The Canadian Centre on Disability Studies produced an exhaustive study on the work of the World Bank in relation to disability and development. The document set a baseline for future comparison. The first appendix provides a coherent discussion of the issue and was written as a primer. It is reproduced below with links to the full report.
From: BASELINE ASSESSMENT: INCLUSION AND DISABILITY IN WORLD BANK ACTIVITIES
June 2002
Appendix 1: People with Disabilities and Poverty: A Primer
A1.1 Introduction
This appendix is intended as a primer for readers not familiar with disability as a critical aspect of poverty in developing countries.
People with disabilities in the developing world are among the poorest of the poor. The numbers of people with disabilities are rising due to conflict, malnutrition and AIDS/HIV. If societies are to be inclusive of people with disabilities they must reform their institutions, laws, policies and practices so that they are disability-positive and promote, rather than discourage or prevent, disabled people’s access, participation and inclusion in the institutions and systems of society. By using practical strategies like universal design, inclusion of people with disabilities is a solution, which creates access for people with the widest range of abilities. The long-term impact of solutions like universal design is to reduce and eventually eliminate the economic costs of disability.
“We know that investment in our independence is a sound investment for our governments. The waste of human resources can and must be ended. Join us in our condemnation of policies that produce waste and destruction, policies of violence and war, policies of perpetuating poverty and undernourishment.” The Singapore Declaration of Disabled Peoples’ International 1981. (DPI 1981, 100)
A1.2 A Paradigm Shift
Throughout the world, societies have created different frameworks to explain disability. Some of these explanations are based in religion or morality while others are rooted in the sciences. While in some societies, people with disabilities are considered gifts of the gods or bearers of extra-ordinary powers, in most societies disabilities create difference, exclusion and poverty. Many of these frameworks treat disability as a physical/mental impairment. They focus in on the problems with the individual, on the disability and medical or rehabilitation solutions to fix those problems. Often linked with this approach is the use of charity, which emphasizes the helplessness of disabled people and their need for paternalistic care. These approaches continue to influence service development for people with disabilities. Telethons that raise money by exploiting pitiful images of people with disabilities and play upon out-dated concepts of the deserving poor are characterized by the charity approach. The medical approach can be seen in defining disabled people by their specific disability. It can also be seen in the promotion of huge institutions all over the world that segregate disabled people from society.
A more effective approach, often called the social, or independent living, model of disability emphasizes that disability is located at the interface between the individual and the physical, social and political environment and the nature of disability. It argues that the environment could be modified to be more accommodating and inclusive for people with disabilities. Indeed, universal design, one of the solutions arising from the social model, promotes the development
of a built environment that is useable by wide range of people with diverse abilities. This approach is both empowering and liberating for people with disabilities. With the focus shifting from the individual to the interface between the environment and the individual, disability becomes a social/ political problem rather than a personal problem.
Table A1.1: A Comparison of the Two Models
Medical/Charity
Social/IL
Definition of Disability:
An individual is limited by his/her impairment or condition
An individual with an impairment requires an accommodation to perform functions required to carry out life activities
Strategy to Address Disability
Fix the individual, correct the deficit
Remove barriers, create access through accommodation and universal design, promote wellness and health
Method to Address Disability:
Provision of medical, vocational, or psychological rehabilitation services
Provision of supports, e.g., assistive technology, personal assistance services, job coach
Source of Intervention:
Professionals, clinicians, and other rehabilitation service providers
Peers, mainstream service providers, consumer information services
Entitlements:
Eligibility for benefits based on severity of impairment
Eligibility for accommodations seen as civil right
Role of Disabled Individual:
Object of intervention, patient, beneficiary, research subject
Consumer or customer, empowered peer, research participant, decision-maker
Domain of Disability:
A medical "problem"
A socio-environmental issue involving accessibility, accommodations, and equity
Source: (US. Department of Education 2000, 10)
A1.3 International Action on Disability
During the latter half of the twentieth century, people with disabilities joined other civil rights movements to claim their human rights. (Driedger 1989) People with disabilities created a number of organizations (Disabled Peoples’ International (DPI), World Blind Union, World Federation of the Deaf), while parents of disabled children organized Inclusion International to voice their call for improved social and economic conditions for people with disabilities worldwide. The work of these groups led to a shift in attitudes and approaches to disability that ultimately affected millions of people around the world.
