|DISABILITY AND DEVELOPMENT AND THE WORLD BANK
--A Briefing Summary on February 2, 2005--
Disability and Development (DD). Interest in inclusive development is growing within governments, civil society, and the development community, but efforts in these areas are hamstrung by the lack of research exploring the link between disability and poverty and evaluations of good practices. This lack results directly from the scarcity of quality data. Therefore, a main priority of the Disability and Development (DD) Team at the World Bank is being proactive in generating the type of information that can make inclusive development possible and helping the Bank to become a leader in this area.
Central to the success of our efforts is building partnerships with other development agencies. To that end the Bank has partnered with the UN, the IDB, OECD and others in data gathering efforts (see Attachment 3). As part of our broader strategy on building partnerships, a conference was convened in December 2004, titled “Disability and Inclusive Development: Sharing, Learning and Building Alliances” (see Attachment 1). This is part of an ongoing effort to build new partnerships.
This memo briefly summarizes what is known about disability prevalence and the relation between disability and poverty, and then outlines the World Bank’s activities in building a solid research base that can inform inclusive development.
Disability Prevalence. The UN often cites a prevalence rate of disability of about 10%, but quality data on disability does not generally exist for developing countries. Within established economies, the prevalence rate varies from 8% to over 20%. This variance is a function of what types of disabilities are included – both in kind and degree.
Many developing countries report very low rates of disability – often 1% or 2%. These low prevalence rates usually result from methodological deficiencies in data collection. This situation is slowly being rectified. Recently, a few countries have adopted an approach to disability measurement based on the WHO’s new International Classification of Functioning, Disability, and Health (ICF), and have thus started recording prevalence rates more in line with developed countries. Briefly, instead of asking questions such as “Are you disabled?” that yield very low prevalence rates, questions address specific functional capacities such as walking, hearing, or being able to communicate.
For example, the 1991 Brazilian census reported only a 1% to 2% disability rate, but the 2001 census, using the improved approach, recorded a 14.5% disability rate. Similar jumps in the measured rate of disability have occurred in Turkey (12.3%) and Nicaragua (10.1%).
The nature of disability and its extent can also vary across countries, depending on the main causes of disability. A study being presently undertaken by the World Bank finds that about 20% of the population of Bosnia is suffering from depression. Similar rates my apply in other post-conflict countries.
Disability and Poverty. Some estimates suggest that roughly 15% to 20% of poor people in developing countries are disabled (Elwan, 1999). A recent disability survey in Nicaragua found disabled people to have much lower rates of education, much higher rates of illiteracy, and much lower rates of economic activity. In Uganda, households with a disabled head are 38% more likely to be poor than their non-disabled counterparts (Hoogeveen, 2005). According to the Serbian Poverty Reduction Strategy Paper, 70 percent of disabled people were poor and only 13 percent had access to employment. In Sri Lanka, about 90 percent of disabled people are unemployed (Tudawe, 2001). One study in India found that disabled people were more likely to be poor, hold fewer assets, and incur greater debts (Harris-White, 1996).
Moreover, the impact of disability goes beyond disabled people to include their family members, as well. The Uganda study showed a significant drop off in school attendance for children with disabled household heads. In Nicaragua, family members spent on average 10 hours a day caring for disabled people, which must affect their employment and other home production.
Still, these figures probably underestimate the extent of poverty among disabled people. As Amartya Sen pointed out in his keynote address at the World Bank’s conference on disability, the poverty line for disabled people should take into account the extra expenses they entail in translating their income into the freedom to live well. A study in the United Kingdom found that the poverty rate for disabled people was 23.1% compared to 17.9% for non-disabled people, but when extra expenses associated with being disabled were considered, the poverty rate for people with disabilities shot up to 47.4% (see Attachment 2).
The two-way link between poverty and disability creates a vicious circle. Poor people are more at risk of acquiring a disability because of lack of access to good nutrition, health care, sanitation, as well as safe living and working conditions. Once this occurs, people face barriers to the education, employment, and public services that can help them escape poverty. These barriers include intense stigma, as well as barriers related to infrastructure and program design. Unfortunately, research in this area is sparse (Yeo and Moore, 2003).
