Key Messages

• "Disability" is now usually defined in terms of functional limitation in activity resulting from a long-term condition or health problem that cannot be readily corrected. Mental illness is increasingly acknowledged as a "disability" rather than an "illness", and is often labelled "psychiatric disability" in recognition of this.
• Approximately one in five New Zealanders report some level of disability.
• Disability rates increase with age. The number of people with disabilities is therefore expected to grow as the population ages.
• In all age groups under 65, Māori have higher rates of disability than non-Māori.
• Half of all adults with disabilities require assistance and one in eight have an unmet need for special equipment.
• The number of people receiving Invalids Benefit has doubled in the last ten years to 64,500. The number receiving Sickness Benefit has increased by 51% to 36,500.

Defining the disability community

The size and characteristics of the disability community were measured in the Disability Surveys of 1996/97 and 2001. Levels of disability in the population and the profile of the disability community presented here are based on information from these surveys, as well as information about people in receipt of disability-related benefits from the Government.

A functional concept of disability was used in the Disability Surveys, based on the World Health Organisation (WHO) definition:

"...any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being."

Using this concept, a disability was defined as any self-perceived limitation in activity resulting from a long-term condition or health problem. People were not considered as having a disability if an assistive device (such as glasses) completely eliminated their limitation. In addition, the limiting condition must have lasted, or be expected to last, for at least six months.

Mental illness has often been regarded as an “illness” rather than as a disability, in particular because it has been seen as a state that can be remedied and is of limited duration. However, there is now increased recognition that mental illness is a continuing condition, although often characterised by a fluctuating pattern which limits activity on an intermittent basis, in response to crises, rather than an ongoing basis. "Mental illness" is thus now generally accepted as a disability, and is increasingly labelled “"psychiatric disability" in recognition of this.

According to WHO1, mental disorders figure among the leading causes of disease and disability in the world. Depressive disorders are already the fourth leading cause of the global disease burden. They are expected to rank second by 2020, behind ischaemic heart disease but ahead of all other diseases.

Numbers and rates of disability

In 2001, a total of 743,800 New Zealanders reported some level of disability in 2001. Although the total number of people with disabilities has increased by 41,800 since 1996/97, the overall disability rate of one in five has not changed.

Twenty percent of people living in households have a disability, compared with 97% of those living in residential facilities.

Estimated disability rates for New Zealand appear to be higher than those of other OECD countries, although the findings are not directly comparable.2

Disability rises with age

Disability rises with age. In 2001, 11% of all New Zealand children under 15, 13% of adults aged 15-44, 25% of adults aged 45-64, and 54% of people aged 65 and over reported having a disability (Table 1). The overall disability rate for 15-64 year olds was 17%. The 2001 disability rates for each age group were similar to those observed in 1996/97.

Of all those who reported a disability in 2001, 90,000 (12%) were children under 15 years, 413,200 (56%) were in the main working ages of 15-64 years, and 241,000 (32%) were aged 65 and over.

Table 1 - Number of people with disabilities and disability rates, by age and gender, 2001

Source: Statistics New Zealand, Disability Counts, 2001, derived from Tables 1.01a, 1.02a. Includes all people with disabilities, whether living in households or residential facilities.

The number of people aged 45-64 years is expected to grow by around 200,000 between 2002 and 2010, as the baby boom generation ages. This could see 50,000 more people with disabilities in this age group over the next eight years, increasing the overall disability rate for people under 65 years.

Over the same period, the number of people aged 65 and over is expected to grow by almost 90,000. With around half of people in this age group experiencing disabilities, this could increase the current number of people with disabilities by a further 40-50,000. People aged 65 and over who have a disability as a result of an illness or the normal ageing process do not necessarily consider themselves as part of the disability sector despite the fact that they often have similar support needs to younger disabled people. Advances in care and medicine are likely to increase the numbers of people with disabilities who live to older ages.3

Gender differences are evident among children

Among children under the age of 15 years, boys are more likely to have a disability than girls (13%, compared with 9% of girls). This gender difference is also evident among Māori and Pacific children.

