (b) degree of severity, (c) impact of disability on different aspects of life, (d) primary carer and caring services required, and (e) transportation. 

Coverage and definition of disability

The special survey adopted a different approach in defining disability from that of the CRR. It defined PWD as those who (i) had been diagnosed by qualified health personnel (such as practitioners of Western medicine and Chinese medicine) as having one or more of the following 7 conditions; or (ii) had perceived themselves as having one or more of the first 4 of the following 7 conditions which had lasted, or were likely to last, for a period of 6 months or more at the time of interview. The seven conditions are further tested by the following indicators to confirm their existence as well as the degree of severity:

Restriction in body movement: confirmed by medical diagnosis, or self reporting as having long-term difficulty in movement of upper/lower limb or other parts of the body; required wheelchair or similar assistive device, had used artificial limbs, needed the help of others to carry a heavy object, grasp a small object and walk up/down a flight of stairs.

Seeing difficulty: confirmed by medical diagnosis, or self reporting as having long-term difficulty in seeing with one eye or both eyes with or without correcting glasses; unable to see at all, required a specialized visual aid, no required a specialized visual aid.

Hearing difficulty: confirmed by medical diagnosis, or self reporting as having long-term difficulty in hearing; unable to hear all, required a specialized hearing aid, not required a specialized hearing aid.

Speech difficulty: confirmed by medical diagnosis, or self reporting as having long-term difficulty in speaking or being understood by others; unable to speak at all, required a specialized aid, not required a specialized aid.

Mental illness: confirmed by medical diagnosis (including ex-mentally ill)

Autism: confirmed by medical diagnosis

Mental handicap: confirmed by medical diagnosis.

Limitations of the GHS survey

The GHS survey is subject to at least two limitations: (a) self-reporting or subjective answers may give wrong information, (b) sensitivity or lack of awareness of certain disability conditions leading to under-reporting.

Under-estimation in respect of persons with mental handicap in the GHS survey

When the survey findings on the number of mentally handicapped persons are compared with that of the CRR, the survey findings showed significant under-estimations. As a result CSD made use of statistical distribution assumptions derived from CRR and GHS and Institutional survey on proportions of pre-schoolers likely to have mental retardation, proportions between students and non-students with mental handicap, and proportions between economically active and non-active persons with mental handicap. Based on these assumptions, CSD estimates that the number of persons with mental handicap is between 62,000 (excluding pre-schoolers) to 87,000 (including pre-schoolers). Because of the crudeness of the estimates for people with mental handicap, CSD does not include them in the statistical tables.

For the purpose of this paper, the crude figure of 87,000 as supplied by CSD is used.

Estimates of people with disabilities and their key statistics

Table 2.3              Estimated number of persons with disabilities by CSD

Source: Census and Statistics Department, 2001; Table 5.1a and Appendix 3C.

Tables 2.4 to 2.8 below give key demographic statistics of the PWD with single or multiple disabilities covering those with restriction in body movement, seeing difficulty, hearing difficulty, speech difficulty, mental illness, autism, but excluding mental retardation.

Table 2.4              Persons with disabilities (those with restriction in body movement, seeing difficulty, hearing difficulty, speech difficulty, mental illness, autism, but excluding mental retardation) by age/sex

Sex

Source: Census and Statistics Department, 2001; Table 5.1b.

Notes:

@        A person might have more than one selected type of disability and hence the overall number of persons with disabilities is smaller than the sum of the number of persons with individual types of disability.

*          As a percentage of all persons in the respective age/sex groups. For example, among all persons aged below 15, 0.8% were persons with disabilities.

Some estimates are based on only a small number of observations and thus should be interpreted with caution.

Table 2.5  Persons with disabilities (those with restriction in body movement, seeing difficulty, hearing difficulty, speech difficulty, mental illness, autism, but excluding mental retardation) by marital status/educational attainment

Source: Census and Statistics Department, 2001; Table 5.1c.

Notes:

*          A person might have more than one selected type of disability and hence the overall number of persons with disabilities is smaller than the sum of the number of persons with individual types of disability.

