The increase in the number of disabled population in European countries as an indicator of the effectiveness of their health policies

Population ageing largely determines the trends associated with people being registered as disabled. An increase in the proportion of older cohorts in the population tends to lead to an increase in primary disability. The World Health Organization (WHO) links the increase in disability to this very cause1. In addition to medical and biological factors, the negative socio-economic conditions contribute to the growth of disability. Disability is inextricably linked to poverty and social exclusion: according to the WHO, it mostly affects vulnerable groups (women, the elderly, the poor) and is more prevalent in low-income countries2. The correlation between the impact of demographic ageing and socio-economic conditions forms the characteristics of disability in different countries. In turn, an analysis of the extent and structure of disability provides insight into the quality of social policy.

Invalidization of the population is the process of increasing the proportion of people with disabilities in the population, due to the spread of disabling pathologies and external influences that lead to disability. The leading causes of disability vary from country to country depending on the stage of epidemiological and demographic transition experienced by the country and on the quality of their social and demographic policies. Disability, in turn, has a certain impact on the social and economic development of society. The increase in the number of the disabled is accompanied by a decrease in the health potential of the population. The increase in government spending on social services and healthcare, under-production of GDP by unemployed persons with disabilities – these are the manifestations of the impact of disability on the economy. Social implications of disability include the years of healthy life lost, and an increased risk of social exclusion.

There are several thematic areas in the disability studies. The first area covers the study of the dynamics of disability [1; 2] and the structure of disability [3], and forecasting [4] their indicators. The second area is closely related to the previous one and includes works on the causes and factors that determine the structure and dynamics of disability [5]. The third area aims to assess socio-economic consequences of disability [6]. A more specific area includes the works that study the socioeconomic situation of people with disabilities [7]. It can include articles dealing with education, employment of disabled people [8], and creating an accessible environment [9].

These areas differ in their main subject. Demographic studies consider the parameters of the process of population invalidization and its consequences for society and economy. Among the sociological and economic studies, we can more often find works aimed at the study of disability as a phenomenon at the macro level (countries and their regions), meso level (on the example of local communities – in professional teams, enterprises) and individual level. At the same time, the grouping we have made is conditional, because there are works that consider the general problem of disability together with the issues concerning the quality of life [10] or other complex problems, such as the effectiveness of public policy in the field of healthcare and social services [11; 12].

In some cases, the term “disability” may not be mentioned in the study, but its conclusions refer the reader to this problem. Thus, the article by V.M. Shkolnikov (et al.; 2019) examines the relationship between the quality of governmental social policy and the state of public health. The authors show that at the current level of GDP per capita, Russia could expect a higher level of life expectancy at birth (LEB) compared to what it is now. They came to this conclusion by comparing the indicators for Russia and a number of countries with a similar level of economic development. By plotting the Preston curve (the ratio of GDP per capita to life expectancy at birth in different countries at one time) for each year for the period 2005–2015, they found that there was no direct relationship between the growth rate of national income and life expectancy. However, the authors of the study say that life expectancy at birth in the developed countries of Europe is growing, although slowly and against the background of the economic crisis, due to investing in the development of new methods of treatment. For Russia, they see the need for more intensive investment of national income in improving public health [13]. And here the question arises that it is important not only to increase average life expectancy, but also to “stretch” its healthy period – without chronic diseases and disability.

Domestic works on demography consider disability indicators among other indicators of public health [14; 15]. Case studies of disability often discuss how to measure the number of persons with disabilities [16; 17], the causes of primary disability [18; 19; 20], quality of life of people with disabilities [21], conditions for equal participation of persons with disabilities in society [22; 23], and their employment [24; 25; 26; 27]. There are very few works aimed at identifying the features of the Russian process of disability against the background of global demographic trends [28].