In the age groups 15-44 and 45-64, there is no statistically significant difference between the disability rates for males and females.

Older women consistently have higher prevalence rates of disability than older men, particularly at ages 75 and over. Women do not develop disability more often than men, but they survive longer with their disabilities.4

Disability rates are higher among Māori

The overall disability rate for Māori is one in five, the same as for the total population, while the overall rate for Pacific peoples is one in seven. However, both the Māori and Pacific populations are relatively young, with smaller proportions aged over 65 where disability is most concentrated. In all age groups under 65, rates of disability are consistently higher for Māori than for other ethnic groups.5

Among children under 15, the Māori disability rate was 15% in 2001, compared with 11% for European children and 8% for Pacific children. At ages 45-64, the Māori disability rate of 34% was substantially higher than the rate for Pacific people (26%) or Europeans (25%). Higher rates for Māori women in this age group account for most of the difference: 39% of Māori women aged 45-64 reported a disability, compared with 29% of Māori men.

For each of the three main ethnic groups, disability rates for 45-64 year olds were around twice those of younger adults.

Source: Statistics New Zealand, Disability Counts, 2001, derived from Table 3.01a

Few people under 65 with disabilities live in residential facilities

Almost all adults with disabilities (96%) live in households, while the remaining 4% (27,300) live in residential facilities, mainly in rest homes. Older people account for a large majority of adults with disabilities in residential care (92%) and the majority (70%) are women.

Of all adults aged 15-64 reporting disabilities in 2001, only 0.5% (an estimated 2,200 people) lived in residential facilities. About half lived in special units for the intellectually, mentally, or physically disabled and the remainder lived in rest homes. Males make up the majority of 15-64 year olds with disabilities living in institutions (59% in 2001).

In 1996/97, the estimated number of 15-64 year olds living in residential facilities was somewhat higher (3,800) and they made up 1% of working-age adults with disabilities. However, the difference in numbers is not statistically significant.

Very few Māori with disabilities live in residential facilities, partly because they are highly concentrated in the younger age groups and most people in residential facilities are aged 65 and over. In 2001, Māori made up less than 3% of all adults with disabilities aged 15 and over living in residential facilities.

The survey of disability among children included only those living in households.

People with disabilities are more likely to live alone

Among those living in households, people with disabilities were more likely to live alone than people without disabilities (18%, compared with 7%). This is partly because disabled people tend to be older than non-disabled people and older people are more likely to live alone. At ages 45-64, 17% of people with disabilities lived alone, compared with 12% of those without disabilities. At ages 65 and over, the proportions were twice as high (36% and 27%, respectively).

The majority of adults with disabilities have partners

An estimated 61% of adults under 65 with disabilities living in households had a spouse or partner. This is on a par with adults of the same age who do not have disabilities (63%). Fewer Māori and Pacific adults with disabilities had partners (52% and 53%, respectively).

Older people with disabilities are much less likely than older people without disabilities to have a partner (56%, compared with 66%). This reflects the higher prevalence of both disability and widowhood among the very old.

Physical disabilities are the most common disability type for adults

Over half (55%) of adults aged 15-64 with disabilities living in households reported some kind of physical disability. Physical disabilities involve some restriction of movement or loss of agility.

Thirty-five percent were affected by sensory disabilities, which cover sight and hearing disabilities. Forty-four percent reported disabilities that were classified as “other”, a group that included speaking, learning or memory disabilities.

Another 21% were limited by psychiatric or psychological disabilities, while intellectual disabilities affected 6% of adults with disabilities in households.

Among older people with disabilities, 83% reported physical disabilities, 51% sensory disabilities, and 30%, “other” disabilities.