World Bank Activities in Disability Research. One of the first data-related activities the Bank has been involved with is partnering with the UN Statistical Commission’s Washington Group on Disability Measurement (WG) to develop improved data instruments. The Bank is supporting their work with a $285,000 Development Grant Facility (DGF) that will pay for regional meetings, travel expenses for representatives from low income countries, and the field testing of questionnaires. The WG is almost ready to pilot test census questions on disability, and is beginning work on survey instruments
Disability is being incorporated in a growing number of Bank research projects including primary data collection (e.g., Afghanistan, Ecuador, Bolivia, and Kenya). In addition, using poverty mapping techniques, the Bank is developing a methodology for estimating the poverty rates of small vulnerable groups (see Hoogeveen, 2005) and applying it to several countries this year. A qualitative data instrument focusing on how disability affects family dynamics is also in development, as is a study on service delivery to disabled people in Indonesia, a regional study of disability in ECA, and a study of cash transfer programs in LAC. In addition, a Bank staff presented an early version of a working paper exploring the relationship between disability and educational attainment at the recent conference. Descriptions of the projects being run by the DD Team are attached (see Attachment 4 and 5).
On November 16, 2004, the Bank convened a one day seminar to develop a strategic plan for generating research to meaningfully assist inclusive development. In addition to Bank staff, a number of outside experts attended – including Anjini Kochar, Paul Schultz, Duncan Thomas, and Chris Udry. Chaired by the new chief economist in HD, Paul Gertler, the group concluded that the Bank should construct a detailed program evaluation of service delivery in the area of employment, education or health as it regards people with disabilities. The evaluation should focus on the family (or household) of the disabled person, and should be incorporated into current operations. The DD Team has since located a few appropriate operations and is in the process of securing funds to add such an evaluative component to our research agenda. The goal is not only to focus attention on the relationship between disability and poverty, but to help develop the tools to better design, monitor, and evaluate policies and operations that include disabled people.
In conclusion, thank you for your interest on this topic. We hope to have the opportunity to work with you on these issues in the future.
Attachment 1: Press Release of “Disability and Inclusive Development: Sharing, Learning and Building Alliances”, a conference organized by the World Bank, Washington, November 30-December 1, 2004
Attachment 2: Disability and Justice, Keynote Speech by Amartya Sen “Disability and Inclusive Development: Sharing, Learning and Building Alliances”, a conference organized by the World Bank, Washington, November 30-December 1, 2004
Attachment 3: Bank-Netherlands Partnership Program: Global and Regional Initiatives
Attachment 4: Development of Qualitative Survey on Disability and Living Standards
Terms of Reference
Attachment 5: Terms of Reference Service Delivery and Disability in Indonesia
Elway, A. (1999) Poverty and Disability: A Review of the Literature, Social Protection Discussion Paper No. 9932, The World Bank
Harris-White, B. (1999) Onto a loser: Disability in India, in B. Harriss-White and S. Subramanian (eds.), Ill fare in India: Essays on India’s Social Sector in Honor of S. Guhan (pp. 135-138) New Delhi: Sage Publications
Hoogeveen, J. G. (Forthcoming), Measuring Welfare for Small but Vulnerable Groups Poverty and Disability in Uganda, Journal of African Economies.
Tudawe, I. (2001) Chronic Poverty and Development Policy in Sri Lanka; Overview Study. Chronic Poverty Research Centre Working Paper 9. Manchester: Institute of Development Policy and Management/CPRC
Yeo, R. and K. Moore, (2003) Including Disabled People in Poverty Reduction Work; “Nothing About Us, Without Us.” World Development, Vol. 31, No.3 pp 571-590
FOR IMMEDIATE RELEASE
The World Bank
Human Development Network
News Release No.
Media Contacts in Washington:
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World Bank, Partners Call for Global Cooperation to “Unlock” Opportunities for Millions of Disabled People
As the world celebrates this year’s UN International Day of Disabled Persons on Friday,
a two-day conference looked at ways to include disabled people’s needs in the fight against poverty
December 2, 2004, Washington DC. As part of the international efforts to fight poverty through more inclusive development policies, the World Bank and its partners called for strengthening global cooperation and partnerships to “unlock” opportunities for the more than 600 million disabled people worldwide, of whom 400 million live in developing countries.