The disability rights and parents movements provided the impetus for the development of the social model. These movements recognized disabled people as citizens with rights and promoted their inclusion into society and refocused attention away from individual impairments onto barriers in the individual’s environment that prevented participation.
Beginning in the 1980s, persuaded by the arguments of the international disability rights movement, various influential institutions began to include concepts from the social model of disability in their work. The United Nations organized the 1981 International Year of Disabled Persons (IYDP) “to improve the social integration and participation of disabled persons in accordance with the year’s theme “Full Participation and Equality.” (Periquet 1981, 7) The International Decade of Disabled Persons(1982-93) followed IYPD. The UN World Programme of Action Concerning Disabled People (1982) recognized the responsibility of governments both to protect the citizenship rights of disabled people and to promote their rights to organize themselves and to play an active role in changing policies and programs in countries. The UN Standard Rules for Equalization of Opportunity provided a set of international guidelines for integrating disabled people into societies. The Economic and Social Council of Asia Pacific declared 1992-2002 as the Decade for the Asia Pacific region. The Organization of African Unity (OAU) established 2000-2009 as the African Decade of People with Disabilities. As with other Decades, the Declaration for the African Decade calls upon OAU Member States to formulate policies and programs to encourage full participation of people with disabilities in social and economic development, support national coordination committees and ensure the effective representation of people with disabilities and their organizations, support community-based service delivery, promote positive attitudes toward people with disabilities. (SAFOD 2000, 11) The Organization of American States has adopted a convention on disability rights within the American regions. The World Bank, the Asian Development Bank and the Inter American Development Bank are examining how to include people with disabilities in their social and economic activities.
A1.4 Value of the Social Model
The social model provides a unique and important contribution to addressing disability across the world. The old approaches have not resulted in the successful economic integration of people with disabilities but have systematically undervalued a potentially contributing part of society. The social model suggests realistic interventions for the achievement of the inclusion of people with disabilities in the mainstream of global society. One of its strategies for addressing inclusion is the concept of universal design. Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for
adaptation or specialized design. The social model provides a framework for disability analysis that has sufficient scope to encompass “individual initiatives in different countries, with different cultural and political structures to be directed at achieving human rights, social and economic inclusion as citizens and democratization for people with disabilities.”(Rioux 1998, 11)
A1.5 The Number of People with Disabilities in the World
People with disabilities exist in every population. Due to a variety of methodological problems recognized by many authors, there are no precise statistics for the number of disabled people in the world (Office of the President of South Africa 2001). Estimates suggest that from four to 10 percent of the population have a disability, with a higher proportion living in developed countries.
While there is uncertainty about the exact number of people who have disabilities, it is acknowledged that the number is increasing due to several factors: armed conflict, malnutrition and the spread of AIDS/HIV.
A1.6 Describing and Measuring Disability
On 15 November 2001, the World Health Organization (WHO) released the International Classification of Functioning, Disability and Health (ICF), which presents a framework of key concepts for addressing disability. The ICF, which is a synthesis of the medical and social models, is significant for several reasons. Rather than classifying people, it classifies health conditions. As all health conditions can be described by the ICF it is universal in its application. It is applicable to all people not just disabled people. It seeks to avoid the systematic labeling of people by their disabilities, because these labels have a detrimental and stigmatizing affect. Having been influenced by the social model of disability, the framework has the scope to point the way toward “the improvement of participation by removing or mitigating social hindrances and encouraging the provision of social supports and facilitators.”(WHO 2001, 4) Like universal design, the ICF is another practical solution for developing societies that do not present barriers to the economic and social participation of people with disabilities. For example, a person living with HIV/AIDS could be disabled in terms of his/her ability to participate actively in a profession. In that case the ICF provides different perspectives as to how measures can be targeted to optimize the person’s ability to remain in the workforce and live a full life in the community.