Chronic health problems and sensory disabilities are the most common types of disabilities among children

Chronic health problems and sensory disabilities were common among children with disabilities, each being reported by over one-third (around 30,000). Psychiatric or psychological disabilities affected 25% (over 22,000) and intellectual disabilities 14% (13,000). An estimated 4,600 children (5%) had a limitation requiring the use of technical equipment such as a standing frame, wheelchair or artificial limb.

A large group of children (58% or 52,000) reported a disability classified as "other". This included children with speaking limitations, learning and developmental difficulties and children requiring special education due to a limitation.

Number of disabilities

Just over half (53%) of adults aged 15-64 living in households have more than one disability, compared with 90% of those living in residential facilities.

People aged 65 and over were much more likely to have more than one disability (70% of those living in households and 97% of those in residential facilities).

Accidents and illness are the leading causes of disability for working-age adults

The leading cause of disability among adults aged 15-64 living in households was an accident or injury (38%), followed by a disease or illness (35%). Thirteen percent reported that they had a disability which had existed since birth.

The ageing process accounted for 7%, while 21% reported causes that were categorised as “other”. Almost one in five (19%) did not specify a cause, and this included those who did not know the cause of their disability.

Disease or illness was the leading cause of disability for those over 65 years, reported by 50%. This was followed by the ageing process (40%), accident or injury (26%), other causes (20%) and conditions that had existed since birth (3%).

Lifelong conditions and illness are the leading causes of disability for children

Forty-one percent of children with disabilities reported a disability that had existed from birth. Thirty-three percent reported a disease or illness-related disability, followed by “other” causes (19%) and accident or injury (3%). One quarter of children did not specify the cause of their disability, including those who did not know the cause.

Half of adults with disabilities require assistance

The severity of limitation caused by disability is defined by the level of assistance required. People with moderate disabilities require special equipment relating to their limitation or assistance with some tasks. People with severe disabilities require daily assistance with tasks such as bathing and preparing meals.

In 2001, 39% of adults aged 15-64 in households had moderate disabilities requiring some assistance and 10% had severe disabilities requiring daily assistance. Of those living in residential facilities, 67% had severe disabilities and another 20% had moderate disabilities.

Of all disabled adults aged 15-64 living in households, 30% reported receiving help with everyday activities. Among those aged 65 and over in households, the proportion was twice as high (60%).

Women are more likely than men to provide help to people with disabilities on an unpaid basis, particularly women in late middle age. According to the 2001 Census, one in six women aged 45-64 years (15%) provided unpaid help in the previous four weeks to someone outside their own household who was ill or had a disability (Table 3, below).

Table 3 - Proportion of adults who helped someone who was ill or had a disability, inside and outside own household, 2001

Source: Statistics New Zealand, derived from 2001 Census National Summary, Table 31. Figures refer to any help given during the four weeks prior to the Census.

One in five has an unmet need for health services

According to surveys, general practitioners were the most common health service used by people with disabilities: 84% of adults aged 15-64 and 88% of children reported visiting a GP in the previous 12 months. A dentist or dental nurse was consulted by an estimated 36% of adults and 71% of children over the same period, while a chemist or pharmacist was consulted by an estimated 74% of adults and 61% of children. Twenty percent of adults and 17% of children reported an unmet need for at least one type of health service.

The pattern of health service use was similar among older people in households, although they were less likely to visit a dentist and more likely to visit an optician. However, only 7% of people with disabilities aged 65 and over had an unmet need for health services.

One in eight has an unmet need for special equipment

Twenty-two percent of adults with disabilities aged 15-64 and living in households reported that they use some type of special equipment, such as a computer to communicate, a voice amplifier or a guide dog. The pro-portion increases with age (17% for those aged 15-44; 27% for those aged 45-64). Over half of disabled people aged 65 and over use special equipment (54%).

As the number of people aged 45 and over grows during the next decade, the demand for special equipment can also be expected to grow. In 2001, 16% of 45-64 year olds and 14% of those aged 65 and over reported an unmet need for special equipment.

People with disabilities are less likely to have formal qualifications

People with disabilities are more likely to have no formal educational qualifications than people without disabilities.