Some estimates are based on only a small number of observations and thus should be interpreted with caution.

Table 2.6               Persons with disability (those with restriction in body movement, seeing difficulty, hearing difficulty, speech difficulty, mental illness, autism, but excluding mental retardation) by age/activity status

Source: Census and Statistics Department, 2001; Table 5.1f.

Notes:

@        A person might have more than one selected type of disability and hence the overall number of persons with disabilities is smaller than the sum of the number of persons with individual types of disability.

*          Figures in brackets represent the percentages in respect of all persons aged 15 and over with the respective types of disability.

^          Figures in brackets represent the percentages in respect of all persons aged 15 and over.

Some estimates are based on only a small number of observations and thus should be interpreted with caution.

Table 2.7            Employed persons with disabilities (those with restriction in body movement, seeing difficulty, hearing difficulty, speech difficulty, mental illness, autism, but excluding mental retardation) by single disability/multiple disabilities

Source: Census and Statistics Department, 2001; Table 5.2a.

Notes:

*          An employed person might have more than one selected type of disability and hence the overall number of employed persons with disabilities is smaller than the sum of the number of employed persons with individual types of disability.

Figures in brackets represent the percentages in respect of all employed persons with the corresponding types of disability.

Some estimates are based on only a small number of observations and thus should be interpreted with caution.

Table 2.8               Employed persons with disabilities (those with restriction in body movement, seeing difficulty, hearing difficulty, speech difficulty, mental illness, autism, but excluding mental retardation) by age/sex

Source: Census and Statistics Department, 2001; Table 5.2b.

Notes:

*          An employed person might have more than one selected type of disability and hence the overall number of employed persons with disabilities is smaller than the sum of the number of employed persons with individual types of disability.

Some estimates are based on only a small number of observations and thus should be interpreted with caution.

Owing to the small number of sample observations in respect of employed persons with autism as identified in the survey, the estimates pertaining to their demographic and socio-economic profiles were subject to relatively large sampling error.  They were therefore not presented in this report in consideration of their limited precision.

PREVALENCE RATES ADOPTED BY THE GOVERNMENT REHABILITATION PROGRAMME PLAN

The prevalence rates of the number of PWD as adopted by the Government Rehabilitation Programme Plan are derived from a range of data sources, including that of CRR, clinical records, prevalence rates as adopted by western countries, local surveys, and etc. (Health and Welfare Bureau, 1999). The prevalence rates are presented in the following tables.

Table 2.9  Estimated Number of Autistic Persons

Source: Health and Welfare Bureau, 1999; Table 5.2

Table 2.10 Estimated Number of Mentally Handicapped Persons

Source: Health and Welfare Bureau, 1999; Table 7.1.

Table 2.11  Prevalence of Hearing Impairment

Source: Health and Welfare Bureau, 1999; Table 6.1.

Table 2.12  Estimated Number of Hearing Impaired Persons

Source: Health and Welfare Bureau, 1999; Table 6.2.

Table 2.13              Estimated Number of Mentally Ill Persons Requiring Rehabilitation Services between 1998 and 2002

Source: Health and Welfare Bureau, 1999; Table 8.2.

Table 2.14              Prevalence of Physical Handicap and Estimated Number of Physically Handicapped Persons

Source: Health and Welfare Bureau, 1999; Table 9.1.

Table 2.15              Prevalence of Visual Impairment

Table 2.16              Estimated Number of Visually Impaired Persons

Source: Health and Welfare Bureau, 1999; Table 11.2.

Table 2.17              Number of persons by types of disability from RPP administrative estimates for Year 2001

Source: Health and Welfare Bureau, 1999.

A CRUDE COMPARISON BETWEEN THE ESTIMATES OF CSD AND RPP

The table below gives a crude comparison between the estimates of CSD and RPP. The comparison must be interpreted with caution as the two systems adopt different definitions for various categories of disability, and also different statistical assumptions.

Table 2.18             A crude comparison between the estimates of PWD as percentage of total Hong Kong population (6.796,700) given by Census and Sta