The ICF has been accepted by 191 countries as an international standard for the description and measurement of disability. One of the aims of this classification system is to “establish a common language for describing health and health-related states in order to improve communication between different users, such as health care workers, researchers, policy-makers and the public, including people with disabilities.”(WHO 2001, 3) Like Metts, the Baseline Assessment rejected the competing framework—the “Disability Adjusted Life Year” (DALY); because it is based upon false assumptions, which ignore the interaction of environmental and personal characteristics. (Metts 2000, 1)
Box A1.1 Concepts for Defining Disability from the World Health Organization
Disability—An umbrella term for impairments, activity limitations, and participation restrictions. It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors).
Impairment—A loss or abnormality of body part or function. Abnormality here is used strictly to refer to a significant variation from established statistical norms (i.e as a deviation from a population mean within measured standard norms) and should be used only in this sense.
Activity—The execution of a task or action by an individual. It represents
Activity Limitations—Difficulties an individual may have in executing activities. An activity limitation may range from a slight to a severe deviation in terms of quality or quantity in executing the activity in a manner or to the extent that is expected of people without the health condition.
Participation—A person’s involvement in a life situation. It represents the societal perspective of functioning.
Contextual Factors—The factors that together constitute the complete context of an individual’s life, and in particular the background against which health states are classified in ICF. There are two components of contextual factors: Environmental Factors and Personal Factors.
Environmental Factors—Constitute a component of ICF and refer to all aspects of the external or extrinsic world that form the context of an individual’s life and, as such, have an impact on that person’s functioning. Environmental factors include the physical world and its features, the human-made physical world, other people in different relationships and roles, attitudes and values, social systems and services, and policies, rules and laws.
Personal Factors—Contextual factors that relate to the individual such as age, gender, social status, life experiences and so on, which are not currently classified in ICF but which users may incorporate in their applications of ICF.
A1.7 Addressing Disability Systematically
The knowledge about disablement, as defined in ICF, generated through such initiatives as the UN International Year/Decade of Disabled Persons, the World Programme of Action Concerning Disabled Persons, the Human Rights and Disability Report by Leandro Despouy, and the United Nations Standard Rules on the Equalization of Opportunities, has resulted in a new approach to sustainable development and poverty reduction that is inclusive of people with disabilities. Some development aid bodies, national governmental agencies and nongovernmental organizations have begun to address disability in a systematic way.
A1.7.1 International Aid Agencies
Norway, Finland, Denmark and Sweden began to work in the field of disability and development in the 1980s. In 2000, the Ministers for Development Co-operation from Denmark, Finland, Norway and Sweden stated their philosophy on disability and development.
The Ministers find the inclusion of disability in development co-operation to be in accordance with the overarching objective of combating poverty, thus recognizing that the elimination of world poverty is unlikely to be achieved unless the rights and needs of people with disabilities are taken into consideration. Persons with disabilities most often belong to the poorest of the poor—the primary target for development cooperation. (Communique 2000)
The aid agencies of the Nordic countries use a reference group, composed of agency staff and advisors appointed by the disability movement, to develops broad guidelines. (For example, in Sweden, in 1992 guidelines were developed addressing healthcare, education, infrastructure, rural development and administration. (CCD 2001, 8-9))
Amongst the Nordic countries, Norway is a leader because disability inclusion in development was debated in Parliament and resulted in a policy and a concrete action plan. The Plan for the Inclusion of Persons with Disabilities in Development Cooperation” that was approved has as its primary objective the social integration of disabled persons. One problem that has been identified by the NGO community is that the action plan does not address the need for internal Ministry of Foreign Affairs (MFA) or Norwegian Agency for Development Co-operation (NORAD) guidelines.
The Swedish Disabled International Aid Association (SHIA) advances 5 principles to guide sustainable development: Social Protection, Accessibility, Consciousness, Influence, Control and it prioritizes initiatives of people with disabilities. (DFID 2000, 8)
USAID has recently begun to address disability and development. It began this work by developing a policy on disability and development that was adopted in 1997. The policy has four objectives:
To enhance the attainment of United States foreign assistance program goals by promoting the participation and equalization of opportunities of individuals with disabilities in USAID policy, country and sector strategies, activity designs and implementation.