At a two-day conference, held at the World Bank’s headquarters and titled “Disability and Inclusive Development: Sharing, Learning and Building Alliances”, representatives from diverse organizations and countries took stock of what has been accomplished in the field of disability—particularly its inclusion into development operations—over the past two years, when the Bank held its first international conference on disability issues.
“We need to unlock the opportunities for 600 million people or more who have one form of disability or another, but who have with these disabilities tremendous competencies,” World Bank President James Wolfensohn said in his opening remarks to a packed room at Preston Auditorium.
About 600 participants –many with disabilities- exchanged experiences and information through panel discussions and 11 break-out sessions covering a variety of topics such as inclusive education, access to health services, employment of disabled people, urban infrastructure and transport, the legal dimension of inclusive development, and others. Among the participants were public and private sector executives, development practitioners, academics, civil society and media representatives from developed and developing countries.
“The World Bank considers it crucial that countries adopt development policies that include the concerns and needs of disabled people so that they can contribute to the societies in which they live,” said Wolfensohn. “In fact, if we are to achieve the Millennium Development Goals of halving poverty by 2015, dealing with education for all, halving the rates of birth and child mortality, it is simply impossible to conceive of doing that without the inclusion of the disabled community.”
According to Bank research, disability is affecting countries in different ways. In Uganda, for example, households headed by a person with a disability are 38 percent more likely to be poor. In Serbia, the poverty rate of disabled people is 70 percent. In Honduras, people with disabilities have an illiteracy rate of 51 percent compared to 19 percent for the general population. In the United States, there is almost a 70 percent rate of unemployment among disabled people. And in some parts of the world, as many as 80 percent of disabled children die before the age of 5, even in areas where the overall child mortality rate has been brought down to under 20 percent.
In a keynote address, Dr. Amartya Sen, Lamont Professor at Harvard University and 1998 Nobel Laureate in economic science, noted that social intervention against disability had to include prevention as well as management and alleviation.
“An understanding of the moral and political demands of disability is important not only because it is such a widespread and impairing feature of humanity, but also because the tragic consequences of disability can be substantially overcome with determined societal help and imaginative intervention,” Sen said. “(…) Given what can be achieved through intelligent and humane intervention, it is amazing how inactive and smug most societies are about the prevalence of the unshared burden of disability.”
Dr. Catherine Le Gales-Camus, Assistant Secretary of the World Health Organization (WHO), spoke on the effect of HIV/AIDS on women, girls and disabled persons. “Poverty, HIV/AIDS, and people with disabilities are linked in a dangerous spiral,” she said. “We are deeply concerned that among all people with disabilities, women and children suffer the most.”
She also noted that a recent Global Survey on HIV/AIDS and Disability released from the World Bank found that people with disabilities have a two- to three-times higher risk of acquiring HIV/AIDS due to widespread abuse and that lack of information for the visual and hearing impaired is a factor. She added that “the HIV/AIDS Department of WHO is now coordinating its efforts with the disability and rehabilitation team to guarantee that information on HIV/AIDS will be, and can be, available to everyone.”
UN Ambassador Luis Gallegos, chairman of the ad-hoc committee on the Convention for the Rights of Persons with Disabilities, said that people with disabilities were prominent leaders in the process of creating this new international human rights instrument. “They are enriching every aspect of the discourse on the Convention, thereby contributing to promoting the human rights of all persons,” he said.
U.S. Senator Tom Harkin, Iowa, said that one of the biggest challenges facing the disabled community was changing people’s attitudes and expectations with regards to persons with disabilities. Harkin, who was one of the forces behind the Americans with Disabilities Act signed into law 15 years ago, noted that the international community needed to work toward three main goals: access, inclusion and awareness of the rights of disabled people on a global scale.
“Unfortunately, the barriers that people with disabilities face here in America, the barriers of isolation, exclusion, low expectations, are pervasive around the world,” Harkin said. “In my view, these are the attitudes that we have got to change, and I believe we can change them.”