In 2001, 36% of disabled adults aged 15-64 reported that they had no qualification, compared with 22% of non-disabled adults. Thirty-four percent of disabled adults under 65 reported that their highest qualification was a school qualification, and a further 30% reported a post-school qualification. The comparable figures for adults under 65 without disabilities were 43% with only school qualifications and 35% with post-school qualifications.

Among all those aged 15 and over with disabilities, there were 55,800 currently enrolled in an educational institution.

People with disabilities are less likely to be employed

An estimated 58% of adults aged 15-64 with disabilities (235,400) were employed in 2001. In contrast, 76% of non-disabled adults of this age were employed.

Among men, 63% of those with disabilities were employed, compared with 82% of non-disabled men. Comparable figures for women were 52% and 70%, respectively.

People with disabilities have higher unemployment rates than those without disabilities. In 2001, 9.4% of disabled people in the labour force were unemployed and actively seeking work, compared with 6.0% of non-disabled people. Unemployment rates were similar for disabled men and women.

Adults with disabilities have lower incomes

Reflecting their lower employment rates, the personal incomes of adults with disabilities are lower than those without disabilities. Almost half (49%) of people aged 15-64 with disabilities reported gross personal incomes of less than $15,000 for the year ended 31 March 2001, compared with 38% of non-disabled adults in that age group. At the other end of the scale, only 8% of disabled adults had personal incomes of $50,000 or more, compared with 14% of non-disabled adults. Among people aged 65 and over, those with disabilities were more likely than non-disabled people to have personal incomes of less than $15,000 (70%, compared with 58%).

A similar pattern was evident for household incomes: 12% of disabled people aged 15-64 lived in households with annual incomes of less than $15,000, compared with 7% of non-disabled people in that age group. One in four adults with disabilities lived in a household with an annual income of $70,000 or more, compared with one in three non-disabled adults.

Twenty-five percent of people aged 65 and over with disabilities lived in households with annual incomes of less than $15,000, compared with 15% of those without disabilities.

Disability and benefit receipt

There are several income-tested benefits available that are specifically designed to meet the needs of people with disabilities. The two primary benefits are Invalids Benefit (IB) and Sickness Benefit (SB). People who are disabled because of an accident may receive income support through the Accident Compensation Corporation.

Invalids Benefit (IB)

At the end of June 2002, there were 64,500 people receiving an Invalids Benefit (IB). To be eligible for IB, a person must have a condition or disability that is ‘permanent and severe’. In this context, permanent refers to an expectation by a doctor that the condition will persist for longer than two years and severe means that the person is unable to work for 15 or more hours a week because of their condition(s). The largest group of people receiving IB are those who report a psychiatric disability as their primary condition (16,500, or 26%), followed by those with intellectual disability (11,000, or 17%), and musculo-skeletal disorders (8,000, or 12%). One in six Invalids Benefit recipients has a dependent spouse.

The number of people receiving Invalids Benefit has been rising steadily for the past twenty years, almost doubling since 1992. The rate of receipt (including spouses) per 100 population aged 15-64 has almost doubled over the past decade, from 1.6% in 1992, to 2.8% in 2001. Rapid growth in rates of receipt among 60-64 year olds, largely reflecting the rising age of eligibility for New Zealand Superannuation between 1992 and 2001, explains more than a quarter of this growth. IB recipients aged 60-64 now make up 15% of all IB recipients, up from 3% in 1992.

Sickness Benefit (SB)

There were 36,500 people receiving Sickness Benefit (SB) at the end of June 2002. To qualify for SB, a person must have a condition or disability that limits his or her capacity to seek or undertake full-time employment (at least 30 hours per week).

The largest group receiving SB are those who report psychiatric illness (12,000, or 33%), followed by those with a musculo-skeletal disorder (6,000, or 16%), and those with conditions resulting from accidents (5,000, or 14%). One in five Sickness Benefit recipients has a dependent spouse.