To increase awareness of issues of people with disabilities both within USAID programs and in host countries.
To engage other US government agencies, host country counterparts, governments implement organizations and other donors in fostering a climate non-discrimination against people with disabilities.
To support international advocacy of people with disabilities. (CCD 2001, 10)
While the policy is an important first step, USAID has recognized that it needs to take this initiative further by: establishing a home base for activities under the Policy, establishing a funding mechanism for implementing the policy, “explicitly incorporating language encouraging programs benefiting and including people with disabilities into application guidelines for various bureau “funds”, such as the Africa Bureau’s Education for Democracy and Development Initiative…”, institutionalize inclusive behaviors. (CCD 2001, 10)
Canada is also recognized as an international leader on disability. Canada has made significant contributions to the United Nations International Year of Disabled Persons (1981), the World Programme of Action Concerning Disabled Persons (1982), and the UN Decade of Disabled Persons. Canada has also been leader with such initiatives as the Landmine Treaty and War Affected Children’s initiative. These two initiatives have the potential to significantly improve the lives of people with disabilities in developing countries. Since the 1980s, the Canadian International Development Agency (CIDA) has been providing on-going support to DPOs/IDPOs for organizational development, capacity building, skills training, microenterprise development. However, CIDA has been criticized by Canadian DPOs for not systematically addressing disability issues and has called upon CIDA to follow the lead of the Nordic countries on disability and development.
A1.7.2 Lessons from Other Sectors
There are also lessons to be learned from the area of gender and development. The UK Department For International Development (DFID) describes its work on gender in the following manner:
In pursuit of greater equality for women, DFID has adopted a so-called ‘twin-track’ approach, combining attempts to take account of women’s needs and rights in the mainstream of development co-operation work, as well as supporting specific initiatives aimed at women’s empowerment. The analysis set out in this paper suggests that a similar approach may be highly pertinent for work related to disability…Strengthening disability work through the twin track approach should help provide an enabling environment for people with disabilities to achieve a greater livelihood security, greater equality, full participation in the life of the community, and more independence and self-determination. (DFID 2000, 11)
A twin-track approach would be also be an effective approach for addressing people with disabilities in development.
A1.7.3 Development Banks
Development banks are taking important steps to become more inclusive of people with disabilities. The Asian Development Bank hosted a workshop on disability and development in October 1999. The workshop made the following recommendations: sensitize governments, strengthen the capacity of the Bank to take into account the disability dimension in the poverty reduction strategy, ensure meaningful participation of disabled people at the community level. The most significant result of the workshop was the inclusion of disability in the ADB’s Poverty
Reduction Strategy. The Bank has hired consultants to “identify disability issues related to poverty reduction” in order to proceed in the implementation of the strategy.
One IDPO identified the Inter American Development Bank as one body that has developed good practices for promoting work on a particular issue. The informant stated,
The Inter American Development Bank when they have elected to promote certain things they have often held large seminars and followed that up with regional seminars to sensitize more people to the issues. The World Bank activities on disability have largely been in Washington. They haven’t really gotten out into their regional or country offices. That is a huge issue. One example of where the Inter American Bank did a large seminar and then regional and country meetings is the issue of social violence. They also did it on children’s issue. Neither Bank has done anything similar on disability. The World Bank had a big seminar on disability in Washington a few years ago with Bengt Lindquist and some others but they have not been pushing it out. Similarly the World Bank Institute for Training doesn’t touch on disability for training.”
A1.7.4 Good Government Practices on Disability
When asked about best practices for addressing disability issues one representative from an IDPO was willing to give unqualified support to two examples drawn from the national, not international realm—the South African Human Rights Commission and the US National Institute on Disability and Rehabilitation Research (NIDRR). About the South African Human Rights Commission the informant stated,
The South African Human Rights Commission has employed large numbers of people with disabilities among their advocates. It has a special program to address the concerns and needs of people with disabilities and yet it [disability] is mainstreamed as well in their on-going efforts.
This is an example of the twin track approach, referred to earlier, being used to address disability inclusion issues.
Source: http://www.disabilitystudies.ca/baselinehtml.html
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