The number of SB recipients has risen considerably over the past 15 years, more than doubling between 1986 and 1992, and increasing by a further 51% by 2002.

Rates of SB receipt (including spouses) per 100 15-64 year olds rose sharply, from 0.5% in 1986, to a peak of 1.8% in 1995, fluctuating at around that level before declining slightly after 1998. Rates of receipt have remained at around 1.6 for the past three years. The increase in SB receipt among 60-64 year olds accounts for a quarter of the rise in SB numbers since 1992.

Source: DSW/SWIFTT, population age estimates.

Reasons for the increase in Invalids and Sickness Benefits

Around half of the growth in the number of Sickness and Invalid Benefit recipients can be explained by the rise in the age of eligibility for New Zealand Superannuation and demographic factors such as population growth and the ageing of the population. The rest of the growth is not so easily explained.

Possible explanations include the flow-on effects of changes in benefit policy, such as the introduction of full-time work-testing, which have encouraged people already receiving benefits to test their eligibility for disability-related benefits. Advocacy and community groups are also making individuals with disabilities and long-term illnesses more aware of possible entitlement to disability-related benefits.

In addition, the prevalence of disabling health conditions may be changing. Since 1993, the number of new entrants to IB and SB with cancer, cardiovascular disorders, psychological or psychiatric conditions, musculo-skeletal and respiratory disorders has grown at a faster than average rate. This may be partly an effect of population ageing but also may reflect increasing prevalence of these conditions in the population. Some conditions, particularly stress and psychological illness, may be an outcome of long-term unemployment and poverty.

Current vocational assistance for SB and IB recipients

Approximately 20% of people in receipt of SB and IB also access vocational services. Informal research suggests that up to 80% of people on IB and SB want to work, so existing vocational services are not assisting all those that want assistance. The Ministry of Social Development is evaluating some new approaches to assisting people on SB and IB into employment. These approaches focus particularly on those with psychiatric disabilities and Māori, groups that are currently underserved by existing vocational services.

Disability Allowance (DA)

Disability Allowance (DA) is available to people who have a disability likely to last at least six months, who have ongoing and additional costs arising from the disability, and who meet an income test. There were 205,000 people in receipt of DA at the end of June 2002. Of these, 66,000 (32%) are in receipt of IB or SB, 32,000 (16%) are in receipt of other working-age benefits, and 4,000 (2%) are not in receipt of an income-tested benefit. The remaining 103,000 (50%) are recipients of New Zealand Superannuation. The number of Disability Allowance recipients increased steadily through the 1990s, although the rate of increase has slowed in recent years.

In mid-2002, there were 24,000 Child Disability Allowances (CDA) being paid. CDA is payable to people who are the principal caregivers of a dependent child with a serious physical or intellectual disability who will need constant care and attention for at least 12 months. It is paid to recognise the extra care required to enable the child to remain in the home. CDA covers a wide range of conditions, with the largest group of children (35%) falling into the “other” category.

The largest single categories are attention deficit disorders (14%), mental disorders (9%), asthma (5%) and diabetes (4%). The number of allowances paid has risen steadily over the past decade. In mid-2001, dependent children for whom CDA was being paid accounted for 2.4% of all children under 18, an increase from 1% in 1992.

Endnotes

1. See World Health Report 2001: Mental disorders affect one in four people, at http://www.who.int/inf-pr-2001/en/pr2001-42.html.
2. Ministry of Health (1998) Disability in New Zealand: Overviews of the 1996/97 Surveys, p67.
3. For example, see http://www.dsa-bristol.org.uk/info.htm, which notes that the life expectancy of people with Downs Syndrome is increasing.
4. Ministry of Health (1998) Disability in New Zealand: Overviews of the 1996/97 Surveys, p73.
5. Disability rates by ethnic group are only available for people living in house-holds. The estimates for Asian New Zealanders are too small to be reliable.

For further information contact the Office for Disability Issues.